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Sample records for inappropriate drug prescribing

  1. Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria.

    PubMed

    Di Giorgio, Concetta; Provenzani, Alessio; Polidori, Piera

    2016-04-01

    Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 % of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person's Prescriptions criteria 21 and 27 %, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 %, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 % had at least one potentially prescribing omission

  2. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria – a population-based cohort study

    PubMed Central

    van der Hooft, Cornelis S; Jong, Geert W 't; Dieleman, Jeanne P; Verhamme, Katia M C; van der Cammen, Tischa J M; Stricker, Bruno H CH; Sturkenboom, Miriam C J M

    2005-01-01

    Background In 1997, Beers and colleagues developed explicit criteria for potentially inappropriate drug prescribing in ambulatory older adults aged 65 years and over. Several studies have been performed to estimate the prevalence of inappropriate drug prescribing based on these criteria. In 2002, the criteria were updated. Aims To examine the extent and trend of inappropriate drug prescribing to ambulatory older adults in the Netherlands between 1997 and 2001, according to the 1997 and the updated Beers criteria. Methods Data were retrieved from the Integrated Primary Care Information (IPCI) project, a general practice research database with data from computer-based patient records of a group of 150 general practitioners in the Netherlands. All subjects aged 65 and over were included. Prescriptions were classified as inappropriate if they fulfilled the Beers criteria of prescriptions that generally should be avoided in older adults because of a high risk of adverse effects, while also considering dose and comorbidity. Results Between 1997 and 2001, the 1-year risk of receiving at least one inappropriate drug prescription for older adults ranged between 16.8% (95% CI: 16.3–17.3%) and 18.5% (18.3–18.7%) according to the 1997 criteria and between 19.1% (18.6–19.6%) and 20.0% (19.5–20.5%) according to the updated Beers criteria. According to the updated criteria, the most frequently prescribed inappropriate drugs were nitrofurantoin, long-acting benzodiazepines, amitriptyline, promethazine and cimetidine. Temazepam and zolpidem were mostly prescribed in supratherapeutic dose. Conventional NSAIDs in persons with a history of gastric/duodenal ulcer were the most frequently prescribed contra-indicated drugs. Conclusions Prescribing potentially inappropriate prescriptions to ambulatory older people in the Netherlands is substantial. Compared with other studies using the 1997 Beers criteria, inappropriate prescribing to the elderly is lower than in the USA but

  3. POPI (Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions): Development of a Tool to Identify Inappropriate Prescribing

    PubMed Central

    Prot-Labarthe, Sonia; Weil, Thomas; Angoulvant, François; Boulkedid, Rym; Alberti, Corinne; Bourdon, Olivier

    2014-01-01

    Introduction Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. Methods A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. Results 108 explicit criteria (80 inappropriate prescriptions and 28 omissions) were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based −50%- or working in community −50%-). Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous). Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references). Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions). Discussion Conclusion POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary. PMID:24978045

  4. Inappropriate prescribing practices: the challenge and opportunity for patient safety.

    PubMed

    Taylor, Laurel K; Kawasumi, Yuko; Bartlett, Gillian; Tamblyn, Robyn

    2005-01-01

    Adverse clinical events related to inappropriate prescribing practices are an important threat to patient safety. Avoidance of inappropriate prescribing in community settings, where the majority of prescriptions are written, offers a major area of opportunity to improve quality of care and outcomes. Electronic medication order entry systems, with automated clinical risk screening and online alerting capabilities, appear as particularly promising enabling tools in such settings. The Medical Office of the Twenty First Century (MOXXI-III) research group is currently utilizing such a system that integrates identification of dosing errors, adverse drug interactions, drug-disease and allergy contraindications and potential toxicity or contraindications based on patient age. This paper characterizes the spectrum of alerts in an urban community of care involving 28 physicians and 32 pharmacies. Over a consecutive nine-month period, alerts were generated in 29% of 22,419 prescriptions, resulting in revised prescriptions in 14% of the alert cases. Drug-disease contraindications were the most common driver of alerts, accounting for 41% of the total and resulting in revised prescriptions in 14% of cases. In contrast, potential dosing errors generated only 8% of all alerts, but resulted in revised prescriptions 23% of the time. Overall, online evidence-based screening and alerting around prescription of medications in a community setting demands confirmation in prescribers' clinical decision making in almost one-third of prescriptions and leads to changed decisions in up to one-quarter of some prescribing categories. Its ultimate determination of clinical relevance to patient safety may, however, have to await more detailed examination of physician response to alerts and patient outcomes as a primary measure of utility. Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. It involves many issues, including

  5. Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study

    PubMed Central

    Morgan, Steven G.; Hunt, Jordan; Rioux, Jocelyn; Proulx, Jeffery; Weymann, Deirdre; Tannenbaum, Cara

    2016-01-01

    Background: Many medications pose greater health risks when prescribed for older adults, compared with available pharmacologic and nonpharmacologic alternatives. We sought to quantify the frequency and cost of potentially inappropriate prescribing for older women and men in Canada. Methods: Using data for 2013 from the National Prescription Drug Utilization Information System database, which contains prescription claims from publicly financed drug plans in all provinces except for Quebec, we identified the frequency of prescribing and cost of potentially inappropriate medications dispensed to provincial drug plan enrollees aged 65 years or more. Potentially inappropriate prescriptions were defined with the use of the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. Results: For the 6 provinces with relatively complete data coverage (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island), 37% of older people filled 1 or more prescription meeting the Beers Criteria. A higher proportion of women (42%) than men (31%) filled potentially inappropriate prescriptions. The highest rates of prescribing of potentially inappropriate medications were among women aged 85 or more (47%). Benzodiazepines and other hypnotics were the leading contributors to the overall frequency of and sex differences in prescribing of potentially inappropriate drugs among older adults. We estimated that $75 per older Canadian, or $419 million in total, was spent on potentially inappropriate medications outside of hospital settings in 2013. Interpretation: Prescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women. Multipronged and well-coordinated strategies to reduce the use and cost of potentially inappropriate drugs would likely generate significant health system savings while simultaneously generating major benefits to

  6. Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

    PubMed Central

    Chou, Chia-Yu; Hsu, Chia-Chen; Chiang, Shu-Chiung; Ho, Chin-Chin; Chou, Chia-Lin; Wu, Min-Shan; Chang, Yuh-Lih; Tsai, Han-Yi; Chen, Tzeng-Ji; Chou, Yueh-Ching

    2013-01-01

    Background Prescription errors that occur due to the process of pill splitting are a common medication problem; however, available prescription information involving inappropriate pill splitting and its associated factors is lacking. Methods We retrospectively evaluated a cohort of ambulatory prescriptions involving extended-release or enteric-coated formulations in a Taiwan medical center during a 5-month period in 2010. For this study, those pill splitting prescriptions involving special oral formulations were defined as inappropriate prescriptions. Information obtained included patient demographics, prescriber specialty and prescription details, which were assessed to identify factors associated with inappropriate pill splitting. Results There were 1,252 inappropriate prescriptions identified in this cohort study, representing a prescription frequency for inappropriate pill splitting of 1.0% among 124,300 prescriptions with special oral formulations. Among 35 drugs with special oral formulations in our study, 20 different drugs (57.1%, 20/35) had ever been prescribed to split. Anti-diabetic agents, cardiovascular agents and central nervous system agents were the most common drug classes involved in inappropriate splitting. The rate of inappropriate pill splitting was higher in older (over 65 years of age) patients (1.1%, 832/75,387). Eighty-seven percent (1089/1252) of inappropriate prescriptions were prescribed by internists. The rate of inappropriate pill splitting was highest from endocrinologists (3.4%, 429/12,477), nephrologists (1.3%, 81/6,028) and cardiologists (1.3%, 297/23,531). Multivariate logistic regression analysis revealed that the strongest factor associated with individual specific drug of inappropriate splitting was particular physician specialties. Conclusion This study provides important insights into the inappropriate prescription of special oral formulation related to pill splitting, and helps to aggregate information that can assist

  7. A Review of Potentially Inappropriate Prescribing in Over 65's in Livinghealth Clinic.

    PubMed

    Sweeney, J; Laoire, F O; Linehan, G; Herlihy, D

    2015-06-01

    Polypharmacy and potentially inappropriate prescribing (PIP) are areas of growing importance and concern. Optimising drug prescribing in older people is challenging and complex at,the individual GP level. At a national level it is an important public health issue for the care and management of the ageing Irish population. The aim of this study was to estimate the prevalence of PIP in Livinghealth Clinic using the STOPP (Screening Tool for Older Persons' Prescribing) criteria and to identify areas of PIP. LHC audits demonstrated PIP levels of between 16% and 29%. Our findings were similar to other studies in that proton pump inhibitors (PPIs) at maximum therapeutic dosage for >8 weeks, and long acting benzodiazepines prescribed for > 1 month, continue to be significant areas of PIP. However, not all identified PIP maybe inappropriate. The STOPP criteria are a useful screening tool for older persons' prescribing, but are best used together with clinical assessment and discretion. PMID:26182803

  8. Potentially inappropriate prescribing in an Irish elderly population in primary care

    PubMed Central

    Ryan, Cristín; O'Mahony, Denis; Kennedy, Julia; Weedle, Peter; Byrne, Stephen

    2009-01-01

    AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers' criteria are the most widely used but have disadvantages when used in Europe. New IP screening tools called Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers' criteria, STOPP and START. METHODS Case records of 1329 patients ≥65 years old from three general practices in one region of southern Ireland were studied. The mean age ± SD of the patients was 74.9 ± 6.4 years, 60.9% were female. Patients' current diagnoses and prescription medicines were reviewed and the Beers' criteria, STOPP and START tools applied. RESULTS The total number of medicines prescribed was 6684; median number of medicines per patient was five (range 1–19). Overall, Beers' criteria identified 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identified by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identified in 22.7% (302) of patients using the START tool. CONCLUSION Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists. PMID:20002089

  9. Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

    PubMed Central

    Hume, Anne L; Quilliam, Brian J; Goldman, Roberta; Eaton, Charles

    2011-01-01

    Objective To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design Literature review, expert panel and focus group. Setting Primary care with access to e-prescribing systems. Participants Primary care physicians using e-prescribing systems receiving medication history. Interventions Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. Main outcome measure Development of 15 treatment algorithms suggesting alternative therapies. Results Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. Conclusion Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events. PMID:21719560

  10. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

    PubMed Central

    Ubeda, Amalia; Ferrándiz, Luisa; Maicas, Nuria; Gomez, Cristina; Bonet, Montserrat; Peris, Jose E.

    Objective The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people. Methods Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more) by pharmacists in a nursing home in the Lleida region (Spain). Results The mean patients’'age was 84 (SD=8) years, with an average of 5 drugs per resident (total prescriptions: 416 medicines). The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%), but omissions corresponding to the cardiovascular system implied 23% of patients. Conclusions The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP) is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes. PMID:24155822

  11. Prescribing of psychotropics in the elderly: why is it so often inappropriate?

    PubMed

    Mort, Jane R; Aparasu, Rajender R

    2002-01-01

    Psychotropic medications are an important treatment approach to mental health disorders; such disorders are common in the elderly population. Elderly patients are more likely to experience adverse effects from these agents than their younger counterparts due to age-related changes in pharmacodynamic and pharmacokinetic parameters. Because of these factors, inappropriate use of psychotropic medications in elderly patients has become a focus of concern. In general an agent is considered inappropriate if the risk associated with its use exceeds its benefit. Implicit and explicit criteria for inappropriate use of medications in the elderly have been created and include psychotropic agents. These criteria vary in their make-up but the explicit criteria tend to agree that amitriptyline, doxepin, and benzodiazepines that have long half-lives are not appropriate. Although explicit inappropriate medication criteria have been in existence since 1991, elderly patients continue to receive inappropriate psychotropic medications. A wide array of factors may be responsible for this practice. Provider-related causes include deficits in knowledge, confusion due to the lack of a consensus on the inappropriate psychotropic criteria, difficulties in addressing an inappropriate medication started by a previous provider, multiple prescribers and pharmacies involved in the care of a patient, negative perceptions regarding aging, and cost issues. Patients may contribute to the problem by demanding an inappropriate medication. Finally, the healthcare setting may inadvertently contribute to inappropriate prescribing by such policies as restrictive formularies or lack of reimbursement for pharmacists' clinical services. Successful approaches to optimising prescribing have been either educational or administrative. Educational approaches (e.g. one-on-one sessions, academic detailing) seek to influence decision making, while administrative approaches attempt to enforce policies to curtail the

  12. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

    PubMed Central

    O'Mahony, Denis; O'Sullivan, David; Byrne, Stephen; O'Connor, Marie Noelle; Ryan, Cristin; Gallagher, Paul

    2015-01-01

    Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. PMID:25324330

  13. Social Trends in Prescribing Mood-Modifying Drugs to Women

    PubMed Central

    Harding, Jim

    1987-01-01

    The author of this article looks at the accumulating research evidence which suggests that there has been inappropriate prescribing and overprescribing of mood-altering drugs to women. This, he holds, in large part reflects problems that are best approached from within the tradition and perspective of social medicine. Socio-health considerations illuminate the need for research in this field. PMID:21263994

  14. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

    PubMed Central

    Lim, Ching Jou; Kong, David CM; Stuart, Rhonda L

    2014-01-01

    Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions. PMID:24477218

  15. Polypharmacy, Drug-Drug Interactions, and Potentially Inappropriate Medications in Older HIV-Infected Adults

    PubMed Central

    Greene, Meredith; Steinman, Michael A.; McNicholl, Ian R.; Valcour, Victor

    2014-01-01

    Objectives To describe the frequency of medication-related problems in older HIV-infected adults Design Retrospective chart review Setting And Participants Community dwelling HIV-infected adults age 60 and older and age and sex-matched HIV-uninfected adults Measurements Total number of medications, potentially inappropriate medications as defined by the modified Beers criteria, anticholinergic drug burden as defined by the Anticholinergic Risk Scale, and drug-drug interactions using Lexi-Interact online drug interactions database. Results Of 89 HIV-infected participants, most were Caucasian (91%) and male (94%) with a median age of 64 (range 60-82). Common comorbidities included hyperlipidemia, hypertension, and depression. Participants were taking a median of 13 medications (range 2-38), of which only a median of 4 were antiretrovirals. At least one potentially inappropriate medication was prescribed in 46 participants (52%). Sixty-two (70%) participants had at least one Category D (consider therapy modification) drug-drug interaction and 10 (11%) had a Category X (avoid combination) interaction. One-third of these interactions were between two non-antiretroviral medications. We identified 15 participants (17%) with an anticholinergic risk scale score ≥3. In contrast, HIV-uninfected participants were taking a median of 6 medications, 29% had at least one potentially inappropriate medication, and 4% had an anticholinergic risk scale score ≥ 3 (p-value <0.05 for each comparison except p=0.07 for anticholinergic burden). Conclusion HIV-infected older adults have a high frequency of medication-related problems, of which a large portion is due to medications used to treat comorbid diseases. These medication issues were substantially higher than HIV-uninfected participants. Attention to the principles of geriatric prescribing is needed as this population ages in order to minimize complications from multiple medication use. PMID:24576251

  16. Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study.

    PubMed

    Zaal, Rianne J; Ebbers, Susan; Borms, Mirka; Koning, Bart de; Mombarg, Erna; Ooms, Piet; Vollaard, Hans; van den Bemt, Patricia M L A; Evenhuis, Heleen M

    2016-08-01

    A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples' Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional

  17. Rooting out institutional corruption to manage inappropriate off-label drug use.

    PubMed

    Rodwin, Marc A

    2013-01-01

    Prescribing drugs for uses that the FDA has not approved - off-label drug use - can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers' conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. PMID:24088156

  18. [Should the ophthalmologist prescribe generic drugs?].

    PubMed

    Nordmann, J-P

    2003-10-01

    It seems obvious that an ophthalmologist should encourage the use of generic drugs. However, it is important to know the exact definition of a generic drug and the type of studies to be conducted before a generic drug is released on the market. A generic drug is a drug that has the same composition quantitatively as well as qualitatively of the active compound as the original drug. It also has the same pharmaceutical mode of action and the same bioavailability, as determined with bioavailability studies. Ophthalmic drops contain both an active compound and many adjuvants used to stabilize the drug. Globally speaking, the active compound corresponds to the efficacy of a topical drug and the adjuvant to its tolerance. It is likely that the efficacy of a generic drug is identical to that of the brand-name drug, even though only bioavailability studies in non-human models are required to evaluate tolerance which is less likely to be identical, as adjuvants can differ. A survey of 520 French ophthalmologists has recently been conducted. It shows that doctors rarely think of prescribing generic drugs, as they do not consider cost as a major issue in treating glaucoma. However, they see no reason not to prescribe generic drugs. This mixed perception is shared by patients who willingly accept that doctors prescribe a generic drug, but do not wish the pharmacist to take the initiative of filling a prescription with a generic drug, which sometimes gives patients the impression of being less well treated. The use of generic drugs should be encouraged, keeping in mind that good tolerance should be ensured. PMID:14646825

  19. Warfarin and Drug Interactions: Prescribing Vigilance.

    PubMed

    Hook, J; Millsopp, Lynne; Field, E Anne

    2016-01-01

    A patient taking warfarin presented to the Oral Medicine Clinic at Liverpool University Dental Hospital, having been prescribed metronidazole and miconazole by his general dental practitioner (GDP) for his oral mucosal problem. He subsequently developed bruising on his torso following mild trauma. Having read the drug information leaflet provided with his metronidazole and miconazole, he noted the potential drug interactions between these and warfarin. He therefore stopped his warfarin. The details of this case are outlined, and the potential for significant drug interactions with warfarin are highlighted. The need for dental practitioners to be vigilant concerning drug interactions is emphasized, together with the importance of CPD in relation to drug prescribing. CPD/CLINICAL RELEVANCE: This case report, which is of relevance to all dental practitioners, highlights the importance of up-to-date medical and drug histories and the continuing awareness of potential drug interactions. In this case, patient intervention after checking drug information leaflets prevented serious consequences. The importance and potentially serious consequences of significant drug interactions needs to be understood. PMID:27024900

  20. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis

    PubMed Central

    Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

    2014-01-01

    Objective To synthesise qualitative studies that explore prescribers’ perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. Design A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. Setting All healthcare settings. Participants Medical and non-medical prescribers of medicines to adults. Outcomes Prescribers’ perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. Results 21 studies were included; most explored primary care physicians’ perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. Conclusions A multitude of highly interdependent factors shape prescribers’ behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the

  1. Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

    PubMed Central

    Clyne, Barbara; Smith, Susan M.; Hughes, Carmel M.; Boland, Fiona; Bradley, Marie C.; Cooper, Janine A.; Fahey, Tom

    2015-01-01

    PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care. METHODS We conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression. RESULTS All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15–0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50–1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14–0.68; P = .04). CONCLUSIONS The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP

  2. Inappropriate Drug Use in People with Cognitive Impairment and Dementia: A Systematic Review

    PubMed Central

    Johnell, Kristina

    2015-01-01

    The aim of this systematic review was to identify, assess and summarize studies about potentially inappropriate drug use (IDU) in cognitive impairment and dementia and to present findings about whether cognitive impairment and dementia are associated with IDU. The search was made in Medline/PubMed using free terms in the title or abstract. The inclusion criteria were: English language, published until 1 March 2014, original quantitative study and assessment of overall IDU with a consensus based summarized measure. Exclusion criteria were: focus on specific patient group (other than cognitive impairment or dementia), focus on specific drug class and failure to present a prevalence measure of IDU or an effect estimate (i.e. odds ratio). Of the initial 182 studies found in Medline, 22 articles fulfilled the criteria. Most studies used the Beers criteria for assessment of IDU. Prevalence of IDU among individuals with cognitive impairment or dementia ranged from 10.2% to 56.4% and was higher in nursing home settings than in community-dwelling samples. Most studies reported a lower likelihood of IDU in case of cognitive impairment or dementia. To conclude, IDU is highly prevalent among persons with cognitive impairment and dementia, although these conditions seem to be associated with a lower probability of IDU. This might reflect an awareness among clinicians of cautious prescribing to this vulnerable group of patients. More studies on large cohorts of persons with cognitive impairment and dementia are needed to draw conclusions about optimal drug prescribing to this frail group of older persons. PMID:26054404

  3. [Impact of potentially inappropriate drug usage on health insurance business results].

    PubMed

    Kirschke, Malin; Böhme, Jacqueline

    2014-09-01

    In Germany a list was drawn up that included 83 potentially inappropriate drugs. The PRISCUS list published in 2010 was intended to highlight certain problems in the pharmakotherapy of elderly patients and serve as a support for improved medicine safety. Almost a third of the insurance portfolio of the HALLESCHE Krankenversicherung aged over 75 years takes drugs that are on the PRISCUS list. Benzodiazepine and Z-drugs are taken most frequently. The costs per insurant with potentially inappropriate medication are on average higher than for policyholders who do not take drugs on the PRISCUS list. The costs per insurant are rising, with an increase in the number of PRISCUS agents being taken as well. However, there is still no scientific proof that potentially inappropriate drugs lead to adverse drug events. PMID:25272660

  4. Inappropriate prescribing of antithrombotic therapy in Ethiopian elderly population using updated 2015 STOPP/START criteria: a cross-sectional study

    PubMed Central

    Getachew, Henok; Bhagavathula, Akshaya Srikanth; Abebe, Tamrat Befekadu; Belachew, Sewunet Admasu

    2016-01-01

    Background Inappropriate use of antiplatelets and anticoagulants among elderly patients increases the risk of adverse outcomes. The aim of this study was to assess the prevalence of inappropriate prescribing of antithrombotic therapy in hospitalized elderly patients. Methods A retrospective cross-sectional, single-center study was conducted at the Gondar University Hospital. A total of 156 hospitalized elderly patients fulfilling the inclusion/exclusion criteria were included in the study. The Screening Tool for Older Person’s Prescription/Screening Tool to Alert doctors to Right Treatment criteria version 2 were applied to patients’ data to identify the total number of inappropriate prescribing (IPs) including potentially inappropriate medications and potential prescribing omissions. Results A total of 70 IPs were identified in 156 patients who met the inclusion criteria. Of these, 36 (51.4%) were identified as potentially inappropriate medications by the Screening Tool for Older Person’s Prescription criteria. The prevalence of IP per patient indicated that 58 of the 156 (37.2%) patients were exposed to at least one IP. Of these, 32 (55.2%) had at least one potentially inappropriate medication and 33 (56.9%) had at least one potential prescribing omission. Patients hospitalized due to venous thromboembolism (adjusted odds ratio [AOR] =29.87, 95% confidence interval [CI], 1.26–708.6), stroke (AOR =7.74, 95% CI, 1.27–47.29), or acute coronary syndrome (AOR =13.48, 95% CI, 1.4–129.1) were less likely to be exposed to an IP. An increase in Charlson comorbidity index score was associated with increased IP exposure (AOR =0.60, 95% CI, 0.39–0.945). IPs were about six times more likely to absent in patients prescribed with antiplatelet only therapy (AOR =6.23, 95% CI, 1.90–20.37) than those receiving any other groups of antithrombotics. Conclusion IPs are less common in elderly patients primarily admitted due to venous thromboembolism, stroke, and acute

  5. Drug-induced arrhythmia: pharmacogenomic prescribing?

    PubMed Central

    Behr, Elijah R.; Roden, Dan

    2013-01-01

    Drug-induced Torsades de Pointes is a rare, unpredictable, and life-threatening serious adverse event. It can be caused by both cardiac and non-cardiac drugs and has become a major issue in novel drug development and for the regulatory authorities. This review describes the problem, predisposing factors, and the underlying genetic predisposition as it is understood currently. The future potential for pharmacogenomic-guided and personalized prescription to prevent drug-induced Torsades de Pointes is discussed. Database searches utilized reports from www.qtdrugs.org up to January 2012, case reports and articles from www.pubmed.com up to January 2012, and the British National Formulary edition at www.bnf.org. PMID:23091201

  6. The effect of "group detailing" on drug prescribing in primary care.

    PubMed

    Mastura, I; Teng, C L

    2008-10-01

    The quality of physician prescribing is suboptimal. Patients are at risk of potentially adverse reaction because of inappropriate or writing error in the drug prescriptions. We assess the effect of "group academic detailing" to reduce writing drug name using brand name and short form in the drug prescriptions in a controlled study at two primary health care clinics in Negeri Sembilan. Five medical officers in Ampangan Health Clinic received an educational intervention consisting of group academic detailing from the resident Family Medicine Specialist, as well as a drug summary list using generic names. The academic detailing focused on appropriate prescribing habit and emphasized on using the full generic drug name when writing the drug prescription. Analyses were based on 3371 prescriptions that were taken from two clinics. The other health clinic was for comparison. The prescribing rates were assessed by reviewing the prescriptions (two months each for pre- and post-intervention phase). Statistically significant reduction in writing prescription using brand name and using short form were observed after the educational intervention. Writing prescription using brand name for pre- and postintervention phase were 33.9% and 19.0% (postintervention vs pre-intervention RR 0.56, 95% CI 0.48 to 0.66) in the intervention clinic. Prescription writing using any short form for pre- and post-intervention phase were 49.2% and 29.2% (post-intervention vs pre-intervention RR 0.59, 95% CI 0.53 to 0.67). This low cost educational intervention focusing on prescribing habit produced an important reduction in writing prescription using brand name and short form. Group detailing appears to be feasible in the public health care system in Malaysia and possibly can be used for other prescribing issues in primary care. PMID:19385492

  7. Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan

    PubMed Central

    Chang, Chirn-Bin; Yang, Shu-Yu; Lai, Hsiu-Yun; Wu, Ru-Shu; Liu, Hsing-Cheng; Hsu, Hsiu-Ying; Hwang, Shinn-Jang; Chan, Ding-Cheng

    2015-01-01

    Objective To investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use. Design Cross-sectional study. Setting This analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database. Participants We identified 1 164 701 subjects who visited ambulatory care clinics and were over 65 years old in 2009. Primary and secondary outcome measures PIM prevalence according to the 2012 Beers criteria, the PIM-Taiwan criteria and the PRISCUS criteria was estimated separately, and characteristics of PIM users were explored. Multivariate logistic regression analysis was used to determine patient factors associated with the use of at least one PIM. Leading PIMs for each set of criteria were also listed. Results The prevalence of having at least one PIM at the patient level was highest with the Beers criteria (86.2%), followed by the PIM-Taiwan criteria (73.3%) and the PRISCUS criteria (66.9%). Polypharmacy and younger age were associated with PIM use for all three sets of criteria. The leading PIMs detected by the PIM-Taiwan and PRISCUS criteria were all included in the 2012 Beers criteria. Non-COX-selective non-steroidal anti-inflammatory drugs in the Beers criteria and benzodiazepines in the PIM-Taiwan and PRISCUS criteria accounted for most leading PIMs. Conclusions The prevalence of PIMs was high among older Taiwanese patients receiving ambulatory care visits. The prevalence of PIM and its associated factors varied according to three sets of criteria at the population level. PMID:26546136

  8. Presenting Multiple Drug Alerts in an Ambulatory Electronic Prescribing System

    PubMed Central

    Weinger, M.B.; Gregg, W.M.; Johnson, K.B.

    2014-01-01

    Summary Objective This study explores alternative approaches to the display of drug alerts, and examines whether and how human-factors based interface design can be used to improve the prescriber’s perception about drug alert presentation, signal detection from noisy alert data, and their comprehension of clinical decision support during electronic prescribing. Methods We reviewed issues with presenting multiple drug alerts in electronic prescribing systems. User-centered design, consisting of iterative usability and prototype testing was applied. After an iterative design phase, we proposed several novel drug alert presentation interfaces; expert evaluation and formal usability testing were applied to access physician prescribers’ perceptions of the tools. We mapped drug alert attributes to different interface constructs. We examined four different interfaces for presenting multiple drug alerts. Results A TreeDashboard View was better perceived than a text-based ScrollText View with respect to the ability to detect critical information, the ability to accomplish tasks, and the perceptional efficacy of finding information. Conclusion A robust model for studying multiple drug-alert presentations was developed. Several drug alert presentation interfaces were proposed. The TreeDashboard View was better perceived than the text-based ScrollText View in delivering multiple drug alerts during a simulation of electronic prescribing. PMID:25024753

  9. Best Practices for Drug Prescribing in Older Adults: A Call for Action.

    PubMed

    Marengoni, Alessandra; Nobili, Alessandro; Onder, Graziano

    2015-11-01

    Achievement of a good quality of prescribing is one of the major challenges for physicians caring for older persons, because of aging-related changes in pharmacokinetics and pharmacodynamics of drugs, the large number of co-occurring chronic diseases affecting older adults and consequent polypharmacy. Several approaches are available and have been used to tackle over-prescription of drugs, such as medication review, application of appropriateness criteria and computerized prescription support systems, but, one by one, they have shown limited effectiveness with respect to patient-centred outcomes. We propose to test a multicomponent intervention with the goal of achieving the best-tailored pharmacotherapy for each patient at a specific point in time. The intervention should start with identification of patients at risk of drug-related problems and identification of their priorities, followed by medication review over time, supported by the use of inappropriateness criteria and computerized systems, and also necessarily embedded in the Comprehensive Geriatric Assessment. PMID:26586379

  10. A review on prescribing patterns of antihypertensive drugs.

    PubMed

    Jarari, Noah; Rao, Narasinga; Peela, Jagannadha Rao; Ellafi, Khaled A; Shakila, Srikumar; Said, Abdul R; Nelapalli, Nagaraja Kumari; Min, Yupa; Tun, Kin Darli; Jamallulail, Syed Ibrahim; Rawal, Avinash Kousik; Ramanujam, Ranjani; Yedla, Ramesh Naidu; Kandregula, Dhilip Kumar; Argi, Anuradha; Peela, Laxmi Teja

    2015-01-01

    Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians' adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries. PMID:27019747

  11. The involvement of prescribed drugs in road trauma.

    PubMed

    Drummer, Olaf H; Yap, Suwan

    2016-08-01

    Coroners files and toxicological records of fatally-injured drivers in Victoria from 2000 to 2006 and from 2007 to 2013 were reviewed in separate studies to establish the role of prescribed drugs on crash risk. 2638 driver fatalities were included in the study, which represented over 97% of all driver fatalities in this period. The detection limits of the drugs were at the low end of those seen with common illicit drugs or prescribed drugs. Drugs of any type were found in 34.4% of the study group, medicinal drugs 21.2%, and alcohol (≥0.05 gram/100mL) was found in 24.8%. The prevalence of the most common drugs detected that are legally available by prescription were anti-depressants (7.9%), benzodiazepines (7.0%), opiates/opioids (6.6%), and sedating anti-histamines (1.1%). Each driver was assessed for responsibility using a previously published and validated method. The crash risk of drivers taking opioids, benzodiazepines, or anti-depressants (primarily the serotonin reuptake inhibitors), were not significantly over-represented compared to the drug-free control group, although there was a suggestion of increased crash risk for benzodiazepines. Crash risk was elevated for drivers using cannabis (by presence of THC in blood at>2ng/mL) and amphetamines. These data show that drivers using medicinal drugs alone are unlikely to show significant crash risk even if drugs are potentially impairing. PMID:26826848

  12. Structured pharmaceutical analysis of the Systematic Tool to Reduce Inappropriate Prescribing is an effective method for final-year medical students to improve polypharmacy skills: a randomized controlled trial.

    PubMed

    Keijsers, Carolina J P W; van Doorn, Adriaan B D; van Kalles, Anouk; de Wildt, Dick J; Brouwers, Jacobus R B J; van de Kamp, Henrieke J; Jansen, Paul A F

    2014-07-01

    Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills. PMID:24916615

  13. Family Physician attitudes about prescribing using a drug formulary

    PubMed Central

    Suggs, L Suzanne; Raina, Parminder; Gafni, Amiram; Grant, Susan; Skilton, Kevin; Fan, Aimei; Szala-Meneok, Karen

    2009-01-01

    Background Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers. Methods Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis. Results Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions. Conclusion Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms. PMID:19835601

  14. Drug use and the role of patients and prescribers.

    PubMed

    Sterky, G; Tomson, G; Diwan, V K; Sachs, L

    1991-01-01

    In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client. One important factor influencing prescribing, drug information, has rarely been assessed scientifically. Experimental studies using group randomization are, however feasible even in developing countries. The individual human being must be in the focus of drug studies and health care and health in the foreground. The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically sound. PMID:2045844

  15. Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria

    PubMed Central

    Oshikoya, Kazeem Adeola; Oreagba, Ibrahim; Adeyemi, Olayinka

    2011-01-01

    Background Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing African countries has necessitated this study. We therefore aimed to determine the sources of drug information for doctors working in a teaching hospital in Nigeria and to assess the self-reported impact of the sources on their prescribing behaviour. Methods A total of 163 doctors working at the University College Hospital (UCH), Ibadan in Nigeria were evaluated with a questionnaire for their demographics and sources of drug information. For doctors who relied on drug promotion, they were asked to self-report and self-rate their opinion on extent of interactions with pharmaceutical companies as well as how such interactions had impacted on their prescribing behaviour. Apart from the demographics, each question was evaluated with a typical five-level Likert item. Data analyses were with simple descriptive statistics. Results Of the 400 doctors working at UCH, only 40.8% participated in the study. Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), scientific papers/journals/internet (149, 91.4%), and drug promotion forum/product launches (144, 88.3%). Each source was highly utilized but there was no wide variation in their pattern of use. According to the self-report of over a half of the respondents, PSRs was an accurate and reliable drug information resource; PSRs increased their awareness of the promoted drugs; and their prescribing behaviours were influenced by information from PSRs. Conclusion Respondents tend to rely on a broad range of drug information resources which include potentially inappropriate resources such as PSRs

  16. Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario’s older population: a population-based cohort study applying subsets of the STOPP/START and Beers’ criteria in large health administrative databases

    PubMed Central

    Bjerre, Lise M; Ramsay, Timothy; Cahir, Catriona; Ryan, Cristín; Halil, Roland; Farrell, Barbara; Thavorn, Kednapa; Catley, Christina; Hawken, Steven; Gillespie, Ulrika; Manuel, Douglas G

    2015-01-01

    Introduction Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale. Methods and analysis The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP—more specifically, the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs. This will be done within the framework of a population-based retrospective cohort study using Ontario's large health administrative and population databases. Eligible patients aged 66 years and older who were issued at least 1 prescription between 1 April 2003 and 31 March 2014 (approximately 2 million patients) will be included. Ethics and dissemination Ethical approval was obtained from the Ottawa Health Services Network Ethical Review Board and from the Bruyère Research Institute Ethics Review Board. Dissemination will occur via publication, presentation at national and international conferences, and ongoing exchanges with regional, provincial and national stakeholders, including the Ontario Drug Policy Research Network and the Ontario Ministry of Health and Long-Term Care. Trial registration number Registered with clinicaltrials

  17. Understanding the molecular properties and metabolism of top prescribed drugs.

    PubMed

    Zhong, Haizhen A; Mashinson, Victoria; Woolman, Theodor A; Zha, Mengyi

    2013-01-01

    Molecular properties such as the molecular weight, hydrophobicity parameter logP, and the total polar surface area (TPSA) have been used extensively in modern drug discovery. We investigated these properties and ADMET scores of the top 200 therapeutic drugs by the U.S. retail sales (2010) and classified them according to the clinical indications and/or routes of administration. This list of drugs provides ample information of these molecular descriptors for successfully approved drugs. The mean logP for oral drugs is 2.5 while the logP for injectable drugs seems to be smaller. Among different types of clinical indications, drugs used for anti-HIV, and antibiotics tend to have lower logP. The molecular weights of anti-HIV drugs, antihypertensives and antibiotics appear to be larger. The ADMET scores, derived from a combination of molecular weights and logP, are consistent for oral drugs, with a mean score of 1.5 and a standard deviation of 1.0. Many clinical drugs that violate Lipinski's rule of five criteria can still exhibit ADMET scores that are very close to the mean value for oral drugs (1.5) and lie within the acceptable standard deviation. The molecular properties of MW, logP, and TPSA appear to vary according to their clinical indications. Many drugs form salts or cocrystals with acids or solvents that increase their solubility. Our data show that addition of hydrochloride is the most common method to increase solubility of drug ingredients. Cytochrome P450 isozymes 3A4, 2D6, 2C9, 2C8 and 3C5 are the top five proteins that metabolize the 200 most prescribed drugs. Drugs metabolized by 3A4 appear to have larger molecular weights and those metabolized by 2D6 have lower molecular weights. CYP2C8-metabolized drugs appear to be most hydrophilic, with the smallest logP and the largest polar surface areas. PMID:23675936

  18. Pharmacoeconomic consequences of variable patient compliance with prescribed drug regimens.

    PubMed

    Urquhart, J

    1999-03-01

    Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of compliance were made, which has not been done in later trials. Economic consequences of variable compliance are estimated by converting dose-dependent changes in absolute risk of incident coronary disease into the unicohort format, which designates how many patients must be treated to prevent, in a given time, a defined 'coronary event'. Two strong influences on the costs of treatment are: (i) the shape of the relation between drug intake and risk reduction; and (ii) the strength of the linkage between intake and prescription refills. The intake-effect relation for cholestyramine is linear, making compliance-neutral the cost to prevent 1 coronary event, provided that refills match intake. If refills exceed intake, treatment costs rise. The intake-effect relation for gemfibrozil is more typically nonlinear, so poorer compliers purchase and take the drug in amounts that have little benefit, increasing the cost to prevent 1 coronary event. If refills run at a higher rate than intake, costs increase still further. A key question for future study is: do policies that encourage timely refills increase compliance enough to offset their potential to waste money in the purchasing of an untaken drug? PMID:10537430

  19. Disease-drug database for pharmacogenomic-based prescribing.

    PubMed

    Hussain, S; Kenigsberg, B B; Danahey, K; Lee, Y M; Galecki, P M; Ratain, M J; O'Donnell, P H

    2016-08-01

    Providers have expressed a strong desire to have additional clinical decision-support tools to help with interpretation of pharmacogenomic results. We developed and tested a novel disease-drug association tool that enables pharmacogenomic-based prescribing to treat common diseases. First, 324 drugs were mapped to 484 distinct diseases (mean number of drugs treating each disease was 4.9; range 1-37). Then the disease-drug association tool was pharmacogenomically annotated, with an average of 1.8 pharmacogenomically annotated drugs associated/disease. Applying this tool to a prospectively enrolled >1,000 patient cohort from a tertiary medical center showed that 90% of the top ∼20 diseases in this population and ≥93% of patients could appropriately be treated with ≥1 medication with actionable pharmacogenomic information. When combined with clinical patient genotypes, this tool permits delivery of patient-specific pharmacogenomically informed disease treatment recommendations to inform the treatment of many medical conditions of the US population, a key initial step towards implementation of precision medicine. PMID:26940584

  20. Association between drug‐specific indicators of prescribing quality and quality of drug treatment: a validation study

    PubMed Central

    Belfrage, Björn; Fastbom, Johan

    2015-01-01

    Abstract Purpose To evaluate the concurrent validity of three European sets of drug‐specific indicators of prescribing quality Methods In 200 hip fracture patients (≥65 years), consecutively recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was assessed according to a gold standard as well as to three drug‐specific indicator sets (Swedish National Board of Health and Welfare, French consensus panel list, and German PRISCUS list). As gold standard, two specialist physicians independently assessed and then agreed on the quality for each patient, after initial screening with STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and START (Screening Tool to Alert to Right Treatment). Results According to the Swedish, French, and German indicator sets, 82 (41%), 54 (27%), and 43 (22%) patients had potentially inappropriate drug treatment. A total of 141 (71%) patients had suboptimal drug treatment according to the gold standard. The sensitivity for the indicator sets was 0.51 (95% confidence interval: 0.43; 0.59), 0.33 (0.26; 0.41), and 0.29 (0.22; 0.37), respectively. The specificity was 0.83 (0.72; 0.91), 0.88 (0.77; 0.94), and 0.97 (0.88; 0.99). Suboptimal drug treatment was 2.0 (0.8; 5.3), 1.9 (0.7; 5.1), and 6.1 (1.3; 28.6) times as common in patients with potentially inappropriate drug treatment according to the indicator sets, after adjustments for age, sex, cognition, residence, multi‐dose drug dispensing, and number of drugs. Conclusions In this setting, the indicator sets had high specificity and low sensitivity. This needs to be considered upon use and interpretation. Copyright © 2015 The Authors Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons, Ltd. PMID:26147790

  1. Development of a core drug list towards improving prescribing education and reducing errors in the UK

    PubMed Central

    Baker, Emma; Pryce Roberts, Adele; Wilde, Kirsty; Walton, Hannah; Suri, Sati; Rull, Gurvinder; Webb, Andrew

    2011-01-01

    AIM To develop a core list of 100 commonly prescribed drugs to support prescribing education. METHODS A retrospective analysis of prescribing data from primary care in England (2006 and 2008) and from two London Teaching Hospitals (2007 and 2009) was performed. A survey of prescribing by foundation year 1 (FY1) doctors in 39 NHS Trusts across London was carried out. RESULTS A core list of 100 commonly prescribed drugs comprising ≥0.1% prescriptions in primary and/or secondary care was developed in 2006/7. The core list remained stable over 2 years. FY1 doctors prescribed 65% drugs on the list at least monthly. Seventy-six% of FY1 doctors did not regularly prescribe any drugs not on the core list. There was a strong correlation between prescribing frequency (prescriptions for each drug class expressed as percentage of all prescriptions written) and error rate described in the EQUIP study (errors made when prescribing each drug class expressed as a percentage of all errors made), n= 39, r= 0.861, P= 0.000. CONCLUSIONS Our core drug list identifies drugs that are commonly used and associated with error and is stable over at least 2 years. This list can now be used to develop learning resources and training programmes to improve prescribing of drugs in regular use. Complementary skills required for prescribing less familiar drugs must be developed in parallel. Ongoing research is required to monitor the effect of new training initiatives on prescribing error and patient safety. PMID:21219399

  2. 42 CFR 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Prescribed drugs, dentures, prosthetic devices, and eyeglasses. 440.120 Section 440.120 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.120 Prescribed drugs,...

  3. Psychotropic drug prescribing in child and adolescent learning disability psychiatry.

    PubMed

    Bramble, David

    2007-07-01

    This postal questionnaire study investigated the prescribing practices of a group of senior British psychiatrists who have responsibilities for children and adolescents with learning disabilities (mental retardation). The study revealed that all of the clinicians surveyed (n = 16) were prescribing psychotropic medication; psychostimulants and major tranquillizers represented the most frequently prescribed classes and, respectively, methylphenidate, risperidone, melatonin, sodium valproate and carbamazepine were the most frequently employed specific agents. Most patients were receiving monotherapy. Many (14/16) clinicians reported difficulties in shared-care prescribing arrangements with General Practitioners. The study concludes that psychopharmacology is an established part of the psychiatric management of learning disabled children but acknowledges the need for the elaboration of clinical governance standards to this area of practice. PMID:17446203

  4. An audit of prescribing practices for benzodiazepines and Z-drugs.

    PubMed

    Cadogan, C; Ryder, S

    2015-03-01

    Concerns persist over the use of benzodiazepines and Z-drugs in Ireland. A prospective prescription audit was conducted in 81 community pharmacies across Ireland over a four week period. The study sought to assess the level of prescription compliance with key components of benzodiazepine and Z-drug prescribing guidelines. 28% of audit booklets issued were returned, yielding data on 4,418 prescriptions. The findings suggest that little progress has been made in improving the prescribing of benzodiazepines and Z-drugs in Ireland in the decade since publication of the Benzodiazepine Committee's report. Fewer than one fifth of prescriptions (18.8%) were fully compliant with the assessment criteria and the majority (53.7%) had multiple discrepancies. This study highlights the importance of monitoring and auditing benzodiazepine and Z-drug prescribing practices. Interventions involving patients, prescribers and pharmacists are required to improve the prescribing and use of these medications in Ireland. PMID:25876301

  5. [Some problems due to the questionable indication for prescribing drugs].

    PubMed

    Mangeot, J P

    1997-01-01

    Once a diagnosis has been done, prescribers must take into account the indications and method of use of a product before prescribing it. The indications are given in the Product License and noted in the Summary of Product Characteristics. The "RMO" informs on what would be dangerous or useless to prescribe. From now on French prescribers will have in addition to take into account indications admitted to reimbursement by the Sécurité Sociale that might be different from the Product License indications. Various problems will follow: Necessity to establish standardised and classified indications to be used by all. Necessity that this standardisation be at a European level. The indications given in the Product License must be in strict accordance with what is in the dictionary. Necessity for the prescribers to be continuously kept up to date on this dictionary. Risk of differences between general practice and hospital where there is no such opposability. This will affect therapeutic research in France. These problems must be examined as a whole. PMID:9453174

  6. Co-Prescribing of Potentially Interacting Drugs during Warfarin Therapy - A Population-Based Register Study.

    PubMed

    Rikala, Maria; Hauta-Aho, Milka; Helin-Salmivaara, Arja; Lassila, Riitta; Korhonen, Maarit Jaana; Huupponen, Risto

    2015-08-01

    We analysed the occurrence of co-prescribing of potentially interacting drugs during warfarin therapy in the community-dwelling population of Finland. We identified drugs having interaction potential with warfarin using the Swedish Finnish INteraction X-referencing drug-drug interaction database (SFINX) and obtained data on drug purchases from the nationwide Prescription Register. We defined warfarin users as persons purchasing warfarin in 2010 (n = 148,536) and followed them from their first prescription in 2010 until the end of the calendar year. Co-prescribing was defined as at least 1-day overlap between warfarin and interacting drug episodes. In addition, we identified persons who initiated warfarin therapy between 1 January 2007 and 30 September 2010 (n = 110,299) and followed these incident users for a 3-month period since warfarin initiation. Overall, 74.4% of warfarin users were co-prescribed interacting drugs. Co-prescribing covered 46.4% of the total person-years of warfarin exposure. Interacting drugs that should be avoided with warfarin were co-prescribed for 13.4% of warfarin users. The majority of the co-prescriptions were for drugs that are not contraindicated during warfarin therapy but require special consideration. Among incident users, 57.1% purchased potentially interacting drugs during the 3-month period after initiation, while 9.0% purchased interacting drugs that should be avoided with warfarin. To conclude, the occurrence of co-prescribing of potentially interacting drugs was high during warfarin therapy. Our findings highlight the importance of close monitoring of warfarin therapy and the need for further studies on the clinical consequences of co-prescribing of interacting drugs with warfarin. PMID:25537751

  7. [Improving drug prescribing in the elderly: a new edition of STOPP/START criteria].

    PubMed

    Delgado Silveira, E; Montero Errasquín, B; Muñoz García, M; Vélez-Díaz-Pallarés, M; Lozano Montoya, I; Sánchez-Castellano, C; Cruz-Jentoft, A J

    2015-01-01

    Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels. PMID:25466971

  8. Prescribing patterns and drug cost among cardiovascular patients in Hospital Universiti Kebangsaan Malaysia.

    PubMed

    Al-Junid, S M; Ezat, W P Sharifa; Surianti, S

    2007-03-01

    A prevalence study was conducted, measuring drug cost and prescribing patterns of clinicians treating cardiovascular patients in UKM Hospital (HUKM). One Hundred and thirty-five patients' case-notes were selected from the Case-Mix database of HUKM. The average and median number of drugs prescribed per patient was 7.56 (+/- 3.37) and 7.0 (+/- 3) respectively. Generic drug prescription rate was still low (45.2%). Significant relationship was observed between generic drug prescriptions with age of patients, types of wards and different levels of clinicians' training. Younger patients, admitted to Coronary Care Unit (CCU) and Cardiology Rehabilitation Ward (CRW) were more likely to be prescribed with branded drugs. Lower generic drugs prescription and higher cost of drugs were mostly practised by Consultants. CCU and CRW wards were the only predictor to having low generic drugs prescriptions. Ninety-nine percent of the total RM28,879.25 drug cost was used to purchase branded drugs. Mean drug cost for a patient is RM213.92 (+/- RM333.36) and median cost is RM102.46 (+/- RM240.51). Higher drug cost and its' predictors were patients with severity level II and III, length of stay of > or = 6 days, number of drugs types of > or = 7, generic drugs prescription rate < 50% and patients admitted in CCU and CRW wards. This study is important for short and long-term decision-making, controlling of providers behaviour and resources. PMID:17682574

  9. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians.

    PubMed

    Bao, Yuhua; Pan, Yijun; Taylor, Aryn; Radakrishnan, Sharmini; Luo, Feijun; Pincus, Harold Alan; Schackman, Bruce R

    2016-06-01

    State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose. We used data from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010. We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of non-opioid analgesics were limited. Increased use of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the policies' comparative effectiveness. PMID:27269021

  10. Effect of Drug Sample Removal on Prescribing in a Family Practice Clinic

    PubMed Central

    Hartung, Daniel M.; Evans, David; Haxby, Dean G.; Kraemer, Dale F.; Andeen, Gabriel; Fagnan, Lyle J.

    2010-01-01

    PURPOSE Little is known about the impact of recent restrictions on pharmaceutical industry detailing and sampling on prescribing behavior, particularly within smaller, independent practices. The objective of this study was to evaluate the effect of a policy prohibiting prescription drug samples and pharmaceutical industry interaction on prescribing patterns in a rural family practice clinic in central Oregon. METHODS Segmented linear regression models were used to evaluate trends in prescribing using locally obtained pharmacy claims. Oregon Medicaid pharmacy claims were used to control for secular prescribing changes. Total and class-specific monthly trends in branded, promoted, and average prescription drug costs were analyzed 18 months before and after policy implementation. RESULTS Aggregate trends of brand name drug use did not change significantly after policy implementation. In aggregate, use of promoted agents decreased by 1.43% while nonpromoted branded agents increased by 3.04%. Branded drugs prescribed for respiratory disease declined significantly by 11.34% compared with a control group of prescribers. Relative to the control group, prescriptions of promoted cholesterol-lowering drugs and antidepressants were reduced by approximately 9.98% and 11.34%, respectively. The trend in average cost per prescription for lipid-lowering drugs was significantly reduced by $0.70 per prescription per month. Overall, average prescription drug costs increased by $5.18 immediately after policy implementation. CONCLUSIONS Restriction of pharmaceutical industry representatives and samples from a rural family practice clinic produced modest reductions in branded drug use that varied by class. Although aggregate average costs increased, prescriptions for branded and promoted lipid-lowering agents and antidepressants were reduced. PMID:20843881

  11. Factors influencing prescribing of fall-risk-increasing drugs to the elderly: A qualitative study

    PubMed Central

    Steinsbekk, Aslak; Granas, Anne Gerd

    2015-01-01

    Objective. Explore the situations in which GPs associate drug use with falls among their elderly patients, and the factors influencing the prescribing and cessation of fall-risk-increasing drugs (FRIDs). Design. A qualitative study with 13 GPs who participated in two semi-structured focus groups in Central Norway. Participants were encouraged to share overall thoughts on the use of FRIDs among elderly patients and stories related to prescribing and cessation of FRIDs in their own practice. Results. The main finding was that GPs did not immediately perceive the use of FRIDs to be a prominent factor regarding falls in elderly patients, exceptions being when the patient presented with dizziness, reported a fall, or when prescribing FRIDs for the first time. It was reported as common to renew prescriptions without performing a drug review. Factors influencing the prescribing and cessation of FRIDs were categorized into GPs’ clinical work conditions, uncertainty about outcome of changing prescriptions, patients’ prescribing demands, and lack of patient information. Conclusions. The results from this study indicate that GPs need to be reminded that there is a connection between FRID use and falls among elderly patients of enough clinical relevance to remember to assess the patient's drug list and perform regular drug reviews. PMID:25965505

  12. Weight considerations in psychotropic drug prescribing and switching.

    PubMed

    Hasnain, Mehrul; Vieweg, W Victor R

    2013-09-01

    Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required

  13. Prescribing narcotics to drug-dependent people in prison: some preliminary results.

    PubMed

    Kaufmann, B; Drelfuss, R; Dobler-Mikola, A

    Switzerland began testing a program in which narcotics are prescribed under medical care for drug-dependent inmates. The goal of the program being run at the Oberschongrun penitentiary is to make drug-dependent people feel better, have the chance of becoming stable in prison, and escape the vicious cycle of committing further drug-related crimes when they are released. Participation in the trial is voluntary. Participants must be at least 20 years of age, been drug dependent for two years, and have undergone unsuccessful drug treatment. An additional selection criterion is illegal consumption of heroin while incarcerated. Issues involved with the trial are described, including the conflicts inherent in prescribing drugs that are usually considered illegal. Preliminary conclusions show that the program is feasible, although there are significant problems in instituting this type of program in an environment that is totalitarian and rigid. The program raises prison role issues of rehabilitation versus punishment. PMID:11365294

  14. Drugs for dementia: the first year. An audit of prescribing practice.

    PubMed Central

    McGirr, G.; Compton, S. A.

    2000-01-01

    In March 1998 the Department of Health and Social Services issued prescribing guidelines for the use of drugs for dementia. A criterion based audit of 202 consecutive cases was undertaken over one year which showed that the prescribing guidelines in general were being followed. A small number of patients, 3, were prescribed the drugs outside the guidelines and most failures, 10, were due to poor recording of data in the clinical record. Despite the recommendation of the DHSS no agreed shared care protocols have been implemented but this does not seem to have affected access to these drugs. As a result of this audit changes have been made with regard to documentation of patient assessments and suggestions made to review Clinical Resource Efficiency Support Team (CREST) guidelines. PMID:11196723

  15. Impact of a drug bulletin on the knowledge, perception of drug utility, and prescribing behavior of physicians.

    PubMed

    Denig, P; Haaijer-Ruskamp, F M; Zijsling, D H

    1990-01-01

    The impact of a drug bulletin was tested in a randomized controlled trial that included 186 family physicians. The length of the trial was six months. It was hypothesized that printed information, such as in drug bulletins, influences physician prescribing behavior by changing their knowledge of drug efficacy and adverse effects and their perceptions of drug utility. Therefore, the impact of a drug bulletin was evaluated on these domains of influence. Interview data were used to assess changes in knowledge, perceived drug utility, and stated prescribing. Health insurance funds' records were used to collect actual prescribing data. Information in the bulletin on the treatment of renal colic changed physicians' knowledge as well as perceived utility of drugs used for renal colic (p less than 0.05). Significant changes in stated prescribing were also found. On the other hand, advice in the same bulletin on the treatment of the irritable bowel syndrome (IBS) had no impact at all. It did not even improve the knowledge of the physicians about the drugs used for IBS. Apparently, the message about the treatment of IBS failed to gain the attention of the physicians. It is suggested that some messages are sufficiently transmitted through written information, and others that are seen as less relevant or too difficult to implement need more intensive strategies. PMID:2301192

  16. Introducing a drug formulary to general practice — effects on practice prescribing costs

    PubMed Central

    Beardon, P.H.G.; Brown, S.V.; Mowat, D.A.E.; Grant, J.A.; McDevitt, D.G.

    1987-01-01

    A drug formulary comprising 249 preparations of 132 drugs and drug combinations was prepared by the partners in a three-doctor general practice serving more than 5000 patients. No attempt was made to change to generic prescribing nor were repeat prescription drugs altered. Introduction of the formulary in September 1981 was followed by an increase in the proportion of prescriptions containing drugs from the formulary from about 55% to more than 60% for both repeat and non-repeat prescriptions. The proportion of formulary drugs on non-repeat prescriptions reached a maximum of 78% within the first year with the additional influence of information feedback. Over the first year the level of formulary drugs used for both repeat and nonrepeat prescribing levelled off at about 62%. Even with these modest changes, when compared with the costs of general practice prescribing in Scotland as a whole, the introduction of the formulary resulted in savings of approximately 10% within the practice for the mean ingredient costs both per patient and per prescription. PMID:3449632

  17. Should Physicians be Encouraged to use Generic Names and to Prescribe Generic Drugs?

    PubMed

    Riaz, Haris; Krasuski, Richard A

    2016-06-01

    While using the brand names seems like a trivial issue at the outset, using these names is inherently problematic. Cardiovascular drugs remain the most commonly prescribed drugs by the physicians. The junior doctors are likely to introject practices of their seniors and consequently to reciprocate from the experiences learnt from their preceptors. Using the generic names may be one way to facilitate prescription of the generic drugs who have a better cost profile and similar efficacy than the more expensive branded drugs. In this editorial, we have outlined several arguments to suggest the importance of using the generic names in academic discussions and clinical documentation. PMID:27179932

  18. Some current factors influencing the prescribing and use of psychiatric drugs.

    PubMed Central

    Poulsen, R L

    1992-01-01

    A reprise of selected known factors about the influences affecting the prescribing and use of drugs, and some new developments in the drug marketplace, are the basis for this summary and observations about future expectations regarding psychotherapeutic agents. This information can be used to assist in formulating or updating, or both, conceptualizations and hypotheses for future policy and research planning in this area. PMID:1738808

  19. Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study

    PubMed Central

    Rao, Shobitha; Chogtu, Bharti

    2015-01-01

    Introduction: Acute respiratory distress syndrome (ARDS) is characterized by acute respiratory failure and is associated with wide range of clinical disorders. Controversy prevails over the pharmacological intervention in this disease. The aim of the study was to observe the prescribing pattern of drugs in patients with ARDS managed at a tertiary care hospital. Materials and Methods: This observational study was conducted at tertiary care hospital in India. Data of patients admitted from January 2010 to December 2012 was collected. Patients aged more than 18 years admitted in ICU, who were diagnosed to have ARDS during the study period, were included. A total of 150 patients of ARDS were selected. Data was collected as per the pre designed proforma and it included patients’ age, gender, clinical disorders precipitating ARDS, prescribing pattern of drugs and outcome. The data of the subjects was collected till discharge from hospital or death. Results: Infection was the cause of ARDS in 81.3% (n=122) of subjects. Antibiotics were prescribed in all the subjects and beta-lactams were prescribed in 97.3% (n=146). 41.3% (n=62) were prescribed corticosteroids, 39.3% (n=59) diuretics and 89.3% (n=134) intravenous fluids. Conclusion: The outcome of patients on different pharmacological treatment did not show any statistically significant difference. PMID:25859465

  20. The Seattle evaluation of computerized drug profiles: effects on prescribing practices and resource use.

    PubMed

    Koepsell, T D; Gurtel, A L; Diehr, P H; Temkin, N R; Helfand, K H; Gleser, M A; Tompkins, R K

    1983-08-01

    Since 1979, all outpatient pharmacy transactions at the US Public Health Service Hospital in Seattle have been captured in a computer system which generates a profile of each patient's active and previously used drugs. We conducted a controlled trial in which patients were allocated to profile or no-profile groups while the computer continued to collect data on everyone. In all, 41,572 clinic visits made by 6,186 patients were studied. The incidence of preventable drug-drug interactions and redundancies was very low and was unaffected by profiles. For unclear reasons, prescription of two interacting drugs on the same visit was significantly more common for patients with profiles. The duration of drug-drug interaction episodes was significantly shorter for profile group patients, perhaps due to earlier detection of the error on subsequent visits. Profiles had no effect on prescribing volume or coordination of drug refill and visit schedules, but profile group patients made about 5 per cent fewer clinic visits than those in the no-profile group. In this setting, it appears that the prescribing of interacting or redundant drugs is more often due to inadequate provider knowledge than to inaccessible patient-specific drug data. Prevention of such errors would thus require a more active educational or monitoring program. PMID:6688154

  1. Prescribing patterns for older heavy drug users living in the community.

    PubMed

    Grymonpre, R E; Sitar, D S; Montgomery, P R; Mitenko, P A; Aoki, F Y

    1991-02-01

    We report an analysis of prescription drugs claimed under a government-sponsored, universal Pharmacare program for community-dwelling adults aged greater than or equal to 50 years in Manitoba during 1975, 1978, 1981, and 1984. We limited our analysis to claimants who reported over six drugs in a year in order to control for effects of inflation and a changing deductible. The median number of prescribed drugs and the percent of claimants over age 50 years receiving prescriptions from multiple physicians decreased during the course of our study. In this sample of heavy drug users, age and sex did not consistently correlate with overall drug use, although there was correlation for specific drug groups. The relative ranking of prescribed drugs changed over the years, although benzodiazepines, thiazide diuretics, topical steroids, and codeine-containing analgesics remained near the top. Barbiturates and topical antibiotics showed the greatest drop in prescription rates; acetaminophen and beta-blockers increased the most. Using these community data, we project the prevalence of drug-related adverse events to be highest with beta-blockers, nonsteroidal antiinflammatory drugs, thiazide diuretics, and benzodiazepines. PMID:2058191

  2. Psychotropic drug prescribing in an Australian specialist child and adolescent eating disorder service: a retrospective study

    PubMed Central

    2013-01-01

    Background To describe the rates, indications, and adverse effects of psychotropic drug prescription in a specialist tertiary hospital child and adolescent eating disorder service. Methods Retrospective case note study of all active eating disorder patients (N = 115) over the period of treatment from referral to time of study (M = 2 years), covering patient demographics, clinical characteristics, drug prescriptions, indications, and adverse effects. Results Psychotropic drugs were prescribed in 45% of cases, most commonly antidepressants (41%), followed by anxiolytics (29%) and antipsychotics (22%), with 8% initiated before referral to the specialist eating disorder program. Common indications were depressed mood, agitation, anxiety, and insomnia. Patient clinical severity and complexity was associated with prescribing. Adverse effects, mostly minor, were recorded in 23% of antidepressant prescriptions, 39% of antipsychotic prescriptions, and 13% of anxiolytic prescriptions. Second generation antipsychotic prescription was associated with subsequent new onset binge eating, in this preliminary observational study. Self-harm by overdose of psychotropics occurred in 11% of patients prescribed medication. Conclusions Psychotropic medications were frequently prescribed to adolescent eating disorder patients to treat distressing symptoms. Prospective randomised controlled trials to clarify efficacy and safety are needed. Given the difficulties of conducting clinical trials in this population, services are encouraged to monitor and audit medication safety and efficacy in everyday practice, and to report their findings. PMID:24999406

  3. Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan

    PubMed Central

    Onda, Mitsuko; Imai, Hirohisa; Takada, Yurina; Fujii, Shingo; Shono, Takako; Nanaumi, Yoko

    2015-01-01

    Objectives A nationwide large-scale survey was conducted to identify the prevalence and causal medications of adverse drug events (ADEs) that are caused by potentially inappropriate medications (PIMs) given to homebound elderly patients, factors associated with ADEs, and measures taken by pharmacists to manage ADEs and their effects on ADEs. Settings A questionnaire was mailed to 3321 pharmacies nationwide. It asked about the details of PIMs and ADEs of up to 5 patients for whom home visits were provided by a pharmacist. Questionnaire forms were filled in by pharmacists who visited the patients. Design and participants Between 23 January and 13 February 2013, comprehensive assessment forms were sent to 3321 pharmacies. Data collected from 1890 pharmacies including data of 4815 patients were analysed and 28 patients of unknown sex were excluded. Their average age was 82.7 years. PIMs were identified based on the 2003 Beers Criteria Japan. Results There were 600 patients who did not provide valid answers regarding the medications. In the remaining 4243 patients, one or more medications that were considered to be PIMs had been prescribed to 48.4% of patients. PIM-induced ADEs were found in 8% of these patients by pharmacists during home visits. The top ADE-inducing medications were strong anticholinergic antihistamines, benzodiazepines, sulpiride and digoxin. The most common ADEs associated with benzodiazepines were frequent lightheadedness, somnolence and sleepiness, which increase the risk of falls and subsequent fractures in elderly patients. The following factors associated with ADEs were identified: sex, pharmacist awareness of prescription issues, frequency of visits and time spent at patients’ homes, and the frequency of detailed checks for patient adverse reactions by pharmacists. Conclusions The PIM prevalence associated with home healthcare in Japan was relatively high, as reported in previous studies. The present study suggests that pharmacists could

  4. The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care

    PubMed Central

    Tamblyn, Robyn; Huang, Allen; Kawasumi, Yuko; Bartlett, Gillian; Grad, Roland; Jacques, André; Dawes, Martin; Abrahamowicz, Michal; Perreault, Robert; Taylor, Laurel; Winslade, Nancy; Poissant, Lise; Pinsonneault, Alain

    2006-01-01

    Objective: To develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians. Design: A 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients. Measurement: MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, and providing electronic prescription, stop order, automated prescribing problem alerts, and compliance monitoring functions. Evaluation of technical performance, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases. Results: Perceived improvements in continuity of care and professional autonomy were associated with physicians' expected use of MOXXI. Physician speed in using MOXXI improved substantially in the first three months; however, only the represcribing function was faster using MOXXI than by handwritten prescription. Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient's drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the represcribing function as the most beneficial aspects of the system. Physicians were more likely to use the drug profile for patients who used more medication, made more emergency department visits, had more prescribing physicians, and lower continuity of care. Conclusion: Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care. PMID:16357357

  5. Methods to reduce prescribing errors in elderly patients with multimorbidity.

    PubMed

    Lavan, Amanda H; Gallagher, Paul F; O'Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in

  6. Did FDA Decisionmaking Affect Anti-Psychotic Drug Prescribing in Children?: A Time-Trend Analysis

    PubMed Central

    Wang, Bo; Franklin, Jessica M.; Eddings, Wesley; Landon, Joan; Kesselheim, Aaron S.

    2016-01-01

    Background Following Food and Drug Administration (FDA) approval, many drugs are prescribed for non-FDA-approved (“off-label”) uses. If substantial evidence supports the efficacy and safety of off-label indications, manufacturers can pursue formal FDA approval through supplemental new drug applications (sNDAs). We evaluated the effect of FDA determinations on pediatric sNDAs for antipsychotic drugs on prescribing of these products in children. Methods Retrospective, segmented time-series analysis using new prescription claims during 2003–2012 for three atypical antipsychotics (olanzapine, quetiapine, ziprasidone). FDA approved the sNDAs for pediatric use of olanzapine and quetiapine in December 2009, but did not approve the sNDA for pediatric use of ziprasidone. Results During the months before FDA approval of its pediatric sNDA, new prescriptions of olanzapine decreased for both children and adults. After FDA approval, the increase in prescribing trends was similar for both age groups (P = 0.47 for schizophrenia and bipolar disorder; P = 0.37 for other indications). Comparable decreases in use of quetiapine were observed between pediatrics and adults following FDA approval of its pediatric sNDA (P = 0.88; P = 0.63). Prescribing of ziprasidone decreased similarly for pediatric and adult patients after FDA non-approval of its pediatric sNDA (P = 0.61; P = 0.79). Conclusions The FDA’s sNDA determinations relating to use of antipsychotics in children did not result in changes in use that favored the approved sNDAs and disfavored the unapproved sNDA. Improved communication may help translate the agency’s expert judgments to clinical practice. PMID:27032095

  7. Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience.

    PubMed

    Chou, Y J; Yip, Winnie C; Lee, Cheng-Hua; Huang, Nicole; Sun, Ying-Pei; Chang, Hong-Jen

    2003-09-01

    In many Asian countries, physicians both prescribe and dispense drugs. This practice is hypothesized to have caused high drug expenditure and widespread prescription of antibiotics in Asia. Recently, Taiwan implemented the separation policy on an experimental basis. This paper's objective is to empirically evaluate the impact of Taiwan's reform to separate drug prescribing and dispensing on drug expenditure and total health expenditure. The research design consists of a pre/post comparison of the experimental with the control sites (difference-in-difference). Separation policy was implemented in Kaohsung and Taipei in March 1997, and expanded to Chia-yi and Taichung in March 1998. Changes in drug prescription behaviour before and after implementation in these two pairs of experimental cities were compared to Hsin-chu and Tainan (control), where separation policy was not implemented during the study period. To reduce resistance, providers in experimental sites were allowed to hire on-site pharmacists and dispense drugs through them if they chose to do so. Our study sample consists of all outpatient visits to clinics in the study sites between December 1996 and June 1998, with a total of 55.23 million claim records. The drug prescription rate, drug expenditure and total health expenditure per visit were the main outcome measures. We found that the probability of prescription and drug expenditure per visit were, respectively, 17-34% and 12-36% less among visits to clinics without on-site pharmacists, compared with the control sites. However, no difference in total health expenditure was found between these two types of visits. Hence, the separation policy could be effective in reducing drug expenditure and affecting prescription behaviour, but is less certain as a policy for reducing total health expenditure. We also found that the policy has practically no effect on clinics that have on-site pharmacists. PMID:12917273

  8. Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions.

    PubMed

    Seidling, Hanna M; Stützle, Marion; Hoppe-Tichy, Torsten; Allenet, Benoît; Bedouch, Pierrick; Bonnabry, Pascal; Coleman, Jamie J; Fernandez-Llimos, Fernando; Lovis, Christian; Rei, Maria Jose; Störzinger, Dominic; Taylor, Lenka A; Pontefract, Sarah K; van den Bemt, Patricia M L A; van der Sijs, Heleen; Haefeli, Walter E

    2016-04-01

    Background While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. Objective We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Setting Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. Methods We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Main outcome measures Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. Results According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. Conclusion While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures. PMID:26964781

  9. Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes

    PubMed Central

    Gabriel, Meghan Hufstader; Encinosa, William; Mostashari, Farzad; Bynum, Julie

    2015-01-01

    Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the “prescription origin code” in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider’s panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations. PMID:25948698

  10. Methods to reduce prescribing errors in elderly patients with multimorbidity

    PubMed Central

    Lavan, Amanda H; Gallagher, Paul F; O’Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews

  11. Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Acute Care Medications

    PubMed Central

    Rowe, Stevie; Siegel, David; Benjamin, Daniel K.

    2015-01-01

    Purpose Approximately 1 out of 6 children in the United States is obese. This has important implications for drug dosing and safety, as pharmacokinetic (PK) changes are known to occur in obesity due to altered body composition and physiology. Inappropriate drug dosing can limit therapeutic efficacy and increase drug-related toxicity for obese children. Few systematic reviews examining PK and drug dosing in obese children have been performed. Methods We identified 25 acute care drugs from the Strategic National Stockpile and Acute Care Supportive Drugs List and performed a systematic review for each drug in 3 study populations: obese children (2–18 years of age), normal weight children, and obese adults. For each study population, we first reviewed a drug’s Food and Drug Administration (FDA) label, followed by a systematic literature review. From the literature, we extracted drug PK data, biochemical properties, and dosing information. We then reviewed data in 3 age subpopulations (2–7 years, 8–12 years, and 13–18 years) for obese and normal weight children and by route of drug administration (intramuscular, intravenous, by mouth, and inhaled). If sufficient PK data were not available by age/route of administration, a data gap was identified. Findings Only 2/25 acute care drugs (8%) contained dosing information on the FDA label for each obese children and adults compared with 22/25 (88%) for normal weight children. We found no sufficient PK data in the literature for any of the acute care drugs in obese children. Sufficient PK data were found for 7/25 acute care drugs (28%) in normal weight children and 3/25 (12%) in obese adults. Implications Insufficient information exists to guide dosing in obese children for any of the acute care drugs reviewed. This knowledge gap is alarming, given the known PK changes that occur in the setting of obesity. Future clinical trials examining the PK of acute care medications in obese children should be prioritized. PMID

  12. Review of Top 10 Prescribed Drugs and Their Interaction with Dental Treatment.

    PubMed

    Weinstock, Robert J; Johnson, Michael P

    2016-04-01

    The proportion of people over age 60 is growing faster than any other group. Many patients take several medications to manage multiple chronic medical conditions. Poor oral health is common and dental visits by patients over the age of 65 are increasing. The dentist must recognize that these medications may interact with dental treatment. This article reviews the top 10 prescribed drugs as listed in the IMS Institute national prescription audit in January 2015 and reviews the interactions between these medications and dental treatment. The medications reviewed include levothyroxine, acetaminophen/hydrocodone, lisinopril, metoprolol, atorvastatin, amlodipine, metformin, omeprazole, simvastatin, and albuterol. PMID:27040293

  13. What Should Junior Doctors Know about the Drugs they Frequently Prescribe? A Delphi Study among Physicians in the Netherlands.

    PubMed

    Brinkman, David; Disselhorst, Guus; Jansen, Bernard; Tichelaar, Jelle; van Agtmael, Michiel; de Vries, Theo; Richir, Milan

    2016-06-01

    The aim of this study was to identify the information about commonly prescribed drugs that junior doctors should know in order to prescribe rationally in daily practice, defined as essential drug knowledge (EDK). A two-round Internet Delphi study was carried out involving general practitioners from one practice cluster, and registrars and consultants from two Dutch academic and eight teaching hospitals. A preliminary list of 377 potential EDK items for three commonly prescribed drugs was assessed on a dichotomous scale; an item was considered EDK if at least 80% consensus was reached. The consensus list of EDK items was discussed by the research team to identify similarities between the three drugs, with a view to forming a list of general EDK items applicable to other commonly prescribed drugs. Sixty experts considered 93 of the 377 items (25%) as EDK. These items were then used to form a list of 10 general EDK items. The list of EDK items identified by primary and secondary care doctors could be used in medical curricula and training programmes and for assessing the prescribing competence of future junior doctors. Further research is needed to evaluate the generalizability of this list for other commonly prescribed drugs. PMID:26506082

  14. Influence of an e-mail with a drug information attachment on sales of prescribed drugs: a randomized controlled study

    PubMed Central

    Edward, Christina; Himmelmann, Anders; Wallerstedt, Susanna M

    2007-01-01

    Background To provide doctors with producer-independent information to facilitate choice of treatment is an important task. The objective of the present study was to evaluate if an e-mail with a drug information attachment has effects on sales of prescribed drugs and if the design of the attachment is of importance. Methods The Swedish pharmaceutical benefit board found rizatriptan (Maxalt®) 10 mg to be the most cost-effective triptan. All 119 heads of primary care units in western Sweden were randomized to receive information concerning this conclusion via (i) e-mail with attachment I, (ii) e-mail with attachment II or (iii) no information (control). Attachment I was a short one (heading plus three lines text), whereas attachment II was a long one (heading plus one page text and one page with tables). The change in percentage rizatriptan of total triptans sold before and after the intervention (May – July 2004 and May – July 2005, respectively) was compared between the groups. Results Totally 48,229 (2004) and 50,674 (2005) defined daily doses of triptans were prescribed and sold during May – July in primary care units in the western part of Sweden. The absolute change in percentage rizatriptan was greater in the intervention groups compared with the control group 2 (25th – 75th percentile: -3 – 7) vs 0 (-7 - 5), P = 0.031). The absolute change in percentage rizatriptan did not differ between the two attachment groups (P = 0.93). Conclusion An e-mail with a drug information attachment may influence sales of prescribed drugs. No difference between different designs of the attachment could be detected. PMID:17942000

  15. Knowledge and attitudes of the pharmacists, prescribers and patients towards generic drug use in Istanbul – Turkey

    PubMed Central

    Toklu, Hale Z.; Dülger, Gül A.; Hıdıroğlu, Seyhan; Akici, Ahmet; Yetim, Aslıhan; Gannemoğlu, H. Mustafa; Güneş, Haşim

    The use of generic drugs has increased significantly in recent years. Since generic drugs are available at a lower cost, they provide an opportunity for savings in drug expenditure. Thus, use of generic drugs is encouraged especially in developing countries. There are only a few studies concerning the perceptions and attitudes of the healthcare providers and patients towards generic drug use. Methods The present study was conducted by a face to face questionnaire in the Kadikoy district of Istanbul in April 2010. From randomly chosen respondents, 68 pharmacists, 56 prescribers and 101 patients consented to participate in the study. Results Thirty one and 32 % of the pharmacists and prescribers, respectively, expressed that they believed that the generics did not differ from the original drugs, whereas only 24% of the patients believed so. Forty percent of the pharmacists and 82% of the prescribers told that they were unsure about the bioequivalence of the generics. Ten percent of the patients claimed that they immediately accept generic substitution by the pharmacist, while 26% accepted it if it was substituted by the prescriber. Cost was the most important factor taken into consideration about generic substitution (92% for prescribers; 83% for patients and 82% for pharmacists). Conclusions Our findings demonstrated that healthcare providers as well as the drug consumers have insufficient knowledge about generic drugs. Therefore, they should be better educated with respect to generic substitution. PMID:24155838

  16. Awareness about prescribed drugs among patients attending Out-patient departments

    PubMed Central

    Singh, Jaswinder; Singh, Narinder; Kumar, Rahat; Bhandari, Vikram; Kaur, Navpreet; Dureja, Sheveta

    2013-01-01

    Background: Communication skills play an important role in establishing doctor-patient relationship is widely recognized throughout the world. The information passed on to the patients affects the treatment outcomes. Objectives: The present study was undertaken to evaluate the level of awareness among OPD patients about prescribed drugs. Materials and Methods: A total of two hundred sixty four patients having a valid prescription from a doctor practicing in allopathic system, visiting 4 different chemist shops in a North Indian city were enrolled in the study. All the enrolled patients were given a preformed questionnaire to be answered on the spot. Results: It was found that though a considerable number of patients were aware about the therapeutic effects of the drugs and the manner of administration of the medicines; they lacked information regarding the side effects, warnings and the information their doctor may require at the next consultation. Conclusion: The study highlighted the fact that doctors need to spend more time with the patients to make them active participants in the drug therapy. PMID:23776839

  17. Do drug advertisements in Russian medical journals provide essential information for safe prescribing?

    PubMed Central

    Vlassov, Vasiliy; Mansfield, Peter; Lexchin, Joel; Vlassova, Anna

    2001-01-01

    Objective To examine pharmaceutical advertisements in medical journals for their adequacy of information. Methods We selected a convenience sample of 5 major Russian medical journals covering different fields of medicine and different types of publications. We evaluated all the ads in all the issues of the selected journals published during 1998. We counted the number of appearances of trade, chemical, and generic names; indication and contraindication; pharmacologic group; safety warnings; and references. Counts in all categories were aggregated for each advertiser. Results There were 397 placements of 207 distinct advertisements. Only 154 placements (40%) mentioned the generic name, 177 (45%) mentioned any indication, 42 (11%) mentioned safety warnings and contraindications, 21 (5%) warned about drug interactions, and 8 (2%) provided references. The 6 companies responsible for the most ads on average provided less information than the other companies. Conclusions Almost none of the drug ads published in Russian medical journals provide the basic information required for appropriate prescribing. This is despite the fact that in Russia, ads that omit essential information and that could lead consumers to misunderstandings about an advertised product are illegal. The arrival of drug advertising in Russia has brought little information and has been potentially damaging. PMID:11381003

  18. Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence

    PubMed Central

    Beau-Lejdstrom, Raphaelle; Douglas, Ian; Evans, Stephen J W; Smeeth, Liam

    2016-01-01

    Objectives To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013. Methods All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated. Results The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years. Conclusions There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries. PMID:27297009

  19. Dental prescribing in Wales and associated public health issues.

    PubMed

    Karki, A J; Holyfield, G; Thomas, D

    2011-01-01

    Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice. PMID:21164522

  20. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    PubMed Central

    Jhaveri, Binit N.; Patel, Tejas K.; Barvaliya, Manish J; Tripathi, Chandrabhanu

    2014-01-01

    Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer's criteria (2012) and PRISCUS list (2010). Results: A total of 676 geriatric patients (52.12% females) were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer's criteria, at least one inappropriate medicine was prescribed in 590 (87.3%) patients. Metoclopramide (54.3%), alprazolam (9%), diazepam (8%), digoxin > 0.125 mg/day (5%), and diclofenac (3.7%) were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in heart and renal failure patients was the commonly identified drug–disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06%) patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients. PMID:25276629

  1. Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

    PubMed Central

    Opondo, Dedan; Eslami, Saied; Visscher, Stefan; de Rooij, Sophia E.; Verheij, Robert; Korevaar, Joke C.; Abu-Hanna, Ameen

    2012-01-01

    Background Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting. Objective The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting. Methods We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class. Results We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription. Conclusions Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly

  2. Prescription Drug Monitoring Program Inquiry in Psychiatric Assessment: Detection of High Rates of Opioid Prescribing to a Dual Diagnosis Population

    PubMed Central

    Hackman, Daniel T.; Greene, Marion S.; Fernandes, Taya J.; Brown, Ashley M.; Wright, Eric R.; Chambers, R. Andrew

    2015-01-01

    Objective An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. Method In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. Results The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95% CI, 1.016–1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95% CI, 1.001–1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. Conclusions Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved

  3. Clinical implications of prescribing nonsteroidal anti-inflammatory drugs in oral health care--a review.

    PubMed

    Nagi, Ravleen; Yashoda Devi, B K; Rakesh, N; Reddy, Sujatha S; Patil, Deepa Jatti

    2015-03-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs), including both the traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. They are routinely prescribed in dental practice for the management of pain and swelling. Their use in treating acute dental pain and chronic orofacial pain, as adjuncts to the treatment of periodontal disease, and to minimize edema following surgical procedures is well documented. However, long-term utilization of nonselective NSAIDs could increase the risk of gastrointestinal symptoms, ranging from mild (e.g., dyspepsia, nausea, or vomiting) to serious gastric problems (e.g., gastric bleeding or perforation). Therefore, selective COX-2 inhibitors have been developed with fewer GI side effects but the recently identified cardiovascular adverse reactions limit their routine use in dental practice. Another major concern for oral physicians is NSAID-induced mucosal lesions and prolongation of bleeding time during invasive dental procedures. This article reviews therapeutic and analgesic uses of NSAIDs in dentistry. The various issues surrounding NSAID-induced adverse reactions and their implications in dentistry are also discussed. PMID:25617120

  4. Antisecretory effect of prescribed appetite stimulator drug cyproheptadine in rat intestine.

    PubMed

    Meddah, Bouchra; Limas-Nzouzi, Nicolas; Mamadou, Godefroy; Miantezila, Joe; Soudy, Imar Djibrine; Eto, Bruno

    2014-06-01

    Cyproheptadine (Cph) is an antiserotoninergic and antihistaminergic agent with alpha-blocking activity and central sedative effect. Cph has been found to be effective in stimulating appetite, but to our knowledge, its direct effects on the intestine have not been documented. We aimed to assess the antisecretory effects of Cph in rat proximal colon using Ussing chambers' technique. In basal and serotonin (5-HT)-stimulated conditions, Cph induced a dose-dependent reduction in short-circuit current (Isc). This effect was different in fed vs. fasted rats (EC50 = 1.9 × 10(-5 ) m and 4.9 × 10(-5 ) m, respectively). As expected, Cph induced a marked dose-dependent rightward shift of the concentration-response curve to 5-HT (pA2 = 5.4). The effect of Cph was found to be close to that of antisecretory agents in the following sequence: peptide YY > somatostatin > clonidine > Cph > C7-sorbin. To our knowledge, this is the first demonstration that Cph has a direct effect on the inhibition of electrogenic ionic secretion in intestinal epithelium in vitro. Our results indicate that Cph can modulate the intestinal transport of electrolytes and provide a new insight into the peripheral effects of this drug, which is frequently prescribed as appetite stimulator in developing countries. PMID:23565811

  5. Sex differences in the risk of receiving potentially inappropriate prescriptions among older adults

    PubMed Central

    Morgan, Steven G.; Weymann, Deirdre; Pratt, Brandy; Smolina, Kate; Gladstone, Emilie J.; Raymond, Colette; Mintzes, Barbara

    2016-01-01

    Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12–1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients. PMID:27151390

  6. Optimizing antimicrobial prescribing.

    PubMed

    Isturiz, Raul E

    2010-11-01

    Antibiotics are universally prescribed drugs. Because they exert selective pressure and because of the innate bacterial ability for adaptation, even the appropriate clinical use of these potentially life-preserving agents inevitably fosters the development and spread of resistance by a variety of microorganisms. Inappropriate use has accelerated and increased the magnitude of a problem that is now considered a public health crisis. For Gram-positive pathogens some compounds offer limited hope, but for Gram-negative organisms no new drugs with radically increased spectra are available for clinical trials. Patients with serious infections due to multiresistant organisms are experiencing adverse, sometimes fatal, clinical outcomes. Use of multiple drugs increases side effects and exposes additional susceptible bacteria to selective pressure. There is evidence that the appropriate use of currently available antibiotics can be associated with a reduction of the spread of resistance. Antibiotic stewardship programmes and the antibiotic 'care bundle' approach can be effective measures to lengthen the useful life of antibiotics and can be implemented in most clinical situations. PMID:21129628

  7. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: A comparison between Beers 2003 and 2012 criteria

    PubMed Central

    Momin, Taufik G.; Pandya, Rushi N.; Rana, Devang A.; Patel, Varsha J.

    2013-01-01

    Objectives: To detect the prevalence and pattern of use of Potentially inappropriate medications (PIMs) in hospitalized elderly patients of a tertiary care teaching hospital using Beers 2012 criteria and to compare the same with Beers 2003 criteria. Materials and Methods: Prescriptions of the elderly patients aged 65 years and above were collected from the medicine ward and analyzed. PIMs were identified with help of Beers 2003 and Beers 2012 criteria and comparison was made between the two criteria. Predictors associated with use of PIM were identified using bivariate and multivariate logistic regression analysis. Results: A total of 210 patients received 2,267 drugs. According to Beers 2003 criteria, 60 (28.57%) elderly patients received at least one PIM and 2.9% drugs were prescribed inappropriately. According to Beers 2012 criteria, 84 (40%) elderly received at least one PIM while 22 (10.47%) received multiple PIMs and about 5% drugs were prescribed inappropriately. The most commonly prescribed PIM was mineral oil-liquid paraffin (30, 14.3%) followed by spironolactone (25, 11.9%), digoxin (19, 9%), and benzodiazepines (14, 6.7%). There was a significant association between the number of patients receiving more than six drugs and the use of PIMs (P < 0.01). Use of more than 10 drugs was a significant predictor for use of PIMs in the elderly. Conclusion: The study shows high prevalence of prescribing PIMs in hospitalized elderly patients. Beers 2012 criteria are more effective in identifying PIMs than Beers 2003 criteria. PMID:24347769

  8. 42 CFR 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... records. (b) “Dentures” are artificial structures made by or under the direction of a dentist to replace a... body. (d) “Eyeglasses” means lenses, including frames, and other aids to vision prescribed by...

  9. 42 CFR 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... records. (b) “Dentures” are artificial structures made by or under the direction of a dentist to replace a... body. (d) “Eyeglasses” means lenses, including frames, and other aids to vision prescribed by...

  10. 42 CFR 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... records. (b) “Dentures” are artificial structures made by or under the direction of a dentist to replace a... body. (d) “Eyeglasses” means lenses, including frames, and other aids to vision prescribed by...

  11. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

    PubMed Central

    Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

    2015-01-01

    Objective To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004-09. Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420 386) who received VHA medical services and opioid analgesics. Main outcome measure Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. Results During the study period 27% (n=112 069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. PMID:26063215

  12. Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrøm County, Denmark

    PubMed Central

    2010-01-01

    Background Whether written feedback on drug prescribing in general practice affects prescribing habits is controversial. Most short-term studies showed no effect. However, the issue has not been tested in long-term studies involving the local general practitioner community. Aims of the study To assess whether prescribing levels in general practice are affected by long-term, unsolicited, systematically repeated, mailed feedback. Methods Each of the 94 general practices in Storstrøm County, Denmark, received semi-annual, mailed feedback about their prescribing volumes and costs within 13 major drug groups, in relation to the levels for all the other 93 practices over a 7-year period in a project initiated by the local general practitioner association. Data on the number of defined daily doses (DDDs) prescribed per 1000 listed patients in each practice per 6-months, and practice characteristics, were obtained from the Pharmaceutical Database at the County Health Department. Results There was a large variation in drug prescribing volume between practices, but little within-practice variation over time. After adjustments for the influence of practice size and other potential outcome-affecting variables, there was no evidence of a general change of prescribing volume over time, no change among practices with a high or a low prescribing level, and no significant change within the various drug groups. Conclusions We found no significant effects on prescribing levels of mailed feedback, even when repeated semi-annually during 7 years and initiated by the local general practitioner community. PMID:20929310

  13. New Study Shows Clinicians Under-Prescribing Flu Antiviral Drugs and Possibly Overprescribing Antibiotics

    MedlinePlus

    ... Should Know About Flu Antiviral Drugs Antiviral Drug Supply Mixing Tamiflu Capsules Drug Resistance Information for Health ... The Flu Season Seasonal Influenza, More Information Vaccine Supply for 2015-2016 Season Seasonal Influenza-Associated Hospitalizations ...

  14. Prescriber preference for a particular tumour necrosis factor antagonist drug and treatment discontinuation: population-based cohort

    PubMed Central

    Fisher, Anat; Bassett, Ken; Wright, James M; Brookhart, M Alan; Freeman, Hugh J; Dormuth, Colin R

    2014-01-01

    Objective To assess the effect of physician preference for a particular tumour necrosis factor α (TNF) antagonist on the risk of treatment discontinuation in rheumatoid arthritis. Design Population-based cohort study. Setting British Columbia administrative health data (inpatients, outpatients and pharmacy). Participants 2742 British Columbia residents who initiated a first course of a TNF antagonist between 2001 and December 2008, had been diagnosed with rheumatoid arthritis, and were treated by 1 of 58 medium-volume to high-volume prescribers. Independent variable A level of physician preference for the drug (higher or lower) was assigned based on preceding prescribing records of the care-providing physician. Higher preference was defined as at least 60% of TNF antagonist courses initiated in the preceding year. Sensitivity analysis was conducted with different thresholds for higher preference. Main outcome measure Drug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. The risk of discontinuation was compared between different levels of physician preference using survival analysis. Results Higher preference for the prescribed TNF antagonist was associated with improved persistence with the drug (4.28 years (95% CI 3.70 to 4.90) vs 3.27 (2.84 to 3.84), with log rank test p value of 0.017). The adjusted HR for discontinuation was significantly lower in courses of drugs with higher preference (0.85 (0.76 to 0.96)). The results were robust in a sensitivity analysis. Conclusions Higher physician preference was associated with decreased risk of discontinuing TNF antagonists in patients with rheumatoid arthritis. This finding suggests that physicians who strongly prefer a specific treatment help their patients to stay on treatment for a longer duration. Similar research on other treatments is warranted. PMID:25270855

  15. Clinically significant interactions between antiretroviral and co-prescribed drugs for HIV-infected children: profiling and comparison of two drug databases

    PubMed Central

    Oshikoya, Kazeem A; Oreagba, Ibrahim A; Ogunleye, Olayinka O; Lawal, Saheed; Senbanjo, Idowu O

    2013-01-01

    Background Drug–drug interactions are an important therapeutic challenge among human immunodeficiency virus-infected patients. Early recognition of drug–drug interactions is important, but conflicts do exist among drug compendia on drug interaction information. We aimed to evaluate the consistencies of two drug information resources with regards to the severity rating and categorization of the potential interactions between antiretroviral and co-prescribed drugs. Methods We reviewed the case files of human immunodeficiency virus-infected children who were receiving treatment at the human immunodeficiency virus (HIV) clinic of the Lagos University Teaching Hospital, Idi Araba, between January 2005 and December 2010. All of the co-prescribed and antiretroviral drug pairs were screened for potential interactions using the Medscape Drug Interaction Checker and the Monthly Index of Medical Specialties Interaction Checker. Drug–drug interaction (DDI) severity and categorization were rated on a scale of A (no known interaction); B (minor/no action needed); C (moderate/monitor therapy); D (major/therapy modification); and X (contraindicated/avoid combination). Results A total of 280 patients were at risk of 596 potential DDIs. The databases showed discrepancies, with Medscape database identifying 504 (84.6%) and USA MIMS database identifying 302 (50.7%) potential DDIs. Simultaneous identification of DDIs by both databases occurred for only 275 (46.1%) listed interactions. Both databases have a weak correlation on the severity rating (rs = 0.45; P < 0.001). The most common DDIs identified by the databases were nevirapine and artemisinin-based combination therapy (170; 28.5%), nevirapine and fluconazole (58; 9.7%), and zidovudine and fluconazole (55; 9.2%). There were 272 (45.6%) interaction severity agreements between the databases. Conclusion Discrepancies occurred in DDI listings between Medscape and USA MIMS databases. Health care professionals may need to consult

  16. 42 CFR 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS... his practice as defined by State law to— (1) Artificially replace a missing portion of the body; (2... body. (d) “Eyeglasses” means lenses, including frames, and other aids to vision prescribed by...

  17. 49 CFR 219.103 - Prescribed and over-the-counter drugs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... on the basis of the available medical history, that use of the substance by the employee at the... Schedules II through V of the controlled substance list) prescribed or authorized by a medical practitioner, or possession incident to such use, if— (1) The treating medical practitioner or a...

  18. New Framework To Diagnose the Direct Disposal of Prescribed Drugs in Wastewater - A Case Study of the Antidepressant Fluoxetine.

    PubMed

    Petrie, Bruce; Youdan, Jane; Barden, Ruth; Kasprzyk-Hordern, Barbara

    2016-04-01

    Intentional or accidental release (direct disposal) of high loads of unused pharmaceuticals into wastewater can go unnoticed. Here, direct disposal of a pharmaceutical drug via the sewer network was identified for the first time using wastewater analysis. An irregularly high load of the antidepressant fluoxetine in raw wastewater (10.5 ± 2.4 g d(-1)) was up to 11 times greater than any other day. National prescription data revealed a predicted daily fluoxetine load for the studied treatment works to be 0.4-1.6 g d(-1). Enantio-selective analysis showed the high load of fluoxetine was present as a racemic mixture, which is typical for fluoxetine in dispensed formulations. As fluoxetine undergoes stereoselective metabolism within the body, a racemic mixture in wastewater suggests a nonconsumed drug was the major contributor of the high load. This was confirmed by its major metabolite norfluoxetine whose load did not increase on this day. Considering the most commonly prescribed formulation of fluoxetine, this increased load accounts for the disposal of ∼915 capsules. Furthermore, as fluoxetine is prescribed as one capsule per day, disposal is unlikely to be at the patient level. It is postulated that direct disposal was from a facility which handles larger quantities of the drug (e.g., a pharmacy). PMID:26974167

  19. The effects of North Carolina's prescription drug monitoring program on the prescribing behaviors of the state's providers.

    PubMed

    Ringwalt, Chris; Garrettson, Mariana; Alexandridis, Apostolos

    2015-04-01

    State-level prescription drug monitoring programs (PDMPs) show promise as a key strategy to respond to the epidemic of the misuse and abuse of controlled substances (CS), particularly opioid analgesics, in the United States. Undocumented concerns have been expressed that these PDMPs may have a "chilling effect" on providers' willingness to prescribe these substances to their patients. Using data from North Carolina's PDMP for the 3-year period from 2009 through 2011, we examined whether rapid increases in (1) the number of providers who queried the system, and (2) the number of days on which they queried it, would be related to their prescribing practices in regards to CS. We hypothesized that neither marker of PDMP utilization would be associated with a decrease in either patients receiving CS prescriptions or CS prescriptions filled. We found no association between either of these variables and the number of patients who filled prescriptions for CS or the number of prescriptions for CS filled. However, we did find a slight positive relationship between the growth in the utilization of the PDMP and the number of prescriptions filled for opioid analgesics. Concerns that PDMPs may constrain prescribing behavior with regards to CS are not supported. PMID:25466768

  20. Antimicrobial drug prescribing patterns for community-acquired pneumonia in hospitalized patients: A retrospective pilot study from New Delhi, India

    PubMed Central

    Kotwani, Anita; Kumar, Santosh; Swain, Prafulla Kumar; Suri, J. C.; Gaur, S. N.

    2015-01-01

    Objective: The objective of this study was to determine patterns and frequency of antimicrobial drug use among hospitalized patients with community-acquired pneumonia (CAP). Methodology: A retrospective 5 years (April 2007–March 2012) detailed medical record review of patients diagnosed with CAP and discharged to home from Non-Intensive Care Unit respiratory medicine wards of two public hospitals in Delhi. Results: A total of 261 medical records were analyzed. Over the 5 years, 82.0% (2007–08), 78.6% (2008–09), 59.5% (2009–10), 64.7% (2010–11), and 67.8% (2011–12) patients were prescribed two antimicrobials. In the last two study years, the proportion of patients receiving three antimicrobials increased (from 2.0% to 26.5% and 28.8%), while the proportion receiving monotherapy decreased (from 16.0% to 8.8% and 3.4%). In accordance with guidelines, beta-lactams and macrolides were the two most frequently prescribed antimicrobials (34.1%). However, newer generation beta-lactams were prescribed. A total of 37 patients were prescribed beta-lactam-tazobactam combination preparations. Overall, beta-lactams constituted more than 40% of prescriptions while macrolides were the second most prescribed class. Cephalosporin prescriptions significantly increased (P < 0.01) and penicillin prescriptions significantly decreased over study periods. The prescription of fluoroquinolones also decreased (21.5–6.0%, P < 0.01) and aminoglycoside prescription ranged from 9.7% to 16.4%, over 5 years. Reasons for prescribing three antimicrobials, use of aminoglycosides, or higher-end/reserve antibiotics were not mentioned in the medical records. There were no hospital-specific guidelines for doctors to follow in the treatment of CAP. Conclusions: These findings suggest the need for implementing antimicrobial treatment guidelines. Adequate documentation and monitoring of antibiotic use for feedback are also lacking. An antimicrobial stewardship program may offer the most

  1. Development and validation of a survey instrument for assessing prescribers' perception of computerized drug–drug interaction alerts

    PubMed Central

    Fear, Kathleen; Chaffee, Bruce W; Zimmerman, Christopher R; Karls, Edward M; Gatwood, Justin D; Stevenson, James G; Pearlman, Mark D

    2011-01-01

    Objective To develop a theoretically informed and empirically validated survey instrument for assessing prescribers' perception of computerized drug–drug interaction (DDI) alerts. Materials and methods The survey is grounded in the unified theory of acceptance and use of technology and an adapted accident causation model. Development of the instrument was also informed by a review of the extant literature on prescribers' attitude toward computerized medication safety alerts and common prescriber-provided reasons for overriding. To refine and validate the survey, we conducted a two-stage empirical validation study consisting of a pretest with a panel of domain experts followed by a field test among all eligible prescribers at our institution. Results The resulting survey instrument contains 28 questionnaire items assessing six theoretical dimensions: performance expectancy, effort expectancy, social influence, facilitating conditions, perceived fatigue, and perceived use behavior. Satisfactory results were obtained from the field validation; however, a few potential issues were also identified. We analyzed these issues accordingly and the results led to the final survey instrument as well as usage recommendations. Discussion High override rates of computerized medication safety alerts have been a prevalent problem. They are usually caused by, or manifested in, issues of poor end user acceptance. However, standardized research tools for assessing and understanding end users' perception are currently lacking, which inhibits knowledge accumulation and consequently forgoes improvement opportunities. The survey instrument presented in this paper may help fill this methodological gap. Conclusion We developed and empirically validated a survey instrument that may be useful for future research on DDI alerts and other types of computerized medication safety alerts more generally. PMID:21486876

  2. Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward

    PubMed Central

    Aung, Tin Htun; Judith Beck, Adèle; Siese, Thomas; Berrisford, Richard

    2016-01-01

    Potentially inappropriate prescribing in healthcare of the elderly (HCE) is associated with avoidable adverse drug events (ADEs).1,2 A recent set of prescribing criteria has been designed and validated, called “Screening Tool of Older Persons' Prescriptions” (STOPP), to rationalise prescribing in hospitalised patients on HCE wards.1,3 The aim of this quality improvement project was to identify how many potentially inappropriate medications (PIMs) were prescribed on these wards, and remove them. This was executed by implementing a ward round checklist, which incorporated STOPP criteria, for the twice weekly, consultant led ward rounds. This quality improvement project was carried out over four months. In a pilot study, we identified eight inappropriate medical prescriptions among 148 medications (5.4% ) prescribed on one ward. After applying a checklist for a structured ward round, we reviewed the medications prescribed on that ward, and found 10 PIMs out of 192 (5.2% ). Utilising the increasingly recognised “plan, do, study, act” (PDSA) cycle,4 we implemented departmental teaching and meetings with other members of the multidisciplinary team, which raised awareness of PIMs among junior doctors, as well as involving our pharmacists in drug chart screening. During this process we continued with a further six cycles on a bi-weekly basis, and saw a gradual decrease in PIM to 1.5%. In conclusion, a structured ward round, facilitated by a checklist that included review of drug charts based on STOPP criteria, demonstrated a considerable reduction of PIMs. It would be interesting to apply this quality improvement project to non-HCE wards, including general surgical wards or adult psychiatry wards, as a means of not only reducing the effects of ADEs, but also the expenditure associated with unnecessary drug prescriptions, and the costs associated with additional care arising from associated ADEs. PMID:27096089

  3. Medicare program; e-prescribing and the prescription drug program. Final rule.

    PubMed

    2005-11-01

    This final rule adopts standards for an electronic prescription drug program under Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). These standards will be the foundation standards or the first set of final uniform standards for an electronic prescription drug program under the MMA, and represent the first step in our incremental approach to adopting final foundation standards that are consistent with the MMA objectives of patient safety, quality of care, and efficiencies and cost savings in the delivery of care. PMID:16273748

  4. Psychopharmacoteratophobia: Excessive fear of malformation associated with prescribing psychotropic drugs during pregnancy: An Indian perspective

    PubMed Central

    Ram, Dushad; Gowdappa, Basavnna; Ashoka, H. G.; Eiman, Najla

    2015-01-01

    “Psychopharmacoteratophobia is the fear or avoidance of prescribing psychotropic medicine to a pregnant woman on a given indication in anticipation of fetal malformation.” It is rooted in the tragedy associated with thalidomide use and is increasing due to the inability to predict accurately, strict legal provision of consumer protection, ethical and legal issues involved, and pitfalls in the available evidence of teratogenicity. In the Indian setting, the physicians face more challenges as the majority of the patients may ask them to decide, what is the best for their health. Most guidelines emphasize more on what not to do than what to do, and the locus of decision is left to the doctor and the patient. In this review, we have focused on relevant issues related to psychopharmacoteraophobia that may be helpful to understand this phenomenon and help to address the deprivation of a mentally ill woman from the required treatment. PMID:26600635

  5. Potential to Enhance the Prescribing of Generic Drugs in Patients with Mental Health Problems in Austria; Implications for the Future

    PubMed Central

    Godman, Brian; Bucsics, Anna; Burkhardt, Thomas; Piessnegger, Jutta; Schmitzer, Manuela; Barbui, Corrado; Raschi, Emanuel; Bennie, Marion; Gustafsson, Lars L.

    2013-01-01

    Background: Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs. Objective: Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics. Methodology: A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time. Results: No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine. Conclusion: Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a “Hawthorne” effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more

  6. An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia

    PubMed Central

    2013-01-01

    Background Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in all age groups worldwide. It may be classified as mild/moderate or severe, the latter usually requiring hospitalisation. Although, there are many studies reported in relation to CAP, there is relatively little known about the treatment of CAP and its antibiotic use in Mongolia. The study aim was to evaluate prescribing practices for the treatment of mild/moderate CAP in Mongolia with respect to national prescribing guidelines. Methods Written prescriptions with a written diagnosis of CAP included were collected prospectively and sequentially for ten weeks from a purposefully selected sample of community pharmacies in rural and urban areas of Mongolia. The data collected included the patient’s age, gender, medication details, frequency and number of doses prescribed. Evaluation was with respect to the Mongolian Standard Treatment Guidelines (2005, 2008). Statistical differences between groups were tested using the Chi-squared and Fisher’s exact tests. Results Prescriptions were collected from 22 pharmacies and represented the prescribing practices of 118 doctors. The study enrolled 394 (193 adults and 201 children) patients, with a median age for children of 2.0 years (range: 0.03-12) and adults of 33.0 years (range: 13–92). The most commonly prescribed drugs were aminopenicillins, vitamins, and mucolytics, with the median number of drugs being three per prescription. Inappropriate drug selection was similar for adults (57.7%) and children (56.6%), and the major reason for an overall frequency of inappropriate prescribing for adults was 89.0% and for children 78.0%. Doctors in urban areas prescribed more inappropriate drugs than those in rural areas for both children and adults, p = .0014. The proportion of prescribed injections was 28.4% for adults and 9.0% for children, and for adults was significantly higher in urban areas. The prescribing standard for non

  7. Relationship of Prescribed Drugs with the Risk of Fall in Inpatients.

    PubMed

    Kozono, Aki; Isami, Keisuke; Shiota, Kimiko; Tsumagari, Kyouichi; Nagano, Masahisa; Inoue, Daisuke; Adachi, Rui; Hiraki, Yoichi; Nakagawa, Yoshihiro; Kamimura, Hidetoshi; Yamamichi, Ken

    2016-01-01

    Falls are common in elderly patients and are often serious. Several drugs have been associated with an increased risk of fall. Older adults often take multiple drugs for chronic diseases, and thus may be at increased risk from drugs associated with fall. We investigated the association between drug use and falling in hospitalized older people, with the goal of identifying medications that may increase the risk of a fall. A retrospective case control study was performed at the National Hospital Organization Kumamoto Saishunso Hospital in Japan. Medications taken by patients who fell (n=57) were compared with those taken by patients who did not fall (n=63). The median age (interquartile range; IQR) of the fall and non-fall groups were 75.0 (67.0-83.0) and 80.0 (70.3-84.5) years, respectively. The characteristics of the two groups were similar, with no significant differences in age, sex, or body weight. The probability of falling increased when the patients used zolpidem [odds ratio (OR)=2.47; 95%CI: 1.09-5.63; p<0.05] and calcium channel antagonists (OR=0.299; 95%CI: 0.13-0.68; p<0.01), and was also related to physical factors (OR=2.27; 95%CI: 1.01-5.09; p<0.05). Elderly patients taking zolpidem may fall due to sleepiness, and blood pressure control may be important to prevent orthostatic high blood pressure. In the treatment of elderly people, medical staff should try to choose drugs that prevent fall or are not associated with falling. PMID:27150933

  8. Variation in Prescribing Patterns and Therapeutic Drug Monitoring of Intravenous Busulfan in Pediatric Hematopoietic Cell Transplant Recipients

    PubMed Central

    McCune, Jeannine S.; Baker, K. Scott; Blough, David K.; Gamis, Alan; Bemer, Meagan J.; Kelton-Rehkopf, Megan C.; Winter, Laura; Barrett, Jeffrey S.

    2016-01-01

    Personalizing intravenous (IV) busulfan doses in children using therapeutic drug monitoring (TDM) is an integral component of hematopoietic cell transplant. The authors sought to characterize initial dosing and TDM of IV busulfan, along with factors associated with busulfan clearance, in 729 children who underwent busulfan TDM from December 2005 to December 2008. The initial IV busulfan dose in children weighing ≤12 kg ranged 4.8-fold, with only 19% prescribed the package insert dose of 1.1 mg/kg. In those children weighing >12 kg, the initial dose ranged 5.4-fold, and 79% were prescribed the package insert dose. The initial busulfan dose achieved the target exposure in only 24.3% of children. A wide range of busulfan exposures were targeted for children with the same disease (eg, 39 target busulfan exposures for the 264 children diagnosed with acute myeloid leukemia). Considerable heterogeneity exists regarding when TDM is conducted and the number of pharmacokinetic samples obtained. Busulfan clearance varied by age and dosing frequency but not by underlying disease. The authors’ group is currently evaluating how using population pharmacokinetics to optimize initial busulfan dose and TDM (eg, limited sampling schedule in conjunction with maximum a posteriori Bayesian estimation) may affect clinical outcomes in children. PMID:23444282

  9. Variation in prescribing patterns and therapeutic drug monitoring of intravenous busulfan in pediatric hematopoietic cell transplant recipients.

    PubMed

    McCune, Jeannine S; Baker, K Scott; Blough, David K; Gamis, Alan; Bemer, Meagan J; Kelton-Rehkopf, Megan C; Winter, Laura; Barrett, Jeffrey S

    2013-03-01

    Personalizing intravenous (IV) busulfan doses in children using therapeutic drug monitoring (TDM) is an integral component of hematopoietic cell transplant. The authors sought to characterize initial dosing and TDM of IV busulfan, along with factors associated with busulfan clearance, in 729 children who underwent busulfan TDM from December 2005 to December 2008. The initial IV busulfan dose in children weighing ≤12 kg ranged 4.8-fold, with only 19% prescribed the package insert dose of 1.1 mg/kg. In those children weighing >12 kg, the initial dose ranged 5.4-fold, and 79% were prescribed the package insert dose. The initial busulfan dose achieved the target exposure in only 24.3% of children. A wide range of busulfan exposures were targeted for children with the same disease (eg, 39 target busulfan exposures for the 264 children diagnosed with acute myeloid leukemia). Considerable heterogeneity exists regarding when TDM is conducted and the number of pharmacokinetic samples obtained. Busulfan clearance varied by age and dosing frequency but not by underlying disease. The authors- group is currently evaluating how using population pharmacokinetics to optimize initial busulfan dose and TDM (eg, limited sampling schedule in conjunction with maximum a posteriori Bayesian estimation) may affect clinical outcomes in children. PMID:23444282

  10. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    MedlinePlus

    ... Hsu. He is an assistant professor of medicine, cardiology and cardiac electrophysiology at the University of California, ... clots. This study -- based on patients from 123 cardiology practices in the United States -- highlights inappropriate prescribing ...

  11. When inappropriate becomes beneficial.

    PubMed

    Arroja, José David; Zimmermann, Marc

    2015-03-01

    We report the case of a young man who accidentally received a prolonged electric discharge from electrical wires and released the electric source with the help of an inappropriate shock from his implantable cardioverter-defibrillator (ICD), after misinterpretation of the electrical signal by the device as a ventricular tachycardia. This case illustrates the "electrical noise" phenomenon, and underscores the need for precautions for patients with an ICD and their physicians. PMID:25707735

  12. Potentially inappropriate prescribing (PIP) in long-term care (LTC) patients: validation of the 2014 STOPP-START and 2012 Beers criteria in a LTC population—a protocol for a cross-sectional comparison of clinical and health administrative data

    PubMed Central

    Bjerre, Lise M; Halil, Roland; Catley, Christina; Farrell, Barbara; Hogel, Matthew; Black, Cody D; Williams, Margo; Ryan, Cristín; Manuel, Douglas G

    2015-01-01

    Introduction Potentially inappropriate prescribing (PIP) is frequent and problematic in older patients. Identifying PIP is necessary to improve prescribing quality; ideally, this should be performed at the population level. Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Beers criteria were developed to identify PIP in clinical settings and are useful at the individual patient level; however, they are time-consuming and costly to apply. Only a subset of these criteria is applicable to routinely collected population-level health administrative data (HAD) because the clinical information necessary to implement these tools is often missing from databases. The performance of subsets of STOPP/START and Beers criteria in HAD compared with clinical data from the same patients is unknown; furthermore, the performance of the updated 2014 STOPP-START and 2012 Beers criteria compared with one another is also unknown. Methods and analysis A cross-sectional study of linked HAD and clinical data will be conducted to validate the subsets of STOPP/START and Beers criteria applicable to HAD by comparing their performance when applied to clinical and HAD for the same patients. Eligible patients will be 66 years and over and recently admitted to 1 of 6 long-term care facilities in Ottawa, Ontario. The target sample size is 275, but may be less if statistical significance can be achieved sooner. Medication, diagnostic and clinical data will be collected by a consultant pharmacist. The main outcome measure is the proportion of PIP missed by the subset of STOPP/START and Beers criteria applied to HAD when compared with clinical data. Ethics and dissemination The study was approved by the Ottawa Health Services Network Research Ethics Board, the Bruyère Continuing Care Research Ethics Board and the ethics board of the City of Ottawa Long Term Care Homes. Dissemination will occur via

  13. Prescribing patterns and the use of therapeutic drug monitoring of psychotropic medication in a psychiatric high-security unit.

    PubMed

    Castberg, Ingrid; Spigset, Olav

    2008-10-01

    The aim of this study was to investigate the use of psychotropic medication and therapeutic drug monitoring in a high-security psychiatric unit and to compare the doses and serum concentrations both with the recommended intervals and with the doses and serum concentrations in a control group. One hundred thirty-two patients were admitted in the period from January 2000 to December 2005. All available samples were used when comparing serum concentrations and doses with the recommended ranges. For the comparison of doses and serum concentration-to-dose (C:D) ratios with the control group only 1 sample from each patient was used. A total of 459 analyses of 27 different drugs in samples from 8 women and 73 men were included. The median number of therapeutic drug monitoring analyses per patient was 4 (range 1-29). Thirty-seven of the 81 patients (46%) used 2 or more antipsychotics at the same time. Clozapine, lamotrigine, olanzapine, quetiapine, ziprasidone, and zuclopenthixol were often given in doses above the recommended. The serum levels were frequently above those recommended for clozapine, olanzapine, quetiapine, risperidone, ziprasidone, and zuclopenthixol. The serum levels were significantly higher in the study group than in the control group for clozapine, lamotrigine, quetiapine, and zuclopenthixol. The given dose was significantly higher in the study group than in the control group for clozapine, lamotrigine and zuclopenthixol. The C:D ratio was significantly lower in the study group than in the control group for olanzapine but higher for quetiapine. The non-evidence based practice of high-dose polypharmacy with several antipsychotics is widely used in this unit. The use of higher doses in the study group than in the control group was not due to differences in metabolism or adherence to treatment between the 2 groups. The frequent use of therapeutic drug monitoring did not seem to have a great impact on the prescribed doses. PMID:18708990

  14. In Silico Analysis to Compare the Effectiveness of Assorted Drugs Prescribed for Swine flu in Diverse Medicine Systems

    PubMed Central

    Raja, Kalpana; Prabahar, Archana; Selvakumar, Suganya; Raja, T. K.

    2014-01-01

    The genome of the virus H1N1 2009 consists of eight segments but maximum number of mutations occurs at segments 1 and 4, coding for PB2 subunit of hemagglutinin. Comparatively less number of mutations occur at segment 6, coding for neuraminidase. Two antiviral drugs, oseltamivir and zanamivir are commonly prescribed for treating H1N1 infection. Alternate medical systems do compete equally; andrographolide in Siddha and gelsemine in Homeopathy. Recent studies confirm the efficacy of eugenol from Tulsi and vitamins C and E against H1N1. As the protein structures are unavailable, we modeled them using Modeller by identifying suitable templates, 1RUY and 3BEQ, for hemagglutinin and neuraminidase, respectively. Prior to docking simulations using AutoDock, the drug likeness properties of the ligands were screened using in silico techniques. Docking results showed interaction between the proteins individually into selected ligands, except for gelsemine and vitamin E no interactions were shown. The best docking simulation was reported by vitamin C interacting through six hydrogen bonds into proteins hemagglutinin and neuraminidase with binding energies -4.28 and -4.56 kcal/mol, respectively. Furthermore, vitamin C showed hydrophobic interactions with both proteins, two bonds with Arg119, Glu120 of HA, and one bond with Arg74 of NA. In silico docking studies thus recommend vitamin C to be more effective against H1N1. PMID:24799734

  15. In Silico Analysis to Compare the Effectiveness of Assorted Drugs Prescribed for Swine flu in Diverse Medicine Systems.

    PubMed

    Raja, Kalpana; Prabahar, Archana; Selvakumar, Suganya; Raja, T K

    2014-01-01

    The genome of the virus H1N1 2009 consists of eight segments but maximum number of mutations occurs at segments 1 and 4, coding for PB2 subunit of hemagglutinin. Comparatively less number of mutations occur at segment 6, coding for neuraminidase. Two antiviral drugs, oseltamivir and zanamivir are commonly prescribed for treating H1N1 infection. Alternate medical systems do compete equally; andrographolide in Siddha and gelsemine in Homeopathy. Recent studies confirm the efficacy of eugenol from Tulsi and vitamins C and E against H1N1. As the protein structures are unavailable, we modeled them using Modeller by identifying suitable templates, 1RUY and 3BEQ, for hemagglutinin and neuraminidase, respectively. Prior to docking simulations using AutoDock, the drug likeness properties of the ligands were screened using in silico techniques. Docking results showed interaction between the proteins individually into selected ligands, except for gelsemine and vitamin E no interactions were shown. The best docking simulation was reported by vitamin C interacting through six hydrogen bonds into proteins hemagglutinin and neuraminidase with binding energies -4.28 and -4.56 kcal/mol, respectively. Furthermore, vitamin C showed hydrophobic interactions with both proteins, two bonds with Arg119, Glu120 of HA, and one bond with Arg74 of NA. In silico docking studies thus recommend vitamin C to be more effective against H1N1. PMID:24799734

  16. American parents’ willingness to prescribe psychoactive drugs to children: a test of cultural mediators

    PubMed Central

    Dillon, Frank R.; Gladwin, Hugh; Rosa, Mario De La

    2013-01-01

    Purpose In the USA, white children receive psychoactive drugs more often than black or Hispanic children. This study investigates whether cultural attitudes statistically mediate differences between American parents’ self-identified racial–ethnic group membership and their willingness to medicate children for behavioral problems. Methods Using data from telephone interviews with 1,145 parents in two Florida counties, structural models tested associations between each group compared with the other, in willingness to medicate children exhibiting different problematic behaviors and hypothesized cultural (familism, fatalism, attitude toward corporal punishment, religiosity, concern about treatment stigma, birth abroad, language of interview) and other mediators (views about medications and causes of children’s problems). Respondent gender, age, socioeconomic status, parent-type household, taking psychoactive medication, and having a child with behavioral problems were used as covariates. Results Race–ethnicity was strongly associated with specific cultural attitudes and views about medications and problems, but only Hispanics distinguished themselves significantly from whites in willingness to medicate children. Across groups, parents who viewed medication favorably and endorsed biomedical causes for problems were more willing to medicate. In Hispanic–white and Hispanic–black comparisons, being interviewed in Spanish was the sole but modest cultural mediator of willingness, and in black–white comparisons, only concern about treatment stigma weakly mediated differences in willingness. Conclusions These findings provide faint support for a parent-centered cultural explanation of reported prescription differences among youths of different racial–ethnic groups in the USA. However, structural and professional components of a broader cultural hypothesis for such differences, within the USA and between different countries, still require evaluation. PMID

  17. A review of the factors influencing antimicrobial prescribing.

    PubMed

    Calbo, Esther; Alvarez-Rocha, Luis; Gudiol, Francisco; Pasquau, Juan

    2013-09-01

    There are multiple benefits of appropriate antimicrobial prescribing: it has a direct impact on clinical outcomes, avoids adverse effects, is cost effective and, perhaps most importantly, it helps to prevent the emergence of resistance. However, any physician can prescribe antibiotics, which is not the case with other clinically relevant drugs. There is great variability in the prescribing physician's (PP) training, motivation, workload and setting, including accessibility to infectious diseases consultants and/or diagnostic techniques, and therefore there is a high risk of inappropriate prescription. Many antibiotic prescribing errors occur around the selection and duration of treatment. This includes a low threshold for the indication of antibiotics, delayed initiation of treatment when indicated, limited knowledge of local antimicrobial resistance patterns by the PPs, errors in the final choice of dose, route or drug and a lack of de-escalation. Similarly, the prescription of prophylactic antibiotics to prevent surgical site infections, despite being commonly accepted, is suboptimal. Factors that may explain suboptimal use are related to the absence of well-defined protocols, poor knowledge of prophylactic protocols, miscommunication or disagreement between physicians, logistical problems, and a lack of audits. A proper understanding of the prescribing process can guide interventions to improve the PP's practices. Some of the potential interventions included in a stewardship program are education in antimicrobial prescribing, information on the local resistance patterns and accessibility to a qualified infectious diseases consultant. PMID:24129284

  18. Impact of prescribed medications on patient safety in older people

    PubMed Central

    Anathhanam, Sujo; Powis, Rachel A.; Robson, Jeremy

    2012-01-01

    Appropriate prescribing for older adults presents unique challenges to the prescriber. An understanding of the scale of the problems and contributing factors is essential when designing interventions to improve patient safety. The altered pharmacology of ageing, the existence of multiple medical conditions and the exclusion of elderly patients from many trials render this subgroup of the population particularly vulnerable to underprescribing and overprescribing. Adverse drug events are common, causing significant morbidity and mortality as well as having economic implications. ‘High-risk’ medications such as opioids, anticoagulants and antipsychotics can have benefits in this group of patients but strategies to optimize their safety are required. Tools exist that help to identify those at risk of adverse drug reactions and to screen for inappropriate prescribing. Developments in information technology are ongoing, and it is hoped that these may enhance the process of medication reconciliation across healthcare transitions and alert the prescriber to potential adverse drug events. This review addresses commonly encountered issues when prescribing for older people, considers strategies to improve medication safety and offers a list of ‘top tips’ to aid the clinician. PMID:25083234

  19. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital.

    PubMed

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt; Lisby, Marianne; Mainz, Jan

    2016-07-01

    Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish university hospital during a 3-month period (September 2013-November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207 (33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP. PMID:26824679

  20. Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods

    PubMed Central

    Tordoff, June; Dovey, Susan; Reith, David; Lloyd, Hywel; Tilyard, Murray; Smith, Alesha

    2016-01-01

    Background Polypharmacy and inappropriate continuation of medicines can lead to a significant risk of adverse drug events and drug interactions with patient harm and escalating health care costs as a result. Thorough review of patients’ medications focusing on the need for each drug can reduce the potential for harm. Limitations in performing effective medicine reviews in practice include consultation time constraints and funding for pharmacy services. We will aim to overcome these problems by designing an automatic electronic decision support tool (the medicines optimization/review and evaluation (MORE) module) that is embedded in general practice electronic records systems. The tool will focus on medicines optimization and reducing polypharmacy to aid prescribers in reviewing medicines and improve patient outcomes. Objective The objectives of this study are: (1) to develop an electronic decision support tool to assist prescribers in performing clinical medication reviews with a particular focus on patients experiencing multimorbidity and polypharmacy, and (2) evaluate and assess the use of the electronic decision support tool, providing pilot data on its usefulness in supporting prescribers during consultations with patients. Methods The first three study phases involve development of clinical rules outlining clinical interventions and the creation and validation of the MORE decision support tool. Phase four is a community-based, single-blind, prospective, 6-month controlled trial involving two interventions and two control general practices, matched for practice demographics. We will be measuring the number of times prescribers engage with the tool, total number of interventions suggested by the tool, and total number of times prescribers change medicines in response to recommendations. There will also be prospective follow-up of patients in the intervention group to examine whether changes to medications are upheld, and to determine the number of

  1. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients

    PubMed Central

    Rognstad, Sture; Brekke, Mette; Fetveit, Arne; Spigset, Olav; Wyller, Torgeir Bruun; Straand, Jørund

    2009-01-01

    Objective To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people ≥70 years. Design A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients. Setting A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (≤70 years) patients. Results Of the 140 invited panellists, 57 accepted to participate and 47 completed all three rounds of the Delphi process. The panellists reached consensus that 36 of the 37 suggested criteria were clinically relevant for general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups’ scores was seen for only one of the 36 criteria. Conclusion The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs’ prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions. PMID:19462339

  2. Generic prescribing of antidepressants.

    PubMed

    Bruck, P; Antao, C A; Henry, J A

    1992-11-01

    Analysis of National Health Service prescription data for the antidepressants from 1980 to 1989 shows a consistent secular trend towards the increased use of generic names on prescriptions for this group of drugs. This apparently reflects national trends for all drugs, and was similar for most antidepressants. However, generic prescribing had by 1989 increased significantly more rapidly with fluvoxamine, which was introduced in 1987. The two drugs introduced in 1989, fluoxetine and amoxapine, also had a high generic prescribing rate in their year of introduction. Increased generic prescribing may become a feature with further new drugs. However, the use of the generic name on the prescription has relatively little influence on what is dispensed to the patient. Pharmacists may dispense a brand name when given a generic prescription. Moreover, pressures on doctors to write generic names on prescriptions may have limited relevance for some drugs; generic alternatives were available for only four out of 22 antidepressants. PMID:1474553

  3. The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics

    PubMed Central

    Holloway, Kathleen Anne; Rosella, Laura; Henry, David

    2016-01-01

    Background Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of ≥20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy

  4. Inappropriate overuse of inhaled corticosteroids for COPD patients: impact on health costs and health status.

    PubMed

    de Miguel-Díez, Javier; Carrasco-Garrido, Pilar; Rejas-Gutierrez, Javier; Martín-Centeno, Antonio; Gobartt-Vázquez, Elena; Hernandez-Barrera, Valentín; Gil de, Miguel Angel; Jimenez-Garcia, Rodrigo

    2011-06-01

    The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: 1,590 (SD = 1,834) vs. 1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36-5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02-1.97)], depression [OR: 1.47 (95% CI: 1.05-2.05)], any allergy [OR 1.69 (95% CI: 1.13-2.54)], and physical health status [OR 0.97 (95% CI: 0.96-0.98)]. Lack of adherence to the

  5. Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

    PubMed Central

    Acheampong, Paul; Cooper, Gill; Khazaeli, Behshad; Lupton, David J; White, Sue; May, Margaret T; Thomas, Simon H L

    2013-01-01

    Aims To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts in the North East of England from 2007/8 to 2011/12 obtained from the ePACT.net database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity and associations between prescribing and indices of toxicity, respectively. Results Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in Primary Care Trusts that introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. Telephone enquiries to NPIS for quinine have declined, with stabilization of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common, and further efforts are needed to reduce availability and use. PMID:23594200

  6. Opioid prescribing pitfalls: medicolegal and regulatory issues

    PubMed Central

    Jammal, Walid; Gown, Grace

    2015-01-01

    Summary Inappropriate opioid prescribing can lead to patient harm as well as a medicolegal risk to prescribers. Prescribers need to be familiar with the indications, contraindications and harms associated with opioids. When prescribing opioids, doctors must be aware of their clinical, ethical and legal responsibilities, particularly the legislative requirements in their state. Failure to comply with these can result in disciplinary action. To avoid potential conflict with differing state regulations on opioid prescribing, doctors should advise patients to get their prescription dispensed in the same state in which it was written. PMID:26843712

  7. Prescribing Pattern of Oral Antihyperglycaemic Drugs, Rationality and Adherence to American Diabetes Association (ADA) Treatment Guidelines among Type 2 Diabetes Mellitus (T2DM) Postmenopausal Women

    PubMed Central

    Sharma, Sudhaa; Tandon, Vishal R.; Roshi

    2016-01-01

    Introduction Oral antihyperglycaemic prescription trends keep on changing and thus the drug prescription trend study may prove to be powerful exploratory tool for health care providers. Aim To investigate trends in prescriptions of oral antihyperglycaemic drugs (OHDs) among postmenopausal women suffering from T2DM in India and evaluate the rationality and adherence to ADA treatment guidelines. Materials and Methods An observational, cross-sectional descriptive prescription audit (n=500) was carried. Postmenopausal women were interviewed in their local language using pre-tested pre validated questionnaire after verbal informed consent at a teaching tertiary care hospital of north India. Oral antihyperglycaemic drugs (OHDs) drugs were categorized as per the pharmacological classification. Adherence to available clinical practice guidelines/recommendations issued under American Diabetes Association (ADA) 2015 Guidelines as well as rationality of these prescriptions were assessed using WHO Guide to Good Prescribing. Results Mean age of the study population was 58.14±12.86. Mean duration since menopause was 5.3 years and of T2DM was 9.5 years. A 93.4% of the prescriptions had only OHDs whereas 6.6% of the prescriptions had various insulin preprations + OHDs (p<0.0001). Biguanides followed by sulfonylureas, thiazolidinediones, DPP-inhibitors and alpha-glucosidases inhibitor were prescribed in 85.6%, 59.8%, 26.6%, 26% and 12.2% respectively as monotherapy or in combination. Among biguanides, metformin was the most frequently prescribed OHDs. In spite of black box warning on pioglitazone, it was prescribed in 26.6% as FDC. However, clear increase use of vidagliptine was noticed upto 26%. Among combinations most frequent was metformin plus glimipride followed by voglibose plus metformin, whereas, among FDC, metformin plus glimipride followed by metformin plus vidagliptine were most frequently prescribed. Conclusion Metformin was the most common OHDs to be prescribed

  8. Electronic Prescribing

    MedlinePlus

    ... 1-877-486-2048 . I went to the pharmacy, and my prescription was ready. Electronic eRx Prescribing ... write and send your prescriptions directly to your pharmacy. This means no more prescriptions on paper and ...

  9. Prescribing patterns of non-steroidal anti-inflammatory drugs in chronic kidney disease patients in the South African private sector.

    PubMed

    Meuwesen, Willem P; du Plessis, Jesslee M; Burger, Johanita R; Lubbe, Martie S; Cockeran, Marike

    2016-08-01

    Background Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are considered nephrotoxic and should therefore be used with caution or be avoided completely in high risk patients, such as chronic kidney disease (CKD) patients. Objective This study aimed to investigate the prescribing of NSAIDs in CKD patients in order to generate awareness and improve the outcome of these patients. Setting The study was conducted using medicine claims data in the private health sector of South Africa. Method A descriptive, quantitative study was performed, using retrospective data obtained from a Pharmaceutical Benefit Management company. Data from 1 January 2009 to 31 December 2013 were analysed. The study population consisted of all patients with an ICD-10 code for a CKD (N18), in association with a paid claim for an NSAID. Main outcome measure The stratification of NSAID prescribing volume among the CKD population in terms of gender, age, NSAID type, dosage and prescriber type. Results The prescribing of NSAIDs in CKD patients varied between 26 and 40 % over the 5 year study period. No association between gender and CKD patients who received NSAIDs versus those who did not was found, with p > 0.05 and Cramer's V < 0.1 for each year of the study. The association between age groups and CKD patients who received NSAIDs versus those who did not was statistically significant, but practically weak (p < 0.05; Cramer's V ≥ 0.1). Most NSAID prescriptions (52-63 %) were for patients aged 35-64 years. Diclofenac (34.25 %) was the single most frequently prescribed NSAID, but the COX-2-inhibitors (celecoxib, meloxicam and etoricoxib) were the preferred NSAID class to be prescribed. The majority (61.6 %) of the NSAIDs were prescribed by general medical practitioners in dosages meeting and even exceeding the recommended daily dosage of patients with normal kidney function. Conclusions Even though NSAIDs are

  10. Prescribing and borderline personality disorder

    PubMed Central

    Chanen, Andrew M; Thompson, Katherine N

    2016-01-01

    Summary Accurate diagnosis is fundamental to effective management of borderline personality disorder, but many patients remain undetected. The first-line management for borderline personality disorder is psychosocial treatment, not drugs. There are major prescribing hazards including polypharmacy, overdose and misuse. Drug treatment might be warranted for patients who have a co-occurring mental disorder such as major depression. If a drug is prescribed for borderline personality disorder, it should only be as an adjunct to psychosocial treatment. There should be clear and collaborative goals that are regularly reviewed with the patient. Use single drugs prescribed in limited quantities for a limited time. Stop drugs that are ineffective. PMID:27340322

  11. Prescribing procrastination

    PubMed Central

    Thomson, George H.

    1979-01-01

    In his everyday work the family physician sees many patients whose problems have been diagnosed but for whom postponement of an active treatment plan is indicated. The physician must therefore prescribe procrastination in a carefully planned way. I describe some ideas and practical methods for doing this. PMID:529244

  12. Off-label or out of bounds? Prescriber and marketer liability for unapproved uses of FDA-approved drugs.

    PubMed

    O'Reilly, James; Dalal, Amy

    2003-01-01

    Professor O'Reilly's study of recent drug review legislation applies a historical and holistic view of promotion practices for unapproved uses of prescription drugs. He faults Congress for moving public health protections away from a strictly protective mode and toward assistance to drug marketers. He argues that the adverse health consequences of "off-label" promotion of drugs are not well understood, and that the 1997 amendments deserved the public health interest while expanding pharmaceutical company profits. PMID:12856461

  13. Development and model testing of anti-mortem screening methodology to predict prescribed drug withholds in heifers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Introduction: A simple, cow-side test for the presence of drug residues in live animal fluids would provide useful information for tissue drug residue avoidance programs. Live animal tests have the potential to allow verification that an individual animal is free of drug residues before sale for h...

  14. Results of anti-mortem screening methodology to predict prescribed drug withholding periods for flunixin and ceftiofur in heifers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Introduction: A simple, cow-side test for the presence of drug residues in live animals would be useful for drug residue avoidance programs. Simple inhibition tests used at slaughter do not detect some drug tolerance concentrations such as those for flunixin and ceftiofur-metabolites. This experim...

  15. Development and model testing of anti-mortem screening methodology to predict prescribed drug withholds in heifers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A simple, cow-side test for the presence of drug residues in live animal fluids would provide useful information for tissue drug residue avoidance programs. This work describes adaptation and evaluation of rapid screening tests to detect drug residues in serum and urine. Medicated herd animals had...

  16. Patients Aged 80 Years or Older are Encountered More Potentially Inappropriate Medication Use

    PubMed Central

    Mo, Li; Ding, Ding; Pu, Shi-Yun; Liu, Qin-Hui; Li, Hong; Dong, Bi-Rong; Yang, Xiao-Yan; He, Jin-Han

    2016-01-01

    Background: Polypharmacy and potentially inappropriate medications (PIMs) are prominent prescribing issues in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65–79 years of age and 80 years or older, who were discharged from Geriatric Department in West China Hospital. Methods: A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively, 618 patients were 65–79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the American Geriatric Society was applied to assess the use of PIM among the investigated samples. Results: A review of the prescribed medications identified 686 patients aged 80 years or older consumed at least one PIM giving a rate of 58.2%. Conversely, 268 (43.4%) patients aged 65–79 years consumed at least one PIM (χ2 = 40.18, P < 0.001). Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65–79 years (all with P < 0.001). Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. Conclusions: The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65–79 years. Anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older. PMID:26712428

  17. Alteplase Treatment in Acute Stroke: Incorporating Food and Drug Administration Prescribing Information into Existing Acute Stroke Management Guide.

    PubMed

    Demaerschalk, Bart M

    2016-08-01

    Despite strong evidence that intravenous tissue plasminogen activator (tPA) improves outcomes in acute ischemic stroke patients, its use in clinical practice remains modest. Complex eligibility criteria have been postulated as barriers to greater utilization. Further complicating this has been multiple guidelines and prescribing labels that have been published since first being approved for use in 1996. In this review, several warning and exclusion criteria for tPA in acute ischemic stroke are reviewed with the goal of providing readers a nuanced understanding of historical context and available evidence to make informed decision. PMID:27363696

  18. AB013. Inappropriate asthma therapy: a tale of two countries

    PubMed Central

    Nibber, Anjan; Belhassen, Manon; Van Ganse, Eric; Ryan, Dermot; Langlois, Carole; Appiagyei, Francis; Skinner, Derek; Laforest, Laurent; Soriano, Joan B.; Price, David

    2016-01-01

    Background Inappropriate prescribing and misuse of asthma medication, have been identified as potentially preventable factors linked to asthma exacerbations and deaths. A recent report by the National Review of Asthma Deaths drew attention to the excessive prescribing of reliever medication, and under-prescribing of controlled medication in the United-Kingdom (UK). The inappropriate prescribing of long-acting beta agonist (LABA) bronchodilator inhalers, as either a monotherapy or without inhaled corticosteroids (ICS) has been highlighted as a major preventable factor of asthma exacerbations and deaths. To determine whether the prevalence of inappropriate LABA therapy use in asthma in the UK and in France has changed over time. Methods Two interval, parallel, population-based cohorts (2007 and 2013), were developed in each country, utilising the UK Optimum Patient Care Research Database and the French Permanent Beneficiaries Sample database. Following inclusion, patients aged 6–40 years were studied over a 12-month period. The use of LABAs without ICS, and ≥2-fold higher use of LABA compared with ICS were investigated. Analyses were stratified by age groups: children (6–13 years) and adults (14–40 years). Results Overall, 39,743 UK and 4,910 French patients were included in 2007 and 14,036 and 5,657 in 2013. In 2013, LABA use without ICS occurred in 0.1% and 1.5% of UK and French adults respectively. This was a marked reduction from 2007 UK and French figures of 0.4% and 2.6% respectively (P<0.05 for both). Excessive use of LABA relative to ICS occurred in 0.2% of UK adults and in 0.7% of French adults in 2013. These percentages represented a decrease from the 2007 figures of 0.6% and 1.4% for UK (P=0.29) and France (P=0.003), respectively. In 2007, LABA inappropriate use was more frequent in French than UK asthmatic children (P<0.0001), but showed a downward trend by time in both countries (0.1% in 2013 in both countries). Conclusions Our study suggests

  19. Nudging Guideline-Concordant Antibiotic Prescribing

    PubMed Central

    Meeker, Daniella; Knight, Tara K.; Friedberg, Mark W.; Linder, Jeffrey A.; Goldstein, Noah J.; Fox, Craig R.; Rothfeld, Alan; Diaz, Guillermo; Doctor, Jason N.

    2015-01-01

    IMPORTANCE “Nudges” that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. OBJECTIVE To investigate the use of a behavioral “nudge” based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). INTERVENTIONS The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. MAIN OUTCOMES AND MEASURES Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. RESULTS Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. CONCLUSIONS AND RELEVANCE Displaying poster-sized commitment letters in examination rooms decreased inappropriate

  20. Prescribers' expectations and barriers to electronic prescribing of controlled substances

    PubMed Central

    Kim, Meelee; McDonald, Ann; Kreiner, Peter; Kelleher, Stephen J; Blackman, Michael B; Kaufman, Peter N; Carrow, Grant M

    2011-01-01

    Objective To better understand barriers associated with the adoption and use of electronic prescribing of controlled substances (EPCS), a practice recently established by US Drug Enforcement Administration regulation. Materials and methods Prescribers of controlled substances affiliated with a regional health system were surveyed regarding current electronic prescribing (e-prescribing) activities, current prescribing of controlled substances, and expectations and barriers to the adoption of EPCS. Results 246 prescribers (response rate of 64%) represented a range of medical specialties, with 43.1% of these prescribers current users of e-prescribing for non-controlled substances. Reported issues with controlled substances included errors, pharmacy call-backs, and diversion; most prescribers expected EPCS to address many of these problems, specifically reduce medical errors, improve work flow and efficiency of practice, help identify prescription diversion or misuse, and improve patient treatment management. Prescribers expected, however, that it would be disruptive to practice, and over one-third of respondents reported that carrying a security authentication token at all times would be so burdensome as to discourage adoption. Discussion Although adoption of e-prescribing has been shown to dramatically reduce medication errors, challenges to efficient processes and errors still persist from the perspective of the prescriber, that may interfere with the adoption of EPCS. Most prescribers regarded EPCS security measures as a small or moderate inconvenience (other than carrying a security token), with advantages outweighing the burden. Conclusion Prescribers are optimistic about the potential for EPCS to improve practice, but view certain security measures as a burden and potential barrier. PMID:21946239

  1. Syndrome of inappropriate antidiuresis in doxylamine overdose.

    PubMed

    Carrascosa, Miguel F; Caviedes, José-Ramón Salcines; Lucena, M Isabel; Cuadrado-Lavín, Antonio

    2012-01-01

    Doxylamine succinate, an H(1)-antihistamine drug, is commonly used as sleep-inducing agent as well as therapy for nausea and vomiting in pregnancy. At usual doses, it may cause impairment of cognitive and psychomotor performance, anticholinergic effects, agitation and postural hypotension. Besides, since this drug is frequently involved in either accidental or intentional overdoses, it seems relevant to bear in mind other possible toxic effects. We report a case of acute severe hyponatremia in the setting of a syndrome of inappropriate antidiuresis (SIAD), an apparent new adverse effect linked to doxylamine overdose. The Naranjo adverse drug reaction probability scale indicated a probable relationship between doxylamine intake and SIAD development. SIAD may be considered as a potential, serious adverse reaction of doxylamine overdose. Clinicians should consider this aetiological possibility when attending patients suffering from hyponatremia. PMID:23166178

  2. Rationalising prescribing: Evidence, marketing and practice-relevant knowledge.

    PubMed

    Wadmann, Sarah; Bang, Lia E

    2015-06-01

    Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interact with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs. PMID:25965891

  3. The economics of direct-to-consumer advertising of prescription-only drugs: prescribed to improve consumer welfare?

    PubMed

    Morgan, Steven; Mintzes, Barbara; Barer, Morris

    2003-10-01

    According to economic theory, one might expect that the informational content of direct-to-consumer advertising of prescription-only drugs would improve consumers' welfare. However, contrasting the models of consumer and market behaviour underlying this theory with the realities of the prescription-only drug market reveals that this market is distinct in ways that render it unlikely that advertising will serve an unbiased and strictly informative function. A review of qualitative evidence regarding the informational content of drug advertising supports this conclusion. Direct-to-consumer prescription drug advertising concentrates on particular products, and features of those products, to the exclusion of others, and the information provided has frequently been found to be biased or misleading in regulatory and academic evaluations. Governments that have so far resisted direct-to-consumer advertising should invest in independent sources of evidence that could help consumers and professionals to better understand the risks and benefits of treating disease with alternative drug and non-drug therapies, rather than permitting direct-to-consumer prescription drug advertising. PMID:14596759

  4. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    PubMed

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898

  5. [Specificities of prescribing medicines for children].

    PubMed

    Mercier, Jean-Christophe; Droz, Nina; Bourgade, Clara; Vizeneux, Audrey; Cotillon, Marie; de Groc, Thibault

    2016-01-01

    The vast majority of medicines have been developed for adults. Consequently, the prescribing of medicines for children must take into account their pharmacodynamic characteristics and must be calculated individually according to the degree of prematurity, the age, the weight or body area and the clinical condition. Medication errors are the most common type of medical errors, notably in children, due to dosage errors or prescribtion of inappropriate medicines. The best way to avoid them lies in the use of prescribing software, the involvement of pharmacists in care units, and proper communication between prescribing doctors, caregivers, pharmacists and families. PMID:27177480

  6. The Rasch Model for Achievement Tests--Inappropriate in the Past, Inappropriate Today, Inappropriate Tomorrow.

    ERIC Educational Resources Information Center

    McLean, Leslie D.; Ragsdale, Ronald G.

    1983-01-01

    Robitaille and O'Shea used the Rasch model in developing a set of 40-item mathematics achievement tests. The Rasch model is inappropriate for such a purpose; their article presents the model in a too favorable light and continued application of the model encourages less desirable educational practice and misdirects scarce resources. (BRR)

  7. Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity

    PubMed Central

    Kersten, Hege; Hvidsten, Lara T; Gløersen, Gløer; Wyller, Torgeir Bruun; Wang-Hansen, Marte Sofie

    2015-01-01

    Objective: To identify potentially inappropriate medications (PIMs), to compare drug changes between geriatric and other medical wards, and to investigate the clinical impact of PIMs in acutely hospitalized older adults. Setting and subjects: Retrospective study of 232 home-dwelling, multimorbid older adults (aged ≥75 years) acutely admitted to Vestfold Hospital Trust, Norway. Main outcome measures. PIMs were identified by Norwegian general practice (NORGEP) criteria and Beers’ 2012 criteria. Clinical correlates were laboratory measures, functional and mental status, physical frailty, and length of stay. Results: Mean (SD) age was 86 (5.7) years, and length of stay was 6.5 (4.8) days. During the stay, the mean number of drugs used regularly changed from 7.8 (3.6) to 7.9 (3.6) (p = 0.22), and drugs used pro re nata (prn) changed from 1.4 (1.6) to 2.0 (1.7) (p < 0.001). The prevalence of any PIM changed from 39.2% to 37.9% (p = 0.076), while anticholinergics and benzodiazepines were reduced significantly (p ≤ 0.02). The geriatric ward reduced drug dosages (p < 0.001) and discontinued PIMs (p < 0.001) significantly more often than other medical wards. No relations between number of PIMS and clinical outcomes were identified, but the concomitant use of ≥3 psychotropic/opioid drugs was associated with reduced hand-grip strength (p ≤ 0.012). Conclusion: Hospitalization did not change polypharmacy or PIMs. Drug treatment was more appropriate on the geriatric than other medical wards. No clinical impact of PIMs was observed, but prescribers should be vigilant about concomitant prescription of ≥3 psychotropics/opioids.KEY POINTSAcute hospitalization of older patients with multimorbidity did not increase polypharmacy or potentially inappropriate medications.Prescription of anticholinergics and benzodiazepines was significantly reduced.The geriatric ward reduced drug dosages and discontinued potentially inappropriate medications more

  8. Bioavailability and generic prescribing.

    PubMed

    Mindel, J S

    1976-01-01

    Although oral drug bioinequivalence has been attributed to a number of causes (excipients, dosage form, variation in dissolution time, and aging) less is known about bioavailability problems of topical medications in ophthalmology. Factors that can alter drug absorption from solutions (pH, partition coefficient, container impurities, contact time, etc.) are noted, and cases in which bioavailability problems should be considered as causes of therapeutic failure are discussed. Various attitudes representing pharmaceutical companies, the federal government, pharmacists, consumers and physicians toward the related problems of bioinequivalence and generic prescribing are examined. Techniques for in vivo and in vitro drug testing and for establishing uniform conditions of drug manufacture and storage can contribute to identification and minimization of bioavailability problems. A rational program based on a combination of such techniques could, ultimately, lead to establishment of the terms "generic equivalency" and "therapeutic equivalency" as synonymous. PMID:13505

  9. Prescribing patterns for Alzheimer disease

    PubMed Central

    Hillmer, Melinda; Krahn, Murray; Hillmer, Michael; Pariser, Pauline; Naglie, Gary

    2006-01-01

    OBJECTIVE To describe Canadian family physicians’ prescribing practices with regard to Alzheimer disease (AD). DESIGN Cross-sectional survey administered by facsimile. SETTING Four regions in Canada (British Columbia, the Prairie Provinces, Ontario, and the Atlantic Provinces). PARTICIPANTS A stratified random sample of 1000 Canadian family physicians (250 per region) chosen from the Canadian Medical Directory; 81 of whom were excluded as ineligible. MAIN OUTCOME MEASURES Prescribing practices regarding cholinesterase inhibitors (ChIs) for patients with AD. RESULTS Response rate was 36.3%. About 27% of respondents reported that ChIs were prescribed for less than 10% of their AD patients, while 12.5% reported that ChIs were prescribed for more than 90% of their AD patients. More physicians prescribed ChIs in the two regions with provincial formulary coverage (Prairie Provinces and Ontario) than in the two regions without coverage (British Columbia and Atlantic Provinces). Factors that significantly predicted lower prescribing rates included female sex, perception of ChIs’ effectiveness, and self-reported knowledge of ChIs. CONCLUSION Canadian physicians’ prescribing patterns for ChIs vary; the optimal prescribing rate is unclear. Provincial coverage of these drugs along with physicians’ sex, knowledge of ChIs, and perception of the effectiveness of ChIs appear to influence prescribing rates. PMID:16926965

  10. Toxic risks of inappropriate therapy.

    PubMed

    Stewart, M J

    1990-02-01

    Drug therapy may produce toxicity. Patient individuality or drug interactions account for many cases of poisoning, but other factors such as genetic predisposition, drug contamination or human error are also known causes. Examples of various types of drug poisoning are given, illustrating the role of the clinical chemist in minimizing or studying drug toxicity. PMID:2184960

  11. Conventional management of inappropriate sinus tachycardia.

    PubMed

    Olshansky, Brian; Sullivan, Renee M

    2016-06-01

    Inappropriate sinus tachycardia is a challenging problem to manage. There are limited data on the best method to evaluate and treat the problem. Here, we consider a conventional approach to inappropriate sinus tachycardia. PMID:26164138

  12. Prosecution of physicians for prescribing opioids to patients.

    PubMed

    Reidenberg, M M; Willis, O

    2007-06-01

    Many patients in pain receive inadequate doses of opioids. Fear of government action against prescribing doctors is one cause of this inadequate treatment. The purpose of the study was to assess criminal prosecutions by reviewing press reports of indictments or trials of doctors for opioid offenses during 2 years. Forty-seven cases were reported involving 53 doctors. Fifteen cases were for offenses unrelated to medical practice. In 32 cases, the charge was based on determining the prescriptions for opioids were outside the bounds of proper medical practice. Only two of these cases were evaluated by a state medical board before indictment. Five doctors were indicted for murder related to drug overdose deaths. None were found guilty of murder. Prosecutorial excesses and hyperbole were common. The state medical board's review of appropriateness of prescribing opioids when a doctor-patient relationship is presumed to exist could decrease inappropriate criminal indictments and reduce this component of fear of prescribing adequate opioid therapy for patients in pain. PMID:17329989

  13. Prescribing for patients on dialysis

    PubMed Central

    Smyth, Brendan; Jones, Ceridwen; Saunders, John

    2016-01-01

    SUMMARY The pharmacokinetics of a drug may be altered in patients with renal impairment who require dialysis. Some drugs are contraindicated. The drug’s clearance and therapeutic index determine if a dose adjustment is needed. A lower dose or less frequent dosing may be required. Consult a reference source or the patient’s nephrologist before prescribing. Start at a low dose and increase gradually. If possible give once-daily drugs after dialysis. PMID:27041803

  14. An Observational Study to Evaluate the Prevalence of Erectile Dysfunction (ED) and Prescribing Pattern of Drugs in Patients with ED Visiting an Andrology Specialty Clinic, Mumbai: 2012-14

    PubMed Central

    Kulkarni, Vijay R.; Bhagat, Sagar B.; Beldar, Amit S.; Patel, Sadiq B.

    2015-01-01

    Introduction: Erectile dysfunction (ED) is a common occurrence and its incidence is expected to increase significantly along with the increase in various lifestyle diseases. The drug utilization for ED is very low. Also, studies describing the prescription pattern in ED are lacking. Materials and Methods: We conducted a retrospective cross-sectional observational study, including a drug utilization analysis, of 606 prescriptions as per the standard guidelines (WHO and STROBE). Results: Out of 606, 249 (41%) were from the age group of 30-39 years. Addictions were present in 388 (64%). Out of 606, 186 had urological, 154 had cardiovascular and 102 had psychological co-morbid disorders. Out of 348, 201 were prescribed Tadalafil (low dose) on a once daily basis. Out of 172, 121 were prescribed Sildenafil (high dose) on an ‘as and when required’ basis. Nutritional/ herbal supplements were prescribed in 126/606. The ratio of ‘Prescribed Daily Dose’ to ‘Defined Daily Dose’ of Tadalafil, Sildenafil, and Dapoxetine were 1.1, 1.3 and 1.5 respectively. Conclusion: Measures for de-addiction play an important role in the overall management of ED. The most common co-morbid disorders were urological, like BPH, LUTS, etc, followed by cardiovascular, psychological and diabetes. Overall, rational pharmacotherapy was observed. Tadalafil was the most commonly prescribed drug for ED. The main factor in the selection of a particular PDE5 inhibitor was its pharmacokinetics and cost. Udenafil, being the costliest, was the least prescribed. Dapoxetine was used in a significant number of individuals primarily for PE with ED. The combination of Papaverine, Chlorpromazine ± Alprostadil was used as intracavernosal injection in patients not responding to oral drugs. PMID:26393163

  15. Improving antibiotic prescribing for children in the resource-poor setting

    PubMed Central

    Le Doare, Kirsty; Barker, Charlotte I S; Irwin, Adam; Sharland, Mike

    2015-01-01

    Antibiotics are a critically important part of paediatric medical care in low- and middle-income countries (LMICs), where infectious diseases are the leading cause of child mortality. The World Health Organization estimates that >50% of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients do not take their medicines correctly. Given the rising prevalence of antimicrobial resistance globally, inappropriate antibiotic use is of international concern, and countries struggle to implement basic policies promoting rational antibiotic use. Many barriers to rational paediatric prescribing in LMICs persist. The World Health Organization initiatives, such as ‘Make medicines child size’, the Model List of Essential Medicines for Children and the Model Formulary for Children, have been significant steps forward. Continued strategies to improve access to appropriate drugs and formulations, in conjunction with improved evidence-based clinical guidelines and dosing recommendations, are essential to the success of such initiatives on both a national and an international level. This paper provides an overview of these issues and considers future developments that may improve LMIC antibiotic prescribing. PMID:24433393

  16. Predicting risk of adverse drug reactions in older adults.

    PubMed

    Lavan, Amanda Hanora; Gallagher, Paul

    2016-02-01

    Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard. PMID:26834959

  17. Predicting risk of adverse drug reactions in older adults

    PubMed Central

    Lavan, Amanda Hanora; Gallagher, Paul

    2016-01-01

    Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal and intracranial bleeding being amongst the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing burden of comorbidity, polypharmacy, inappropriate prescribing and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular review of prescribed and over-the-counter medications through standardized medication reconciliation. New medications should be prescribed cautiously with clear therapeutic goals and recognition of the impact a drug can have on multiple organ systems. Prescribers should regularly review medication efficacy and be vigilant for ADRs and their contributory risk factors. Deprescribing should occur at an individual level when drugs are no longer efficacious or beneficial or when safer alternatives exist. Inappropriate prescribing and unnecessary polypharmacy should be minimized. Comprehensive geriatric assessment and the use of explicit prescribing criteria can be useful in this regard. PMID:26834959

  18. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review.

    PubMed

    Reckmann, Margaret H; Westbrook, Johanna I; Koh, Yvonne; Lo, Connie; Day, Richard O

    2009-01-01

    Previous reviews have examined evidence of the impact of CPOE on medication errors, but have used highly variable definitions of "error". We attempted to answer a very focused question, namely, what evidence exists that CPOE systems reduce prescribing errors among hospital inpatients? We identified 13 papers (reporting 12 studies) published between 1998 and 2007. Nine demonstrated a significant reduction in prescribing error rates for all or some drug types. Few studies examined changes in error severity, but minor errors were most often reported as decreasing. Several studies reported increases in the rate of duplicate orders and failures to discontinue drugs, often attributed to inappropriate selection from a dropdown menu or to an inability to view all active medication orders concurrently. The evidence-base reporting the effectiveness of CPOE to reduce prescribing errors is not compelling and is limited by modest study sample sizes and designs. Future studies should include larger samples including multiple sites, controlled study designs, and standardized error and severity reporting. The role of decision support in minimizing severe prescribing error rates also requires investigation. PMID:19567798

  19. Prescription of potentially inappropriate medication in older persons in Switzerland: does the dispensing channel make a difference?

    PubMed Central

    Blozik, Eva; Rapold, Roland; Reich, Oliver

    2015-01-01

    Background Drugs can be supplied either directly from the prescribing physician (physician dispensing [PD]) or via a pharmacy. It is unclear whether the dispensing channel is associated with quality problems. Potentially inappropriate medication (PIM) is associated with adverse outcomes in older persons and can be considered a marker for quality deficits in prescribing. We investigated whether prevalence of PIM differs across dispensing channels. Patients and methods We analyzed basic health insurance claims of 50,747 person quarter years with PIM use of residents of the Swiss cantons Aargau and Lucerne of the years 2012 and 2013. PIM was identified using the Beers 2012 criteria and the PRISCUS list. We calculated PIM prevalence stratified by supply channel. Adjusted mixed effects logistic regression analysis was done to estimate the effect of obtaining medications through the dispensing physician as compared to the pharmacy channel on receipt of PIM. The most frequent PIMs were identified. Results There is a small but detectable difference in total PIM prevalence: 30.7% of the population supplied by a dispensing physician as opposed to 29.3% individuals who received medication in a pharmacy. According to adjusted logistic regression individuals who obtained the majority of their medications from their prescribing physician had a 15% higher chance to receive a PIM (odds ratio 1.15, 95% confidence interval 1.08–1.22; P<0.001). Conclusion Physician dispensing seems to affect quality and safety of drug prescriptions. Quality issues should not be neglected in the political discussion about the regulations on PD. Future studies should explore whether PD is related to other indicators of inefficiency or quality flaws. The present study also underlines the need for interventions to reduce the high rates of PIM prescribing in Switzerland. PMID:25977609

  20. Safe prescribing: a titanic challenge

    PubMed Central

    Routledge, Philip A

    2012-01-01

    The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

  1. Attitudes and Behaviours to Antimicrobial Prescribing following Introduction of a Smartphone App

    PubMed Central

    Panesar, Preet; Jones, Alisdair; Aldous, Alicia; Kranzer, Katharina; Halpin, Eamus; Fifer, Helen; Macrae, Bruce; Curtis, Carmel

    2016-01-01

    Objectives Our hospital replaced the format for delivering portable antimicrobial prescribing guidance from a paper-based pocket guide to a smartphone application (app). We used this opportunity to assess the relationship between its use and the attitudes and behaviours of antimicrobial prescribers. Methods We used 2 structured cross-sectional questionnaires issued just prior to and 3 months following the launch of the smartphone app. Ordinal Likert scale responses to both frequencies of use and agreement statements permitted quantitative assessment of the relationship between variables. Results The smartphone app was used more frequently than the pocket guide it replaced (p < 0.01), and its increased use was associated with sentiments that the app was useful, easy to navigate and its content relevant. Users who used the app more frequently were more likely to agree that the app encouraged them to challenge inappropriate prescribing by their colleagues (p = 0.001) and were more aware of the importance of antimicrobial stewardship (p = 0.005). Reduced use of the app was associated with agreement that senior physicians’ preferences for antimicrobial prescribing would irrespectively overrule guideline recommendations (p = 0.0002). Conclusions Smartphone apps are an effective and acceptable format to deliver guidance on antimicrobial prescribing. Our findings suggest that they may empower users to challenge incorrect prescribing, breaking well-established behaviours, and thus supporting vital stewardship efforts in an era of increased antimicrobial resistance. Future work will need to focus on the direct impact on drug prescriptions as well as identifying barriers to implementing smartphone apps in other clinical settings. PMID:27111775

  2. Prescribing for unlabeled conditions: patient benefit or therapeutic roulette?

    PubMed

    Serradell, J; Rucker, T D

    1990-01-01

    There is ample evidence that prescribed medications are employed for uses far broader than the approved label indications in the U.S. An enormous research agenda thus exists that should be addressed in the not-too-distant future. In fact, it seems essential that operation of the Medicare Catastrophic Drug Benefit program be designed with the best available knowledge in this area. Perhaps it might be appropriate for several universities, the U.S. Pharmacopeial Convention, and/or the FDA to establish a center to study this question. This model has been applied with clinical/surgical registries, with adverse reaction reporting, and with device failures. We need a rational, science-compatible, and uniform policy free of political and emotional arguments to address the issue of handling, monitoring, and regulating the use of drugs for unlabeled conditions. Comprehensive data should be provided for policy makers, regulators, payers, and clinicians in their evaluating the use of different drug products. Even a brief glance at any page from the National Disease and Therapeutic Index shows intended use that would cause most experts to react in disbelief. Further, there seem to be relatively few instances in which the use of a given pharmaceutical for an unlabeled indication would qualify as a drug of choice in the first place. The therapeutic and economic consequences of the use of legend drugs for unlabeled indications are difficult to document. We do know that a significant proportion of hospital admissions and days can be traced to the inappropriate use of pharmaceutical products but the net impact of our subject on institution cost has not been established.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10106657

  3. Promoting rational prescribing: an international perspective.

    PubMed Central

    Hogerzeil, H V

    1995-01-01

    Irrational prescribing is a global problem. Rational prescribing cannot be defined without a method of measurement and a reference standard. The former is now available but the latter needs further development. Proven effective interventions to promote rational prescribing in developed countries are treatment protocols based on wide consultation and consensus, properly introduced and with a possibility of feedback; face-to-face education focussed on a particular prescribing problem in selected individuals; structured order forms; and focussed educational campaigns. Essential drugs lists are probably effective when based on consensus and used within a comprehensive educational programme. Printed materials alone are not effective. In most cases the usefulness of such strategies in developing countries has not been proven and should be studied. Medical education in clinical pharmacology and pharmacotherapy should be based on the practical needs of future prescribes, should include the principles of rational therapeutics and problem solving, and should immunize the students against the influences they are likely to encounter in their professional life, such as patient pressure, drug promotion and irrational prescribing by peers. Within the scope of a national formulary, specialist departments in teaching hospitals should define prescribing policies as the basis for prescribing, teaching, examinations and medical audit. PMID:7756093

  4. Safe disposal of prescribed medicines.

    PubMed

    Bergen, Phillip J; Hussainy, Safeera Y; George, Johnson; Kong, David Cm; Kirkpatrick, Carl Mj

    2015-06-01

    The National Return and Disposal of Unwanted Medicines Program provides a free and safe method for the disposal of unwanted and expired medicines. This stops drugs being dumped in landfill and waterways. An audit showed that over 600 tonnes of medicines are returned through the program. A substantial proportion of these medicines were still within their expiry dates. Salbutamol, insulin and frusemide are the most commonly discarded medicines. More than $2 million of public money is wasted each year. Hoarding and non-adherence to treatment contribute to waste. Health professionals may be able to help minimise waste by informing patients about the importance of completing prescribed courses of treatment, and discouraging them from hoarding medicines after reaching the safety net threshold on the Pharmaceutical Benefits Scheme. Prescribe no more than the required quantity of medicines. When starting a new therapy, prescribe a minimal quantity in case the drug is unsuitable for the patient. Advise patients to return all unwanted medicines to a pharmacy for disposal. PMID:26648628

  5. Safe disposal of prescribed medicines

    PubMed Central

    Bergen, Phillip J; Hussainy, Safeera Y; George, Johnson; Kong, David CM; Kirkpatrick, Carl MJ

    2015-01-01

    SUMMARY The National Return and Disposal of Unwanted Medicines Program provides a free and safe method for the disposal of unwanted and expired medicines. This stops drugs being dumped in landfill and waterways. An audit showed that over 600 tonnes of medicines are returned through the program. A substantial proportion of these medicines were still within their expiry dates. Salbutamol, insulin and frusemide are the most commonly discarded medicines. More than $2 million of public money is wasted each year. Hoarding and non-adherence to treatment contribute to waste. Health professionals may be able to help minimise waste by informing patients about the importance of completing prescribed courses of treatment, and discouraging them from hoarding medicines after reaching the safety net threshold on the Pharmaceutical Benefits Scheme. Prescribe no more than the required quantity of medicines. When starting a new therapy, prescribe a minimal quantity in case the drug is unsuitable for the patient. Advise patients to return all unwanted medicines to a pharmacy for disposal. PMID:26648628

  6. Prescribing for periodontal disease.

    PubMed

    Blair, Fiona M; Chapple, Iain L C

    2014-11-01

    With concerns about the ever-increasing development of antimicrobial resistance, it is imperative that antimicrobials are prescribed responsibly and used appropriately. This article provides an overview and simple guidelines for antimicrobial prescribing in the management of periodontal diseases. PMID:25668374

  7. Quetiapine-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone

    PubMed Central

    2016-01-01

    The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can be induced by various conditions, including malignant neoplasms, infections, central nervous system disorders, and numerous drugs. We here report a case of a 65-year-old female patient, treated with quetiapine for schizophrenia, who presented with generalized tonic-clonic seizures and was finally diagnosed with quetiapine-induced SIADH. Quetiapine-associated hyponatremia is extremely uncommon and only a few, relevant reports can be found in the literature. This case underlines the fact that patients on antipsychotic medication and more specifically on quetiapine should be closely monitored and routinely tested for electrolyte disorders. PMID:27034875

  8. Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis

    PubMed Central

    van der Werf, Marieke J.; Langendam, Miranda W.; Huitric, Emma; Manissero, Davide

    2012-01-01

    We conducted a systematic review and meta-analysis to assess the evidence for the postulation that inappropriate tuberculosis (TB) regimens are a risk for development of multidrug-resistant (MDR)-TB. MEDLINE, EMBASE and other databases were searched for relevant articles in January 2011. Cohort studies including TB patients who received treatment were selected and data on treatment regimen, drug susceptibility testing results and genotyping results before treatment and at failure or relapse were abstracted from the articles. Four studies were included in the systematic review and two were included in the meta-analysis. In these two studies the risk of developing MDR-TB in patients who failed treatment and used an inappropriate treatment regimen was increased 27-fold (RR 26.7, 95% CI 5.0–141.7) when compared with individuals who received an appropriate treatment regimen. This review provides evidence that supports the general opinion that the development of MDR-TB can be caused by inadequate treatment, given the drug susceptibility pattern of the Mycobacterium tuberculosis bacilli. It should be noted that only two studies provided data for the meta-analysis. The information can be used to advocate for adequate treatment for patients based on drug resistance profiles. PMID:22005918

  9. The moral choice in prescribing barbiturates.

    PubMed Central

    Wells, F.

    1976-01-01

    Dr Wells, a general practitioner, looks at the problem of barbiturate dependence from the point of view of the prescribing doctor who has to choose for his patients - of all ages - the drug, usually a hypnotic, which is sought for insomnia or states of anxiety and stress. He argues that it is wise to prescribe non-barbiturates, but that even in elderly people it is possible and the right course of action is to wean these patients from their dependence on sleep-inducing drugs. Young people often acquire the drug habit by taking hypnotics from a bedside table or a bathroom cabinet in their own homes. PMID:940140

  10. Blueprint for prescriber continuing education program.

    PubMed

    2012-06-01

    On October 25, 2011, the Center for Drug Evaluation and Research (CDER) of the Food and Drug Administration (FDA) posted online this Blueprint for Prescriber Continuing Education, labeled "final," relating to extended-release and long-acting opioids. The pending FDA Risk Evaluation Management Strategy (REMS) requires prescriber education. This document provides guidance to sponsors of these dosage forms in developing the prescvriber education component of their REMS. This report was posted online by the federal agency on October 25, 2011 at: http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm277916.pdf. It is in the public domain. PMID:22764849

  11. Teachers' Beliefs about Inappropriate Behaviour: Challenging Attitudes?

    ERIC Educational Resources Information Center

    Grieve, Ann M.

    2009-01-01

    This paper focuses on taking a first step in the process of influencing teachers' attitudes by building a description of beliefs about inappropriate behaviour that can be used in staff development work to provoke dissonance-led change. It describes a study, undertaken in two parts, exploring teachers' attitudes to inclusion, and ascertaining their…

  12. Functional analysis of inappropriate mealtime behaviors.

    PubMed Central

    Piazza, Cathleen C; Fisher, Wayne W; Brown, Kimberly A; Shore, Bridget A; Patel, Meeta R; Katz, Richard M; Sevin, Bart M; Gulotta, Charles S; Blakely-Smith, Audrey

    2003-01-01

    The purpose of the current investigation was to apply the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) to the inappropriate mealtime behaviors of 15 children who had been referred to an intensive program for the assessment and treatment of severe feeding disorders. During Study 1, we conducted descriptive assessments of children and parents during meals. The results of Study 1 showed that parents used the following consequences for inappropriate mealtime behaviors: coaxing and reprimanding, allowing the child to periodically take a break from or avoid eating, and giving the child preferred food or toys following inappropriate behavior. The effects of these consequences were tested systematically in Study 2 when we conducted analogue functional analyses with the children. During alternating meals, one of the consequences typically used by parents consistently followed inappropriate child behavior. Results indicated that these consequences actually worsened behavior for 10 of the 15 children (67%). These results suggested that the analogue functional analysis described by Iwata et al. may be useful in identifying the environmental events that play a role in feeding disorders. PMID:12858984

  13. Children's Context Inappropriate Anger and Salivary Cortisol

    ERIC Educational Resources Information Center

    Locke, Robin L.; Davidson, Richard J.; Kalin, Ned H.; Goldsmith, H. Hill

    2009-01-01

    Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as…

  14. Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China.

    PubMed

    Yip, Winnie; Powell-Jackson, Timothy; Chen, Wen; Hu, Min; Fe, Eduardo; Hu, Mu; Jian, Weiyan; Lu, Ming; Han, Wei; Hsiao, William C

    2014-03-01

    Pay-for-performance in health care holds promise as a policy lever to improve the quality and efficiency of care. Although the approach has become increasingly popular in developing countries in recent years, most policy designs do not permit the rigorous evaluation of its impact. Thus, evidence of its effect is limited. In collaboration with the government of Ningxia Province, a predominantly rural area in northwest China, we conducted a matched-pair cluster-randomized experiment between 2009 and 2012 to evaluate the effects of capitation with pay-for-performance on primary care providers' antibiotic prescribing practices, health spending, outpatient visit volume, and patient satisfaction. We found that the intervention led to a reduction of approximately 15 percent in antibiotic prescriptions and a small reduction in total spending per visit to village posts-essentially, community health clinics. We found no effect on other outcomes. Our results suggest that capitation with pay-for-performance can improve drug prescribing practices by reducing overprescribing and inappropriate prescribing. Our study also shows that rigorous evaluations of health system interventions are feasible when conducted in close collaboration with the government. PMID:24572187

  15. Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems

    PubMed Central

    2013-01-01

    Background Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used. Methods Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale. Results Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome. Conclusions Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation. PMID:24344973

  16. E-prescribing: clinical implications for patients with diabetes.

    PubMed

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-09-01

    With the recent Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many clinicians are expected to adopt or enhance their use of e-prescribing systems. E-prescribing has nearly eradicated medication errors resulting from prescriber handwriting interpretations, yet several other patient-care and workflow benefits still remain a promise. As prescribers select or update their e-prescribing systems (whether stand-alone or integrated with electronic health records), close attention is needed to the e-prescribing application features and level of clinical decision support to avoid clinical blind spots, including incomplete or inaccurate patient medication lists, poor drop-down menu or screen design, and lack of clinically relevant and actionable drug interaction and drug allergy alerts. This article presents three case studies that highlight common e-prescribing problems involving diabetes patients. PMID:20144439

  17. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report

    PubMed Central

    Lago, Paola; Bizzarri, Giancarlo; Scalzotto, Francesca; Parpaiola, Antonella; Amigoni, Angela; Putoto, Giovanni; Perilongo, Giorgio

    2012-01-01

    Objective Administering medication to hospitalised infants and children is a complex process at high risk of error. Failure mode and effect analysis (FMEA) is a proactive tool used to analyse risks, identify failures before they happen and prioritise remedial measures. To examine the hazards associated with the process of drug delivery to children, we performed a proactive risk-assessment analysis. Design and setting Five multidisciplinary teams, representing different divisions of the paediatric department at Padua University Hospital, were trained to analyse the drug-delivery process, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure and plan changes in practices. Primary outcome To identify higher-priority potential failure modes as defined by RPNs and planning changes in clinical practice to reduce the risk of patients harm and improve safety in the process of medication use in children. Results In all, 37 higher-priority potential failure modes and 71 associated causes and effects were identified. The highest RPNs related (>48) mainly to errors in calculating drug doses and concentrations. Many of these failure modes were found in all the five units, suggesting the presence of common targets for improvement, particularly in enhancing the safety of prescription and preparation of endovenous drugs. The introductions of new activities in the revised process of administering drugs allowed reducing the high-risk failure modes of 60%. Conclusions FMEA is an effective proactive risk-assessment tool useful to aid multidisciplinary groups in understanding a process care and identifying errors that may occur, prioritising remedial interventions and possibly enhancing the safety of drug delivery in children. PMID:23253870

  18. Synthetic disease-modifying antirheumatic drug prescribing variability in rheumatoid arthritis: a multilevel analysis of a cross-sectional national study.

    PubMed

    Ferraz-Amaro, Iván; Seoane-Mato, Daniel; Sánchez-Alonso, Fernando; Martín-Martínez, María A

    2015-11-01

    The objective of this study was to describe the variability in the prescription of csDMARDs for the treatment of RA between centers in Spain and to explore how this variability relates to demographic, disease, physician, and institutional characteristics. A cross-sectional nationwide study was carried out to examine data from 1352 patients. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as physician and hospital characteristics, vis-à-vis csDMARD prescription. Having three or more comorbidities (OR 0.353 [0.173-0.721]), disease duration (OR 0.321 [0.174-0.595]), and the existence of an early-arthritis unit (OR 0.552 [0.335-0.910]) were negatively associated with the prescription of one csDMARD versus nonprescription; contrary, the presence of rheumatoid factor (OR 1.909, 95 % CI [1.181-3.086]) was positively associated. On the other hand, while corticoid intake (OR 1.561 [1.088-2.240]), the maximum number of painful joints, and the presence of nursing consultation (OR 1.626 [1.078-2.452]) were positively associated with the prescription of multiple csDMARDs versus one csDMARD, patient's age (OR 0.984 [0.974-0.995]) and disease duration (OR 0.669 [0.462-0.968]) were negatively associated. Despite all these, variability in the prescription of csDMARDs between hospitals remained statistically significant after adjusting for these individual and hospital characteristics. Within the emAR II study, there was a marked variation in the number of csDMARDs prescribed between hospitals. The reasons for these variations remain unclear and cannot be solely related to disease or center characteristics. PMID:26403284

  19. Adverse Effects of Common Drugs: Adults.

    PubMed

    Lewis, Peter R; Karpa, Kelly Dowhower; Felix, Todd Matthew

    2015-09-01

    Although drugs can be an essential and lifesaving component of the care of adult patients, their use frequently is accompanied by adverse effects and life-threatening adverse drug reactions that can result in significant disability and mortality. The potential for drug-related severe morbidity and mortality is compounded during periods of hospitalization, when high-risk drugs such as anticoagulants or insulin are used, and when care in an intensive care unit is required. Patient factors in adults that can increase the risk of drug harms include immunosuppression, cognitive impairment, depression, alcoholism and other substance abuse disorders, chronic kidney disease, hepatic dysfunction, coagulopathies, limited English proficiency, institutional/nursing home care, and underinsurance or lack of insurance. Physician factors that can increase the risk of drug harms include inappropriate prescribing of drugs (including to pregnant and breastfeeding women), failure to appropriately discontinue/deprescribe drugs, insufficient drug reconciliation, failure to coordinate care among multiple prescribing clinicians, and failure to elicit and incorporate into health histories and clinical decision-making the widespread use of nonprescription drugs, herbal products, and dietary supplements. PMID:26375995

  20. Reducing inappropriate accident and emergency department attendances:

    PubMed Central

    Ismail, Sharif A; Gibbons, Daniel C; Gnani, Shamini

    2013-01-01

    Background Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. Aim To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Design and setting Systematic review of UK and international primary care interventions. Method Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. Results In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Conclusion Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance. PMID:24351497

  1. Epidemiology and definition of inappropriate sinus tachycardia.

    PubMed

    Pellegrini, Cara N; Scheinman, Melvin M

    2016-06-01

    Inappropriate sinus tachycardia (IST) is a clinical syndrome lacking formal diagnostic criteria. It is generally defined as an elevated resting heart rate (HR; >90-100 bpm) with an exaggerated response to physical or emotional stress and a clearly sinus mechanism. Clinical manifestations are broad from a complete lack of symptoms to incapacitating incessant tachycardia. Now understood to be relatively prevalent, it is observed to have a generally benign prognosis, though symptoms may persist for years. Whether IST is a single discrete entity or a heterogeneous condition with overlap to other syndromes such as postural orthostatic tachycardia syndrome remains a matter of debate. PMID:26310298

  2. Catheter ablation of inappropriate sinus tachycardia.

    PubMed

    Gianni, Carola; Di Biase, Luigi; Mohanty, Sanghamitra; Gökoğlan, Yalçın; Güneş, Mahmut F; Horton, Rodney; Hranitzky, Patrick M; Burkhardt, J David; Natale, Andrea

    2016-06-01

    Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST. PMID:26310299

  3. Matrix with Prescribed Eigenvectors

    ERIC Educational Resources Information Center

    Ahmad, Faiz

    2011-01-01

    It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

  4. Functional analysis and treatment of inappropriate verbal behavior.

    PubMed Central

    Dixon, M R; Benedict, H; Larson, T

    2001-01-01

    The present study examined the possible function of inappropriate verbal behavior of an adult man who had been diagnosed with both mental retardation and psychosis. Results of a functional analysis indicated that inappropriate verbal utterances were maintained by attention. An intervention consisting of the differential reinforcement of appropriate verbal behavior effectively reduced the inappropriate behavior. PMID:11678535

  5. Update on drug interactions with phosphodiesterase-5 inhibitors prescribed as first-line therapy for patients with erectile dysfunction or pulmonary hypertension.

    PubMed

    Gur, Serap; Kadowitz, Philip J; Gokce, Ahmet; Sikka, Suresh C; Lokman, Utku; Hellstrom, Wayne J G

    2013-02-01

    Phosphodiesterase-5 inhibitors (PDE5i, sildenafil, vardenafil, tadalafil and avanafil) are a first-line medical therapy for erectile dysfunction (ED). In all likelihood, PDE5i usage will increase because sildenafil (Viagra® and Revatio®) and tadalafil (Cialis® and Adcirca®) have recently been recommended as first-line therapy for patients with pulmonary hypertension (PH). PDE5i exhibit higher plasma concentrations when co-administered with cytochrome P (CYP) 3A inhibitors, which influences their side-effect profile. The higher PDE5i plasma concentrations, caused by CYP3A inhibitors, influence the severity and timing of PDE5i drug interactions and require dose adjustment. PDE5i are safe when used with most antihypertensive agents, but co-administration with nitrates or α-blockers can cause severe hypotension and syncope. Dose adjustment is also necessary when PDE5i are co-administered with CYP3A inducers. The combination of oral tadalafil and bosentan (endothelin receptor antagonist) reduces tadalafil levels and requires dose adjustment. Current literature reports a number of interactions between PDE5i and other agents and further studies are needed to expand our knowledge base of these interactions. This review discusses relevant PDE5i drug interactions, including those with CYP 450 inhibitors and inducers which are frequently used during the treatment of ED and PH. PMID:23140258

  6. A Survey of Off-Label Prescribing for Inpatients with Mild Intellectual Disability and Mental Illness

    ERIC Educational Resources Information Center

    Haw, C.; Stubbs, J.

    2005-01-01

    Background: The term "off-label prescribing" refers to the use of a drug outside the terms of its Marketing Authorisation, including prescribing for an unlicensed indication. There have been few reports about off-label prescribing in psychiatry. The aims of the study were to determine the frequency of off-label prescribing of psychotropics for…

  7. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

    PubMed Central

    Aqqad, Sana’ MH Al; Chen, Li Li; Shafie, Asrul Akmal; Hassali, Mohamed Azmi; Tangiisuran, Balamurugan

    2014-01-01

    Background Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. Methods A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results The median age of the 211 participants was 77 years (interquartile range 72–82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. Conclusion PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents

  8. The epidemiology of prescribing in an urban general practice

    PubMed Central

    Murdoch, J. C.

    1980-01-01

    The total prescribing in an urban general practice was recorded over a six-month period and classified according to the length of time that drugs were continued. The number of patients receiving any prescription rose with age, as did the total number of items per patient prescribed for; while the continued items rose with age, the number of items prescribed once only per patient remained constant in all age groups. The bulk of the total prescribing was for the elderly and this was mainly for continued items. The classification also shows that certain drug groups are liable to be continued whereas others are virtually always prescribed once only. The implications of these findings for self-audit of prescribing and the care of the elderly in general practice are discussed. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:7452600

  9. Syndrome of inappropriate antidiuretic hormone secretion and Ibuprofen, a rare association to be considered: role of tolvaptan.

    PubMed

    Artom, Nathan; Oddo, Silvia; Pende, Aldo; Ottonello, Luciano; Giusti, Massimo; Dallegri, Franco

    2013-01-01

    The association between the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is rare and has never been treated with an arginine vasopressin receptor antagonist. We report a unique case of SIADH associated with ibuprofen use and successfully treated with tolvaptan. A 76-year-old man came to our observation because of lumbar pain and epigastric discomfort. He was taking ibuprofen orally 400 mg bid as an analgesic treatment. Laboratory tests showed low levels of sodium (116 mmol/L) and chloride; a diagnosis of SIADH was formulated and ibuprofen was stopped immediately. Imaging tests allowed to rule out the presence of malignancies or cerebral and lung diseases. Slightly hypertonic saline infusion was administered for 3 days without significant sodium improvement; therefore, tolvaptan was started at the initial dose of 7.5 mg daily, doubled after 5 days. After 8 days of treatment the patient showed progressive increase of sodium levels up to normal values. In the following weeks tolvaptan was prescribed at progressively titrated dosage to full suspension; afterwards the sodium levels remained normal without any type of treatment. PMID:23819075

  10. Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

    PubMed

    O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

    2015-01-01

    The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program. PMID:26176326

  11. Cefdinir-Induced Hepatotoxicity: Potential Hazards of Inappropriate Antibiotic Use

    PubMed Central

    Chen, Joy

    2008-01-01

    Drug-induced hepatotoxicity is well recognized but can cause some diagnostic problems, particularly if not previously reported. The present case involves a 22-year-old male who presented with jaundice and elevated liver enzymes after a course of cefdinir (Omnicef®) for streptococcal pharyngitis. A diagnosis of drug-induced liver injury was suspected but a liver biopsy was required after his jaundice worsened despite cessation of the presumed offending agent. A short course of steroids was initiated and eventually the jaundice resolved. This case highlights the need to suspect medication-induced liver injury in cases of jaundice, even if not previously reported. In addition, it illustrates the potential for adverse outcomes in situations where antibiotics are used inappropriately or where first line antibiotics are not used for routine infections. We report a case of a young male who developed jaundice associated with cefdinir use with pathological confirmation of moderate cholestasis with portal and lobular mixed inflammation and focal bile duct injury consistent with drug-induced liver injury. PMID:18752027

  12. Palifermin: new drug. Prevention of oral mucositis: inappropriate evaluation.

    PubMed

    2007-08-01

    (1) Patients treated with high-dose chemotherapy combined with total body irradiation (myeloablative therapy) often develop oral mucositis. Prevention is based mainly on sucking ice during chemotherapy. (2) Palifermin is a growth factor marketed for the prevention of severe oral mucositis in adults with malignant haemopathies who are receiving myeloablative therapy followed by peripheral stem cell autografting. (3) Palifermin has not been compared with sucking ice, despite the efficacy of this simple treatment. (4) In a randomised placebo-controlled double-blind trial involving 212 adult patients treated with high-dose chemotherapy and total body irradiation, palifermin reduced the incidence of severe oral mucositis (63% versus 98%) and its duration (about 3 days versus 9 days). The myeloablative regimen used in this trial is not that commonly used in Europe. The efficacy of palifermin during less aggressive regimens, which cause less severe oral mucositis, is not known. (5) The main adverse events noted in clinical trials were erythema and cutaneous oedema. It is not known whether palifermin increases the long-term risk of cancer. (6) Treatment with palifermin is expensive, 4800.00 euros in France); the optimal dosing schedule is not known and the unit dose chosen by the manufacturer is wastefully large. (7) In practice, it remains to be demonstrated that palifermin is more effective than simply sucking ice. PMID:17724832

  13. An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

    PubMed Central

    2013-01-01

    Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing

  14. More than a prescriber: gerontological nurse practitioners' perspectives on prescribing and pharmaceutical marketing.

    PubMed

    Mahoney, Diane Feeney; Ladd, Elissa

    2010-01-01

    The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. PMID:20159350

  15. Pharmaceutical marketing research and the prescribing physician.

    PubMed

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue. PMID:17502635

  16. Guideline for Prescribing Opioids for Chronic Pain.

    PubMed

    Centers For Disease Control And Prevention Public Health Service U S Department Of Health And Human Services

    2016-06-01

    Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. The Centers for Disease Control and Prevention (CDC) developed and published the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care. PMID:27301691

  17. Pharmacogenetics in drug regulation: promise, potential and pitfalls

    PubMed Central

    Shah, Rashmi R

    2005-01-01

    result in complex prescribing information. Genotype-specific dosing regimens will have to be more precise and marketing strategies more prudent. However, not all variations in drug responses are related to pharmacogenetic polymorphisms. Drug response can be modulated by a number of non-genetic factors, especially co-medications and presence of concurrent diseases. Inappropriate prescribing frequently compounds the complexity introduced by these two important non-genetic factors. Unless prescribers adhere to the prescribing information, much of the benefits of pharmacogenetics will be squandered. Discovering highly predictive genotype–phenotype associations during drug development and demonstrating their clinical validity and utility in well-designed prospective clinical trials will no doubt better define the role of pharmacogenetics in future clinical practice. In the meantime, prescribing should comply with the information provided while pharmacogenetic research is deservedly supported by all concerned but without unrealistic expectations. PMID:16096112

  18. A Study on Polypharmacy and Potential Drug-Drug Interactions among Elderly Patients Admitted in Department of Medicine of a Tertiary Care Hospital in Puducherry

    PubMed Central

    Kalyansundaram, Dharani; Bahurupi, Yogesh

    2016-01-01

    Introduction The proportion of elderly population has been constantly increasing over last few years. Polypharmacy is unavoidable in the elderly as they often suffer from multiple co-morbidities. Potential drug-drug interaction due to polypharmacy and potential inappropriate medication among the elderly must be carefully assessed. Aim To find out polypharmacy and potential drug-drug interactions among elderly patients admitted and discharged in Department of Medicine. Materials and Methods This study was carried out on 100 patients above 65 years of age both males and females. Data was collected through review of case sheets. Polypharmacy was observed based on admission and discharge prescriptions. Frequently occurring drug-drug interactions were assessed using online checks. Results Mean number of drugs prescribed to patients on admission (7.61 ± 3.37) was more than that on discharge (5.48±2.46). More than half of these patients received 5 to 9 number of drugs. On admission 52.69% potential drug-drug interactions were observed and on discharge 52.91%. Most common drug interactions observed in both the groups were of moderate grade. Conclusion From the present study we can conclude that polypharmacy leads to more potential drug-drug interactions. To improve drug safety in this high-risk population, appropriate prescribing is very important. PMID:27042480

  19. 78 FR 42455 - Medications Prescribed by Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-16

    ... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse... section to read as follows: Sec. 17.96 Medication prescribed by non-VA physicians. * * * * * (a) * * *...

  20. The impact of prescribed psychotropics on youth

    PubMed Central

    2007-01-01

    Many psychotropics prescribed to children are unlicensed or off-label. This article uses the two most prescribed psychotropics (MPH and SSRIs) to illustrate various concerns about their impact on youth. Many mental illnesses begin in childhood or early adulthood, warranting a treatment of some kind. However, commentators have argued that prescribing is influenced by five myths: (1) children are little adults; (2) children have no reason to develop depression or anxiety; (3) psychiatric disorders are the same across adults and children; (3) children can be prescribed lower doses of the same drug; (5) drugs are preferable to alternative treatments and are more successful. Several lines of evidence suggest that these are incorrect assumptions. We update readers with recent research in relation to these myths, concluding that researchers should clarify child/adult differences for psychotropics, attend to the growth of "cosmetic" use of psychotropics in children and adolescents, and address concerns about the diagnostic validity of mental illness in the current DSM classification system. PMID:17949504

  1. Off-label prescribing in older patients.

    PubMed

    Jackson, Stephen H D; Jansen, Paul A F; Mangoni, Arduino A

    2012-06-01

    The practice of off-label prescribing, i.e. prescribing drugs either for unregistered/unapproved therapeutic indications and age groups or using unregistered/unapproved doses or methods of administration, is common in older patients. This may be due to the poor representation of this group in pre-marketing clinical trials assessing therapeutic efficacy and safety of novel therapies or merely to the fact that trials in a particular indication have not been undertaken. Off-label prescribing should not be viewed as scientifically or ethically unsound when there are good clinical data to support a particular therapeutic indication. However, a number of steps should be followed in order to ensure therapeutic efficacy, reducing, at the same time, the risk of adverse drug reactions and/or medical litigation. This article discusses the current epidemiology and trends in off-label prescribing in older patients, the scientific and ethical justification of this practice, medico-legal implications, and proposed strategies for risk mitigation. PMID:22642777

  2. The risks of inappropriateness in cardiac imaging.

    PubMed

    Picano, Eugenio

    2009-05-01

    The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks. PMID:19543412

  3. The Risks of Inappropriateness in Cardiac Imaging

    PubMed Central

    Picano, Eugenio

    2009-01-01

    The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged “worried-well” asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks. PMID:19543412

  4. What to do about Inappropriate Behavior

    NASA Astrophysics Data System (ADS)

    Durand, Bernice

    2011-01-01

    If you believe you are a victim of harassment, bias, or prejudice, your first need is to know what person you should confide in who would be qualified to help you understand and go through the process of resolving your difficult situation. You will be best off if you have an accessible, trustworthy institutional infrastructure in place for dealing with inappropriate behavior. The exact nature of the infrastructure varies among institutions; but it starts with leadership from the top person in every unit, for example the university president, the dean, the department chair, and the research group leader. A good "safety net” structure also includes a reliable system for reporting and addressing problems before they escalate; an institutional "enforcer” who is widely known to mean business; and trainings and frequent publicity about the consequences of such behavior. The components of a good structure, as well as some alternative routes to take if you don't have such a system, will be described in the contexts of different types of institutions; and you will learn the criteria for prohibited behaviors. There will be time for analysis and discussion of scenarios taken from real incidents, altered to protect privacy.

  5. [Porphyria and inappropriate antidiuretic hormone syndrome].

    PubMed

    López Montes, A; Lorenzo, I; Pérez Martínez, J

    2004-01-01

    We report the case of a 37-years-old woman with inappropriate antidiuretic hormone syndrome due to an attack of acute porphyria. The patient was admitted to our hospital for abdominal pain, sleepiness and pink urine. Family and personal history were normal. Seven days before the admission the patient had a laparoscopy operation for endometriosis in her left ovary. The patient had had two normal pregnancies. The physical examination was normal, the skin turgor was good and no edema was present, the blood pressure was 140/90 mmHg. Her serum sodium was 114 mEq/L, serum osmolality 243 mOsm/kg, urine sodium 146 mEq/L and urine osmolality 457 mOsm/kg. Values from laboratory examination revealed a normal peripheral haematogram, a normal kidney function, normal liver, adrenal and thyroid function. The urine tested for amino-levulinic acid, coproporphyrin and uroporphyrin was strongly positive. These findings are compatible with Porphyria Variegata or Coproporphyria Hereditary. A diagnosis of Porphyria acute with SIADH was made, and water fluid restriction, i.v. hypertonic saline infusion and furosemide to correct the hyponatremia was begun. In 1966, lesions of the median eminence of the hypothalamus and both hypothalamic -hypophyseal tracts were described in a patient with Porphyria acute intermittent and SIADH. It was suggested that SIADH occurred because of damage to these areas of the brain from excessive exposure to porphyrins. PMID:15219077

  6. Intended and unintended consequences of China's zero markup drug policy.

    PubMed

    Yi, Hongmei; Miller, Grant; Zhang, Linxiu; Li, Shaoping; Rozelle, Scott

    2015-08-01

    Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. We collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. We found large reductions in drug revenue, as intended by policy makers. However, we also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue. PMID:26240254

  7. Drug utilisation and off-label use of medications in anaesthesia in surgical wards of a teaching hospital

    PubMed Central

    Patil, Amol E; Shetty, Yashashri C; Gajbhiye, Snehalata V; Salgaonkar, Sweta V

    2015-01-01

    Background and Aims: When a drug is used in a way that is different from that described in regulatory body approved drug label, it is said to be ‘off label use’. Perioperative phase is sensitive from the point of view of patient safety and off-label drug use in this setup can prove to be hazardous to patient. Hence, it was planned to assess the pattern of drug utilisation and off-label use of perioperative medication during anaesthesia. Methods: Preoperatively, demographic details and adverse events check list were filled from a total of 400 patients from general surgery, paediatric surgery and orthopaedics departments scheduled to undergo surgery. The perioperative assessment form was assessed to record all prescriptions followed by refilling of adverse events checklist in case record form. World Health Organization (WHO) prescribing indicators were used for analysis of drug utilisation data. National Formulary of India 2011 was used as reference material to decide off-label drug use in majority instances along with package insert. Results: A total of 3705 drugs were prescribed to the 400 participants and average number of drugs per patient was 9.26 ± 3.33. Prescriptions by generic name were 68.07% whereas 85.3% drugs were prescribed from hospital schedule. Off-label drugs overall formed 20.19% of the drugs prescribed. At least one off-label drug was prescribed to 82.5% of patients. Inappropriate dose was the most common form of off-label use. There was 1.6 times greater risk of occurrence of adverse events associated with the use of off-label drugs. Conclusion: Prescription indicators were WHO compliant. Off-label drug use was practiced in anaesthesia department with questionable clinical justification in some instances. PMID:26755837

  8. Reconsidering "The inappropriateness of conventional cephalometrics".

    PubMed

    Bookstein, Fred L

    2016-06-01

    Of all the articles on cephalometrics this journal has published over the last half-century, the one most cited across the scientific literature is the 1979 lecture "The inappropriateness of conventional cephalometrics" by Robert Moyers and me. But the durable salience of this article is perplexing, as its critique was misdirected (it should have been aimed at the craniometrics of the early twentieth century, not merely the roentgenographic extension used in the orthodontic clinic) and its proposed remedies have all failed to establish themselves as methods of any broad utility. When problems highlighted by Moyers and me have been resolved at all, the innovations that resolved them owe to tools very different from those suggested in our article and imported from fields quite a bit farther from biometrics than we expected back in 1979. One of these tools was the creation de novo of a new abstract mathematical construction, statistical shape space, in the 1980s and 1990s; another was a flexible and intuitive new graphic, the thin-plate spline, for meaningfully and suggestively visualizing a wide variety of biological findings in these spaces. On the other hand, many of the complaints Moyers and I enunciated back in 1979, especially those stemming from the disarticulation of morphometrics from the explanatory styles and purposes of clinical medicine, remain unanswered even today. The present essay, a retrospective historical meditation, reviews the context of the 1979 publication, its major themes, and its relevance today. This essay is dedicated to the memory of Robert E. Moyers on the 100th anniversary of the American Journal of Orthodontics and Dentofacial Orthopedics. PMID:27241987

  9. Social determinants of prescribed and non-prescribed medicine use

    PubMed Central

    2010-01-01

    Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively). The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%). In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%). A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona. PMID:20441578

  10. Setting Limits: The Child Who Uses Inappropriate Language

    ERIC Educational Resources Information Center

    Greenberg, Polly

    2004-01-01

    This article discusses how to work with a child who uses inappropriate language. The words inappropriately used by young children are grouped into five categories: (1) names of body parts considered as private, and their nicknames; (2) bathroom words and body products; (3) religion-related words; (4) sexually charged words overheard when adults…

  11. Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior

    ERIC Educational Resources Information Center

    Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.

    2009-01-01

    Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

  12. 20 CFR 369.4 - Inappropriate use of the seal.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Inappropriate use of the seal. 369.4 Section... OF THE SEAL OF THE RAILROAD RETIREMENT BOARD § 369.4 Inappropriate use of the seal. The Railroad Retirement Board shall not grant permission for use of the seal in those instances where use of the seal...

  13. 20 CFR 369.4 - Inappropriate use of the seal.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Inappropriate use of the seal. 369.4 Section... OF THE SEAL OF THE RAILROAD RETIREMENT BOARD § 369.4 Inappropriate use of the seal. The Railroad Retirement Board shall not grant permission for use of the seal in those instances where use of the seal...

  14. 20 CFR 369.4 - Inappropriate use of the seal.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Inappropriate use of the seal. 369.4 Section... OF THE SEAL OF THE RAILROAD RETIREMENT BOARD § 369.4 Inappropriate use of the seal. The Railroad Retirement Board shall not grant permission for use of the seal in those instances where use of the seal...

  15. 20 CFR 369.4 - Inappropriate use of the seal.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Inappropriate use of the seal. 369.4 Section... OF THE SEAL OF THE RAILROAD RETIREMENT BOARD § 369.4 Inappropriate use of the seal. The Railroad Retirement Board shall not grant permission for use of the seal in those instances where use of the seal...

  16. Assessing Student Perceptions of Inappropriate and Appropriate Teacher Humor

    ERIC Educational Resources Information Center

    Frymier, Ann Bainbridge; Wanzer, Melissa Bekelja; Wojtaszczyk, Ann M.

    2007-01-01

    This study replicated and extended Wanzer, Frymier, Wojtaszczyk, and Smith's (2006) preliminary typology of appropriate and inappropriate teacher humor and advanced three explanations for differences in interpretations of teacher humor. Students were more likely to view teacher humor as inappropriate when it was perceived as offensive and when it…

  17. e-Learning initiatives to support prescribing.

    PubMed

    Maxwell, Simon; Mucklow, John

    2012-10-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

  18. e-Learning initiatives to support prescribing

    PubMed Central

    Maxwell, Simon; Mucklow, John

    2012-01-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

  19. Side effects of commonly prescribed analgesic medications.

    PubMed

    Carter, Gregory T; Duong, Vicky; Ho, Stanley; Ngo, Kathryn C; Greer, Christopher L; Weeks, Douglas L

    2014-05-01

    Analgesics, including opioids, steroidal and nonsteroidal anti-inflammatory drugs, aspirin, acetaminophen, antiepileptics, and serotonin-norepinephrine reuptake inhibitors, are medications commonly used to treat many forms of pain. However, all of these agents may have significant adverse side effects. Adverse effects may occasionally be inseparable from desired effects. Side effects are often dose dependent and time dependent. It is critical that the prescribing practitioner and the dispensing pharmacist provide a thorough, understandable review of the potential side effects to all patients before these drugs are administered. Proper monitoring and follow-up during therapy are crucial. PMID:24787343

  20. Scope and nature of prescribing decisions made by general practitioners

    PubMed Central

    Denig, P; Witteman, C; Schouten, H

    2002-01-01

    Background: This study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support. Methods: While thinking aloud, 61 general practitioners made prescribing decisions for five patients with urinary tract infections or stomach complaints. The resulting 305 transcripts were analysed to determine the scope and nature of the decision processes. Differences in the process were related to case or doctor characteristics, and to differences in the quality of prescribing behaviour. Results: The decision processes were not extensive, particularly for patients with a urinary tract infection. The doctors did not actively consider all possible relevant information. Considerations referring to core aspects of the treatment were made in 159 cases (52%) and to contextual aspects in 111 cases (36%). Habitual behaviour, defined as making a treatment decision without any specific contemplation, was observed in 118 cases (40%) and resulted in prescribing first choice as well as second choice drugs. For stomach complaints, second choice drugs were often prescribed after considering other treatments or in view of specific circumstances. Experience of the doctor was not related to the type of decision process. Conclusions: The processes observed deviate from the decision theoretic norm of thoroughly evaluating all possible options, but these deviations do not always result in suboptimal prescribing. Decision support is useful for bringing pertinent information and first choice treatments to the prescriber's attention. In particular, information about relevant contraindications, interactions, and costs could improve the quality of prescribing. PMID:12448805

  1. Clinical presentation of inappropriate sinus tachycardia and differential diagnosis.

    PubMed

    Peyrol, Michael; Lévy, Samuel

    2016-06-01

    Inappropriate sinus tachycardia (IST) is a syndrome characterized by a sinus tachycardia not related to a medical condition, to a physiological response, or to medication or drugs and associated with symptoms, often invalidating and altering the quality of life of affected patients. It occurs predominantly in adolescents and young adults, and in the female sex. The diagnosis requires a complete work-up in order to exclude other causes of sinus tachycardia and one or several additional tests: 24-h ECG ambulatory recordings, echocardiogram, exercise testing, and autonomous nervous system assessment. It should be differentiated from the postural orthostatic tachycardia syndrome, with which it shares a number of symptoms, and other supraventricular tachycardias originating in the high right atrium. An electrophysiological study should be considered in selected cases in order to differentiate IST from other supraventricular tachycardias. The mechanism is still unclear, and possible etiologies may include intrinsic abnormality of the sinus node, autonomic dysfunction, hypersensitivity of the sinus node to catecholamines, blunted vagal system, or a combination of the above. The authors emphasize the wide spectrum of clinical presentations and the need to better define the IST and the criteria required to ascertain its diagnosis. PMID:26329720

  2. Constipation in people prescribed opioids

    PubMed Central

    2010-01-01

    Introduction Constipation is reported in 52% of people with advanced malignancy. This figure rises to 87% in people who are terminally ill and taking opioids. Constipation may be the most common adverse effect of opioids. There is no reason to believe that people with chronic non-malignant disease who take opioids will be any less troubled by this adverse effect. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: oral laxatives, rectally applied medications, and opioid antagonists for constipation in people prescribed opioids? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: arachis oil enemas, bisacodyl, co-danthrusate/co-danthramer, docusate, glycerol suppositories, ispaghula husk, lactulose, liquid paraffin, macrogols plus electrolyte solutions, magnesium salts, methylcellulose, opioid antagonists, phosphate enemas, senna, sodium citrate micro-enema, and sodium picosulfate. PMID:21718572

  3. Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

    PubMed Central

    Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Zarrintan, Mohammad Hossein; Wahlstrom, Rolf

    2008-01-01

    Background Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education. Methods The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field. Results Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment. Conclusions Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context. PMID:18510774

  4. EMPADE Study: Evaluation of Medical Prescriptions and Adverse Drug Events in COPD Patients Admitted to Intensive Care Unit

    PubMed Central

    Khan, M. Amer; Khan, M. Nematullah; Sultan, Ihtisham; Khan, M. Aamer; Ali, S. Amir; Farooqui, Afroze

    2015-01-01

    Introduction Inappropriate drug usage may preclude ideal benefit due to increased medical cost, antimicrobial resistance, adverse effects and mortality. Therefore drug utilization studies have become a plausible means in evaluating the healthcare systems. COPD management usually involves more than one drug which may escalate the risk of ADEs (adverse drug events). Aim The present study was aimed at assessing the current drug practice and ADEs in COPD management in ICU. Materials and Methods A total of 1,044 patients admitted for the treatment of COPD were included in the study. Their prescriptions were recorded for evaluation of drug utilization and patients were counseled for assessing ADEs. Results were evaluated by Chi-square test and percentages. Result All-embracing 15,360 drugs were prescribed at an average of 14.71 drugs per patient, wherein β2-agonists were extensively prescribed agents followed by inhaled-corticosteroids and anti-cholinergics. 372 ADEs were reported in 252 patients, wherein restlessness was the most frequent ADE and theophylline was found to be associated with highest cases of ADEs. Conclusion Practitioners should prescribe least number of drugs to mitigate the likelihood of adverse outcomes in patients due to numerous drugs usage, which may be achieved by following GOLD guidelines. The present work may help in improving the current management of COPD by rectifying the flaws delineated in this article. PMID:26675667

  5. Impact of drug-drug and drug-disease interactions on gait speed in community-dwelling older adults

    PubMed Central

    Naples, Jennifer G.; Marcum, Zachary A.; Perera, Subashan; Newman, Anne B.; Greenspan, Susan L.; Gray, Shelly L.; Bauer, Douglas C.; Simonsick, Eleanor M.; Shorr, Ronald I.; Hanlon, Joseph T.

    2016-01-01

    Background Gait speed decline, an early marker of functional impairment, is a sensitive predictor of adverse health outcomes in older adults. The effect of potentially inappropriate prescribing on gait speed decline is not well known. Objective To determine if potentially inappropriate drug interactions impair functional status as measured by gait speed. Methods The sample included 2,402 older adults with medication and gait speed data from the Health, Aging and Body Composition study. The independent variable was the frequency of drug-disease and/or drug-drug interactions at baseline and three additional years. The main outcome was a clinically meaningful gait speed decline ≥ 0.1 m/s the year following drug interaction assessment. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate generalized estimating equations for both the overall sample and a sample stratified by gait speed at time of drug interaction assessment. Results The prevalence of drug-disease and drug-drug interactions ranged from 7.6–9.3% and 10.5–12.3%, respectively, with few participants (3.8–5.7%) having multiple drug interactions. At least 22% of participants had a gait speed decline of ≥ 0.1 m/s annually. Drug interactions were not significantly associated with gait speed decline overall or in the stratified sample of fast walkers. There was some evidence, however, that drug interactions increased the risk of gait speed decline among those participants with slower gait speeds, though p values did not reach statistical significance (adjusted odds ratio 1.22, 95% confidence intervals 0.96–1.56, p=0.11). Moreover, a marginally significant dose-response relationship was seen with multiple drug interactions and gait speed decline (adjusted odds ratio 1.40; 95% confidence intervals 0.95–2.04, p=0.08). Conclusions Drug interactions may increase the likelihood of gait speed decline among older adults with evidence of preexisting debility. Future studies

  6. Potential effects of rational prescribing on national health care spending

    PubMed Central

    Littman, Jordan; Halil, Roland

    2016-01-01

    Abstract Objective To estimate the cost savings that could result from implementation of a rational prescribing model for drug classes that are equivalent in terms of efficacy, toxicity, and convenience. Design The top 10 drug classes based on annual spending were gathered from the Canadian Institute for Health Information. They were reviewed for potential inclusion in the study based on the ability to compare intraclass medications. When equivalence in efficacy, toxicity, and convenience was determined from a literature review, annual prescribing data were gathered from the National Prescription Drug Utilization Information Systems Database. The potential cost savings were then calculated by comparing current market shares with potential future market shares. Setting Canada. Main outcome measures Estimated differences in spending produced by a rational prescribing model. Results Statins, proton pump inhibitors, angiotensin-converting enzyme inhibitors, and selective serotonin reuptake inhibitors were determined to have class equivalence for efficacy, toxicity, and convenience. Total current annual spending on these classes is $856 million through public drug programs, and an estimated $1.97 billion nationally. Through rational prescribing, annual savings could reach $222 million for public drug programs, and $521 million nationally. Conclusion Most of the potential savings are derived from deprescribing the newest patent-protected medications in each class. Avoiding prescribing the newest intraclass drug, particularly in the absence of research to support its superiority in relevant clinical outcomes, could lead to considerable savings in health care expenditures and might push the pharmaceutical industry to innovate rather than imitate. PMID:26975917

  7. Drug diversion

    PubMed Central

    Wood, Danielle

    2015-01-01

    SUMMARY Prescription drug diversion has significant health, legal and social implications. Deaths from misuse of prescription drugs account for a significant proportion of overdose deaths. The drugs most commonly involved are analgesics, particularly opioids, and psychoactive drugs, particularly benzodiazepines. Diverted drugs are most often sourced from a family member or friend, but are also sourced from overseas pharmacies or laboratories, or bought from drug dealers. Drug diversion can be mitigated by good prescribing practices. Systems for monitoring the prescribing and dispensing of medicines are being instituted across Australia. PMID:26648654

  8. Initiatives to improve appropriate antibiotic prescribing in primary care.

    PubMed

    Harris, Diane J

    2013-11-01

    Influencing clinicians' prescribing behaviour is important because inappropriate use and overuse of antibiotics are major drivers of antibiotic resistance. A systematic review of interventions for promoting prudent prescribing of antibiotics by general practitioners suggests that multifaceted interventions will maximize acceptability. This article reports how this type of approach has been used successfully in Derbyshire, UK over the last 4 years. The range of interventions that have been used includes educational meetings (both open group events and others targeted at higher prescribers in the surgery) using a supportive and guiding ethos; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients' knowledge and confidence in self-management; and the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit. Education on antibiotics in schools was a novel approach, which was developed in North Derbyshire to increase public awareness of the appropriate treatment for common illnesses without using antibiotics. PMID:24030546

  9. Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study

    PubMed Central

    Shankar, Ravi Pathiyil; Partha, Praveen; Shenoy, Nagesh Kumar; Easow, Joshy Maducolil; Brahmadathan, Kottallur Narayanan

    2003-01-01

    Background Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns. Methods The study was carried out over a 3-month period (01.04.2002 to 30.06.2002) at the Manipal Teaching Hospital, Western Nepal. The median number of days of hospitalization and mean ± SD cost of antibiotics prescribed during hospital stay were calculated. The use of antibiotics was classified for prophylaxis, bacteriologically proven infection or non-bacteriologically proven infection. Sensitivity patterns of the common organisms were determined. Defined daily dose/100 bed-days of the ten most commonly prescribed antibiotics were calculated. Results 203 patients were prescribed antibiotics; 112 were male. Median duration of hospitalization was 5 days. 347 antibiotics were prescribed. The most common were ampicillin, amoxicillin, metronidazole, ciprofloxacin and benzylpenicillin. Mean ± SD cost of antibiotics was 16.5 ± 13.4 US$. Culture and sensitivity testing was carried out in 141 patients. The common organisms isolated were H. influenzae, E. coli, K. pneumoniae and S. aureus. Conclusions Antibiotic resistance is becoming a problem in the Internal Medicine ward. Formulation of a policy for hospital antibiotic use and an educational programme especially for junior doctors is required. PMID:12904265

  10. Controlled drugs.

    PubMed

    2016-05-18

    Essential facts Controlled drugs are defined and governed by the Misuse of Drugs Act 1971 and associated regulations. Examples of controlled drugs include morphine, pethidine and methadone. Since 2012, appropriately qualified nurses and midwives can prescribe controlled drugs for medical conditions within their competence. There are some exceptions when treating addiction. PMID:27191427

  11. When not to trust therapeutic drug monitoring

    PubMed Central

    Westergreen-Thorne, Mathew; Lee, Sook Yan; Shah, Nilesh; Dodd, Alan

    2016-01-01

    Therapeutic drug monitoring (TDM) is the measurement of serum or plasma drug concentration to allow the individualization of dosing. We describe the case of a patient who was prescribed inappropriately large doses of vancomycin due to inaccurate TDM. Specifically, our laboratory reported progressively lower vancomycin concentrations despite dose increases. Eventually, when duplicate samples were sent to a different laboratory vancomycin concentrations were found to be in the toxic range. We hypothesize this was due to the patient generating immunoglobulin antibodies against her infection that interfered with the original TDM immunoassay. Immunogenic TDM interference has been known to rarely occur in patients with immune related comorbidities; however, if we are correct, this is a unique case as this patient did not have such a background. This case illustrates the importance of using clinical judgement when interpreting TDM as, in this case, substantial harm to the patient was likely only narrowly avoided. PMID:27606069

  12. When not to trust therapeutic drug monitoring.

    PubMed

    Westergreen-Thorne, Mathew; Lee, Sook Yan; Shah, Nilesh; Dodd, Alan

    2016-09-01

    Therapeutic drug monitoring (TDM) is the measurement of serum or plasma drug concentration to allow the individualization of dosing. We describe the case of a patient who was prescribed inappropriately large doses of vancomycin due to inaccurate TDM. Specifically, our laboratory reported progressively lower vancomycin concentrations despite dose increases. Eventually, when duplicate samples were sent to a different laboratory vancomycin concentrations were found to be in the toxic range. We hypothesize this was due to the patient generating immunoglobulin antibodies against her infection that interfered with the original TDM immunoassay. Immunogenic TDM interference has been known to rarely occur in patients with immune related comorbidities; however, if we are correct, this is a unique case as this patient did not have such a background. This case illustrates the importance of using clinical judgement when interpreting TDM as, in this case, substantial harm to the patient was likely only narrowly avoided. PMID:27606069

  13. Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice.

    PubMed

    Kourlaba, Georgia; Gkrania-Klotsas, Effrossyni; Kourkouni, Eleni; Mavrogeorgos, Georgios; Zaoutis, Theoklis E

    2016-06-30

    We provide a representative analysis of antibiotic prescribing, identify factors associated with broad-spectrum antibiotic prescribing and assess the costs associated with antibiotic use in adult outpatients in Greece. Outpatient antibiotic prescriptions for patients older than 19 years between 2010 and 2013 in Greece were extracted from the IMS Health Xponent database. Prescribing rate and total cost for prescribed antibiotics were calculated. Multivariate logistic regression was used to identify factors related to broad-spectrum antibiotic prescribing. More than 20 million antibiotics were prescribed during the study period, an annual rate of 768 prescribed antibiotics per 1,000 adults. Overall, 33.5% of antibiotics were prescribed for acute respiratory tract infections (ARTIs) for which antibiotics are often not indicated. Macrolides (29.9%), cephalosporins (26.9%) and fluoroquinolones (21.0%) were the most commonly prescribed antibiotic classes. The majority (89.0%) of antibiotics were broad-spectrum. Antibiotic expenditures were approximately EUR 185 million during the study period. Factors associated with broad-spectrum prescribing included older patient age, specialty pulmonologists or otorhinolaryngologists, training in eastern Europe, diagnosis of ARTI, acute diagnosis, and first episode of disease. Broad-spectrum antibiotic prescribing for ARTIs is common in adult Greek outpatients and frequently inappropriate. These data indicate the need for initiatives aiming to control antibiotic prescribing. PMID:27390126

  14. Prescribing Strategies for the Frail Elderly

    PubMed Central

    Sloan, John P.

    1992-01-01

    Current recommendations for prescribing for the frail elderly can be supplemented by others of value to family physicians. Minimization or simplification of medication regimens, proof of medication efficacy, vigilance for adverse drug reactions, and knowledge of aging and medications are important. Compliance is critical for the community-dwelling frail elderly but is rarely a problem in long-term care facilities. High-yield, high-risk conditions with presentations different from the “geriatric giants” must be recognized. Less medication is not necessarily the best treatment. Routine surveillance and frequent follow up are essential to adequate pharmacotherapy of frail elderly people. PMID:21221302

  15. Salbutamol in paediatrics: pharmacology, prescribing and controversies.

    PubMed

    Andrzejowski, Paul; Carroll, Will

    2016-08-01

    Salbutamol has become a key drug in respiratory medicine since it was first developed by Sir David Jack et al in 1968, 5000 years after the β agonist ephedrine was first used in its raw form, as the Ma Huang herb in Chinese medicine to treat asthma. It is one of the most commonly encountered medicines in paediatric practice and the authors have found that an understanding of its pharmacology in clinical practice is incredibly helpful. In this article, we discuss its pharmacology and pharmacodynamics, practical prescribing points and some unresolved issues surrounding its use, which should serve to provide an essential working knowledge for the busy paediatrician. PMID:27059284

  16. Leveraging hospital formularies for improved prescribing.

    PubMed

    Karas, Albert; Kuehl, Bonnie

    2014-01-01

    Hospital formularies, guided by the Pharmacy and Therapeutics Committee, exist to optimize medication use by identifying and designating drugs of choice to guide rational prescribing, ultimately reducing patient risk and costs and improving patient outcomes. Guidelines and a framework exist to guide critical evaluations of medications for formulary listing; however, there may be opportunities to improve and standardize how a formulary change could be instituted in Canadian hospitals. A formulary change at an Ontario hospital revealed that there are some key challenges to the formulary change process including the importance of a robust project plan, appropriate resources, healthcare staff education, and acceptance. PMID:25046967

  17. Perspectives on electronic prescribing and terminologies.

    PubMed

    Liebovitz, David

    2013-01-01

    Electronic medical records provide potential benefits and also drawbacks. Potential benefits include increased patient safety and efficiency. Potential drawbacks include newly introduced errors and diminished workflow efficiency. In the patient safety context, medication errors account for significant patient harm. Electronic prescribing (e-prescribing) offers the promise of automated drug interaction and dosage verification. In addition, the process of enabling e-prescriptions also provides access to an often unrecognized benefit, that of viewing the dispensed medication history. This information is often critical to understanding patient symptoms. Obtaining significant value from electronic medical records requires use of standardized terminology for both targeted decision support and population-based management. Further, generating documentation for a billable encounter requires usage of proper codes. The emergence of International Classification of Diseases (ICD)-10 holds promise in facilitating identification of a more precise patient code while also presenting drawbacks given its complexity. This article will focus on elements of e-prescribing and use of structured chart content, including diagnosis codes as they relate to physician office practices. PMID:23714550

  18. Variations in primary care prescribing: lessons to be learnt for GP commissioners.

    PubMed

    Houten, Rachel; Wailoo, Allan; Jonsson, Pall; McLeod, Claire

    2014-01-01

    The quality and quantity of primary care prescribing represents a fundamental determinant of the clinical and cost-effectiveness of the UK NHS. The aim of this study was to determine the 'supply' factors that affect primary care prescribing, controlling for 'demand' factors and consider the implications for clinical commissioning groups (CCGs). A detailed regression analysis was undertaken of prescribing in six therapeutic areas to determine differences in prescribing across primary care trusts (PCTs) in England. Results indicate that there are large unexplained variations in primary care prescribing. With the disbanding of the PCTs, and budgets moving to general practitioners (GPs), the role of efficiently and effectively managing prescribing will fall to GP commissioners. Therefore, mechanisms need to be put in place now to ensure that GPs are able to monitor their prescribing and reduce unnecessary drug usage, and further research into the reasons for variations in prescribing needs to be conducted at the CCG level. PMID:23714273

  19. Chinese regulation of off-label use of drugs.

    PubMed

    Ma, Feng; Lou, Nan

    2013-01-01

    China has significant gaps and weaknesses in its regulatory oversight of the off-label use of drugs. As in the United States, the off-label prescribing of drugs is not prohibited in China if there is a sound scientific basis. Physicians are allowed to prescribe off-label drugs based on their medical judgment if they follow certain requirements. There is some constraint on the right to prescribe by the imposition of malpractice liability if patients are harmed from improper off-label prescribing. However, damages awarded to successful plaintiffs are usually insignificant compared to malpractice damage awards in the U.S. Advertisement of off-label use is prohibited in China. All drug advertisements in China are subject to pre-approval, and must be based on information included in the approved package insert. However, the term "advertisement" is poorly defined. As a result, non-advertisement promotion of drugs for on-label or off-label use exist in a unregulated gray area. To better address the problem of inappropriate off-label promotion and use, China should (i) regulate both drug advertisements and non-advertisement promotion under a standard requiring off-label use to have a sound scientific basis, (ii) introduce harsher regulatory penalties, and (iii) increase compensation available for victims of medical malpractice. Such reform would not only discourage improper off-label use by introducing penalties (or increasing existing penalties) for improper promotion, but would also provide reasonable compensation for victims harmed by off-label use. PMID:24640468

  20. Codeine in paediatrics: pharmacology, prescribing and controversies.

    PubMed

    Andrzejowski, Paul; Carroll, Will

    2016-06-01

    Codeine is a drug that until recently was widely used in children. It was endorsed by the WHO as the second step on the analgesic ladder for cancer pain and has been used routinely for postoperative and breakthrough pain. Recently, its safety and efficacy have been called into question, following deaths after adenotonsillectomy was associated with its use. This has led to regulation by the US Food and Drug Administration, European Medicines Agency and the UK Medicines and Healthcare products Regulatory Agency to place significant restrictions on its use, and some centres have stopped using it altogether.In this article, we discuss the developmental pharmacology underpinning its action, reviewing what is known about the pharmacokinetics, pharmacodynamics and pharmacogenetics in children, how this relates to prescribing, as well as the practical issues and the recent regulatory framework surrounding its use. PMID:26984558

  1. E-Prescribing: History, Issues, and Potentials

    PubMed Central

    Salmon, J. Warren; Jiang, Ruixuan

    2012-01-01

    Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform. PMID:23569654

  2. E-prescribing: history, issues, and potentials.

    PubMed

    Salmon, J Warren; Jiang, Ruixuan

    2012-01-01

    Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform. PMID:23569654

  3. Effectiveness of a vancomycin restriction policy in changing the prescribing patterns of house staff.

    PubMed

    Richardson, L P; Wiseman, S W; Malani, P N; Lyons, M J; Kauffman, C A

    2000-01-01

    After noting a rise in vancomycin-resistant enterococci (VRE) infections, we initiated a program to decrease inappropriate vancomycin use that focused on improvement of house staff prescribing practices. The initial intervention in June, 1995, encouraging house staff to follow hospital guidelines for vancomycin use and eliciting support from service chiefs in this effort, had little impact. A more intensive educational intervention, beginning in January, 1996, involved concurrent review of all vancomycin orders and one-on-one discussion with the house staff regarding the rationale for the order by an infectious diseases clinical pharmacist. When usage was deemed inappropriate, the pharmacist asked that vancomycin be discontinued, but no automatic stop orders were issued. During the next two and one-half years, this second intervention proved effective at decreasing inappropriate use from 39% to 16.8% +/- 2.4% (p = 0.005). This change was primarily due to a decrease in appropriate vancomycin prophylaxis by cardiothoracic surgery. VRE infections decreased from 0.29/100 patients discharged prior to initiating the program to 0.13/100 patients discharged after the second intervention (p = 0.01). This educational program, although labor-intensive, preserved house staff decision-making skills related to antibiotic prescribing at the same time that it decreased inappropriate vancomycin use. PMID:11272262

  4. Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

    PubMed Central

    Lu, Wan-Hsuan; Wen, Yu-Wen; Chen, Liang-Kung; Hsiao, Fei-Yuan

    2015-01-01

    Background: Polypharmacy, potentially inappropriate medications and anticholinergic burden (as assessed by the anticholinergic risk scale) are commonly used as quality indicators of pharmacotherapy in older adults. However, their role in clinical practice is undefined. We sought to investigate longitudinal changes in these indicators and their effects on clinical outcomes. Methods: We used Taiwan’s Longitudinal Health Insurance Database to retrieve quarterly information about drug use for people aged 65 years and older over a 10-year period. We analyzed the association between indicators and all-cause admission to hospital, fracture-specific admission to hospital and death using generalized estimating equations. Results: The study cohort comprised 59 042 older adults (65–74 yr: 39 358 [66.7%], 75–84 yr: 16 903 [28.6%], and ≥ 85 yr: 2781 [4.7%]). The mean changes in polypharmacy over the course of the study were greatest among patients aged 65–74 years (absolute difference +2.14, 95% confidence interval [CI] 2.10–2.19), then among those aged 75–84 yr (+1.79, 95% CI 1.70–1.88), and finally those aged 85 years and older (+0.71, 95% CI 0.36–1.05). The number of potentially inappropriate medications increased among patients aged 65–74 years (+0.16 [0.15–0.18]) and 75–84 years (+0.09 [0.06–0.08]), but decreased in those aged 85 years and older (−0.15 [−0.26 to −0.04]). Polypharmacy, potentially inappropriate medications and anticholinergic risk scale were each associated with an increased risk of admission to hospital, but not with death. In addition, both polypharmacy (5–9 drugs: odds ratio [OR] 1.18, 95% CI 1.12–1.24; ≥ 10 drugs: OR 1.54, 95% CI 1.42–1.66) and anticholinergic burden (score 1–2: 1.39, 95% CI 1.31–1.48; ≥ 3: 1.53, 95% CI 1.41–1.66) showed dose–response relations with fracture-specific admission to hospital. Interpretation: The total number of drugs taken (polypharmacy), number of potentially inappropriate

  5. Prescribing behaviour in general practice: the impact of promoting therapeutically equivalent cheaper medicines.

    PubMed Central

    Roberts, S J; Bateman, D N; Smith, J M

    1997-01-01

    BACKGROUND: The volume and cost of prescribing varies considerably between practices. This variation is at least in part due to the prescribing behaviour of individual doctors, who are often faced with a range of therapeutically equivalent generic and brand-name drugs. AIM: To assess the impact on general practitioners' prescribing behaviour of promoting therapeutically equivalent lower cost prescribing in conjunction with an incentive scheme. METHOD: Annual prescribing data from before (1992-93) and after (1993-94) implementation of the incentive scheme were compared retrospectively for general practices in the former Northern Regional Health Authority. Main outcome measures were the practices' 1993-94 rates of prescribing relative to those in 1992-93 for 18 drugs prescribed by brand name, of which 10 were targeted in the promotion, and for 14 drugs or classes of drugs either with equivalent cheaper alternatives or of limited clinical value (10 targeted and four not). RESULTS: For 17 of the 18 drugs, brand name prescribing rates were significantly lower in 1993-94. Reductions in rates were greater for the 10 drugs appearing in the scheme's promotional literature. For other cost-saving measures, total prescribing rates were lower for seven classes of drugs, unchanged for one, but higher for the other six, all of which had been targeted. According to the growth in their overall per capita prescribing costs between the two study years, the 499 practices were categorized as low, average or high. Overall costs and individual prescribing rates for the majority of drugs studied were similar for these three practice groups in 1992-93. In 1993-94, practices' changes in prescribing volume differed between the groups, with the lowest increases in the low cost-growth group for all but one of the 32 classes of drugs. CONCLUSION: Generic substitution was more easily implemented than more complex hints regarding cost-saving substitutions. Practices with smaller overall cost

  6. To prescribe codeine or not to prescribe codeine?

    PubMed

    Fleming, Marc L; Wanat, Matthew A

    2014-09-01

    A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting. PMID:25102040

  7. Conducting a Prescribed Burn and Prescribed Burning Checklist

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Grasslands of the central Great Plains developed with periodic fire. Prescribed burning is an important tool for managing grasslands to maintain desirable species composition, increase grazing livestock performance, maintain productivity, and control invasive weeds. The safe and effective use of pre...

  8. Specialist Pediatric Palliative Care Prescribing Practices: A Large 5-year Retrospective Audit

    PubMed Central

    Damani, Anuja; Salins, Naveen; Ghoshal, Arunangshu; Muckaden, MaryAnn

    2016-01-01

    Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010–2014) to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%), and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription noncompliance by

  9. Appropriate and Inappropriate Practices for Coaching Female Athletes

    ERIC Educational Resources Information Center

    Bryan, Charity; Sims, Sandra

    2014-01-01

    This article is intended to provide coaches, parents/guardians and school administrators with specific guidelines that identify coaching practices that are in the best interests of the adolescent female athlete (appropriate) and those that are counterproductive or even harmful (inappropriate). These guidelines can be used as a self-assessment for…

  10. Experimental Analysis of Response Covariation among Compliant and Inappropriate Behaviors.

    ERIC Educational Resources Information Center

    Parrish, John M.; And Others

    1986-01-01

    The study investigated the relationship between topographically different child behaviors (compliance and inappropriate activities) in four mentally retarded subjects (aged 3-5) by using a methodology that tests for response covariation. Regardless of the intervention used, the behavior targeted, or the direction manipulated, the nontargeted…

  11. Altering the Inappropriate Comments of a Student with Multiple Disabilities

    ERIC Educational Resources Information Center

    Schoen, Sharon Faith; Thomas, Rachel

    2006-01-01

    This article offers an example of how teachers may successfully use a process for addressing problem behaviors in the classroom. The process includes (1) framing critical questions, (2) collecting relevant data, (3) taking well-researched actions, and (4) reflecting on the impact of these actions. Guided by these steps, the inappropriate comments…

  12. Appropriate and Inappropriate Uses of Humor By Teachers

    ERIC Educational Resources Information Center

    Bekelja Wanzer, Melissa; Bainbridge Frymier, Ann; Wojtaszczyk, Ann M; Smith, Tony

    2006-01-01

    The use of humor in teaching has been linked to learning in several studies, although the research has been equivocal. The various types of humor used by teachers have also been investigated but not in terms of what students view as appropriate and inappropriate uses of humor. Participants in this study were asked to generate examples of…

  13. Inappropriate Student Behavior--A Problem for Student Teachers.

    ERIC Educational Resources Information Center

    Boyce, Ann

    1997-01-01

    Describes a strategy used in a preservice teacher education program to help student teachers and practicum students deal effectively with inappropriate pupil classroom behavior. The three-step strategy helps student teachers effectively identify and modify the behavior of children who misbehave. (SM)

  14. Functional Analysis and Treatment of Inappropriate Sexual Behavior.

    ERIC Educational Resources Information Center

    Fyffe, Christie E.; Kahng, SungWoo; Fittro, Ellen; Russell, David

    2004-01-01

    The results of a functional analysis showed that inappropriate sexual behaviors exhibited by a 9-year-old boy who had been diagnosed with traumatic brain injury were maintained by positive reinforcement in the form of social attention. An intervention consisting of functional communication training and extinction resulted in reduced levels of…

  15. Sexually Inappropriate or Abusive Behaviour among Pupils in Special Schools

    ERIC Educational Resources Information Center

    Fyson, Rachel

    2009-01-01

    In this article, Rachel Fyson of the Centre for Social Work in the School of Sociology and Social Policy at the University of Nottingham reports the findings of a study into sexually inappropriate or abusive behaviour occurring between pupils in special schools in four local authorities in England. The behaviours identified ranged from relatively…

  16. PGN Prescribed Burn Research Summary

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Since 1997, we have been studying the effects of prescribed burns conducted during late winter on shortgrass steppe on the Pawnee National Grassland. During 1997 – 2002, we studied burns on the western (Crow Valley) portion of the Pawnee by comparing plant growth on burns conducted by the Forest Ser...

  17. Prescribed fire as an alternative measure in European grassland conservation

    NASA Astrophysics Data System (ADS)

    Valkó, Orsolya; Deák, Balázs; Török, Péter; Tóthmérész, Béla

    2015-04-01

    There are contrasting opinions on the perspectives of prescribed burning management in European grasslands. One hand, prescribed burning can be effectively used with relatively low implementation costs for the management of open landscapes, the reduction of accumulated litter or for decreasing the chance of wildfires. On the other hand burning can also have serious detrimental impacts on grassland ecosystems by promoting the dominance of some problem species (e.g. some competitors or invasive species) and by threatening endangered plant and animal species, especially invertebrates, thus, inappropriate burning can result in a loss of biodiversity in the long run. Our goal was to review the publications on the application of prescribed burning in European grasslands considering general (e.g. timing, frequency and duration) and specific (e.g. types of grasslands, effects on endangered species) circumstances. Even prescribed burning forms an integral part of the North-American grassland management practice, it is rarely applied in Europe, despite the fact that uncontrolled burning occurs frequently in some regions. According to the North-American experiences prescribed burning can be a viable solution for biodiversity conservation and can be a feasible solution for several nature conservation problems. We reviewed prescribed burning studies from Europe and North-America to identify findings which might be adapted to the European grassland conservation strategy. We found that not only the application of fire management is scarce in Europe but there is also a lack of published studies on this topic. European studies - contrary to the North-American practice - usually used yearly dormant-season burning, and concluded that this burning type solely is not feasible to preserve and maintain species-rich grasslands. In North-American grasslands, application of burning has a stronger historical, practical and scientific background; it is fine-tuned in terms of timing, frequency

  18. Serial pharmacological prescribing practices for tic management in Tourette syndrome.

    PubMed

    Farag, Mena; Stern, Jeremy S; Simmons, Helen; Robertson, Mary M

    2015-11-01

    Pharmacological treatments for Tourette syndrome (TS) vary in efficacy between different patients. The evidence base is limited as even high quality controlled studies tend to be of relatively short duration which may lose relevance in clinical usage. Patients are frequently treated with serial agents in the search for efficacy and tolerability. The success of this strategy has not been previously documented. We examined 400 consecutive TS patients seen over a 10-year period, some with a longer prior history in other clinics; 255/400 (64%) were prescribed medication. We present this heterogeneous cohort in terms of the number of drugs they had tried, and as a proxy measure of some benefit of the last drug used, whether it had been prescribed under our supervision for ≥ 5 months. The most commonly prescribed medications were aripiprazole (64%), clonidine (40%), risperidone (30%) and sulpiride (29%) with changes in prescribing practises over the period examined. The number of different drugs tried were one (n = 155), two (n = 69), three (n = 36), four (n = 14), five (n = 15), six (n = 5), seven (n = 2) and eight (n = 1). The data illustrate the difficulty in drug treatment of tics and suggest that even after trials of several agents there is potential benefit in trying further options. PMID:26299248

  19. Doctors Urged to Prescribe Lower Doses of Opioids, No Refills

    MedlinePlus

    ... high-risk prescribing, over which clinicians have greater control. This in part reflects concern that we are dealing with risky drugs, not risky patients," he said. SOURCE: Journal of General Internal Medicine , news release, Aug. 3, 2016 HealthDay Copyright ( ...

  20. The cost-effectiveness of direct-to-consumer advertising for prescription drugs.

    PubMed

    Atherly, Adam; Rubin, Paul H

    2009-12-01

    In this paper we use published information to analyze the economic value of Direct to Consumer Advertising (DTCA). The reviewed research finds that DTCA leads to increased demand for the advertised drug and that the effect of the drug tends to be class-wide rather than product specific. There is weak evidence that DTCA may increase compliance and improve clinical outcomes. However, there is little research on the effect of DTCA on inappropriate prescribing or on the characteristics of patients who respond to treatment. On net, if the advertised drugs are cost effective on average and the patients using the drugs in response to the advertisement are similar to other users, DTCA is likely cost effective. Overall, the literature to date is consistent with the idea that DTCA is beneficial, but further research is needed before definitive conclusions can be drawn. PMID:19423875

  1. Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu

    PubMed Central

    Gopalakrishnan, Sekharan; Ganeshkumar, Parasuraman; Katta, Ajitha

    2013-01-01

    Background: Studying drug use pattern among medical practitioners is of vital importance in the present scenario where irrational drug use and development of drug resistance is becoming rampant. Objective: To assess, the pattern of prescribing practices among the general practitioners in a defined rural and urban area of Tamil Nadu. Materials and Methods: A community based descriptive study was conducted to collect 600 prescriptions from the catchment areas of rural and urban health training centers of a medical college using prescribing indicators as per the WHO “How to investigate drug use in health facilities” tool. Results: This prescription study revealed that multivitamins (19.5%), antibiotics (19.3%), drugs for gastro-intestinal tract (GIT) (18%), analgesic non-steroidal anti-inflammatory drugs/ (NSAID's) (15.1%), and antihistaminic (12.5%) were prescribed frequently. Among the antibiotics, amoxicillin (49.2%) was the most commonly prescribed followed by gentamicin (31.7%). Percentage of prescriptions with an antibiotic was 55% and nearly 62% of the practitioners prescribed drugs by their generic names. As a practice of poly-pharmacy, it was observed that the average number of drugs prescribed in urban and rural area was nearly 5 and 4, respectively. Nearly 80% of the urban and rural practitioners were prescribing at least one injection. Study of the quality of prescriptions revealed that there was poor legibility, high usage of abbreviations, inadequate details of the drugs, and absence of signature by practitioners in the prescriptions. Conclusion: This study clearly highlights the practice of poly-pharmacy, low usage of generic drugs, injudicious usage of antibiotics and injections and low usage of drugs prescribed from essential drugs list. PMID:23833368

  2. Knowledge and Attitude of Physicians Toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals

    PubMed Central

    Alothman, Adel; Algwizani, Abdullah; Alsulaiman, Mohammed; Alalwan, Abdullah; Binsalih, Salih; Bosaeed, Mohammad

    2016-01-01

    INTRODUCTION Antibiotics are essential and abundantly prescribed in hospitals because of their effectiveness and lifesaving benefits. However, the unnecessary use of antibiotics has been observed in earlier studies, and it has persisted through recent years as a major issue since it is one of the leading causes of antibiotic resistance. The increase in antibiotic resistance nowadays is one of the most critical concerns in global public health around the world. The objective of this study was to evaluate the knowledge and perceptions related to antibiotic prescription among physicians at our medical centers. METHOD A cross-sectional survey of non-infectious diseases specialized physicians. The study was conducted during 2015 at two tertiary care centers in Riyadh, Saudi Arabia. RESULT Of the 107 returned questionnaires, 93 were complete and valuable. Most respondents (82%) perceived antibiotic resistance to be a critical problem globally, and 78% also think that it is a very important national problem. These attitudes did not differ across specialty or level of training. Widespread antibiotic use and inappropriate empirical choices were believed by 81% of the participants to be important general causes of resistance. Only half of respondents thought that antibiotic restriction is a useful intervention to decrease the antibiotic resistance. The physicians believed educational interventions are the most useful and effective way to improve prescription patterns and decrease antibiotic resistance. Complications due to infection with resistant organisms were acknowledged by almost all of the participants, with some differences in their estimations of how often it will occur. CONCLUSION Antimicrobial resistance, globally and nationally, is considered as a serious threat, and physicians in this survey acknowledged that. Among the most significant factors is antimicrobial misuse, either by overprescribing or providing inappropriate drugs with some ambivalence, as well as

  3. London 2012: prescribing for athletes in ophthalmology

    PubMed Central

    Nicholson, R G H; Thomas, G P L; Potter, M J; Norris, J H

    2012-01-01

    Aims Prescribing for athletes requires an up-to-date knowledge of the World Anti-Doping Agency's list of prohibited substances. As the London 2012 Olympic Games attract athletes from around the world, we review the current guidelines with respect to all medications licensed for ophthalmic use in the United Kingdom. We describe the process that an ophthalmologist can use to check for permissible medications and also highlight treatments that are contraindicated. Methods We systematically reviewed all 77 drugs listed in Section 11 of the British National Formulary (Issue 63) for use in the treatment of ophthalmic conditions, and referenced these against the 2012 Prohibited List published by the World Anti-Doping Agency. Results The majority of ophthalmic preparations are suitable for use in- and out-of-competition. Some preparations, such as glucocorticoids, are prohibited when administered systemically but permitted for topical administration. Beta-blockers are prohibited in-competition and oral carbonic anhydrase inhibitors are prohibited in- and out-of competition. Conclusion The 2012 Prohibited List has important implications for the pharmacological treatment of ophthalmic conditions in athletes. Clinicians prescribing for athletes have a duty to familiarise themselves with the list in order to avoid causing significant damage to their patient's career and reputation. PMID:22744394

  4. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID–warfarin co-prescribing as a test case

    PubMed Central

    Schinnar, Rita; Bilker, Warren; Hennessy, Sean; Leonard, Charles E; Pifer, Eric

    2010-01-01

    Background Studies that have looked at the effectiveness of computerized decision support systems to prevent drug–drug interactions have reported modest results because of low response by the providers to the automated alerts. Objective To evaluate, within an inpatient computerized physician order entry (CPOE) system, the incremental effectiveness of an alert that required a response from the provider, intended as a stronger intervention to prevent concurrent orders of warfarin and non-steroidal anti-inflammatory drugs (NSAIDs). Design Randomized clinical trial of 1963 clinicians assigned to either an intervention group receiving a customized electronic alert requiring affirmative response or a control group receiving a commercially available passive alert as part of the CPOE. The study duration was 2 August 2006 to 15 December 2007. Measurements Alert adherence was compared between study groups. Results The proportion of desired ordering responses (ie, not reordering the alert-triggering drug after firing) was lower in the intervention group (114/464 (25%) customized alerts issued) than in the control group (154/560 (28%) passive alerts firing). The adjusted OR of inappropriate ordering was 1.22 (95% CI 0.69 to 2.16). Conclusion A customized CPOE alert that required a provider response had no effect in reducing concomitant prescribing of NSAIDs and warfarin beyond that of the commercially available passive alert received by the control group. New CPOE alerts cannot be assumed to be effective in improving prescribing, and need evaluation. PMID:20595308

  5. Clinical drug research in chronic central neurodegenerative disorders.

    PubMed

    Müller, Thomas; Foley, Paul

    2016-05-01

    Several compounds developed the treatment of Alzheimer's disease and Parkinson's disease have been clinically unsuccessful. Suggested reasons for these failures have included heterogeneous symptom expression, inappropriate assessment of effects, safety and tolerability hurdles, short duration of disease-modifying trials, recruiting pressure on study centers, administrative and bureaucratic overload, and pooling results from trial centers in different health care systems with differing quality and therapeutic concepts. The solution to these problems will include reducing the costs of drug development, with a concomitant reduction of approval hurdles. Trial designs are influenced by ethics committees, health care officials, political administrations, and research scientists. None have direct contact with the treated patients. Approval of novel therapeutic agents lies in the remit of health care officials, whereby price plays a more dominant role than therapeutic efficacy. Patients and prescribing physicians, however, are better placed to act as arbiters of the efficacy, risks, and overall value of a new drug in practice. PMID:26950806

  6. Risk and liabilities of prescribing compounded medications.

    PubMed

    Randell, Michael D; Duffy, Phillip J

    2014-07-01

    Complications resulting from the use of compounded medications have become a troubling trend nationwide. There is a significant potential for patients to suffer serious harm from the use of substandard medications prepared by compounding pharmacies, and the reality of this problem has been demonstrated in several well-publicized incidences of serious medical complications, including patient deaths, that directly resulted from the use of medications prepared at compounding pharmacies. Unlike US Food and Drug Administration (FDA)-approved drugs, compounded products are not required to meet evidentiary standards for establishing safety and efficacy. Moreover, these products are not held to Good Manufacturing Practices, which require regular inspections, quality control testing, and rejection of material not meeting specifications. Physicians, as well as other prescribers, need to be aware that when a patient suffers harm from using a compounded medication, those injured patients may bring negligence and malpractice claims, not only against the pharmacy and the pharmacist responsible for preparing the medication, but also against the prescribing physician and the physician’s practice. Consequently, the best way for physicians to manage professional risk and avoid both litigation and potential negative patient outcomes related to compounded pharmaceuticals is to not use these products if there is an FDA-approved product available. However, if the use of a compounded medication is medically necessary, then physicians should adhere to the FDA guidance concerning traditional compounding. Moreover, it would be prudent for any physician who intends to either resell or participate in the distribution of compounded products beyond the direct treatment of their patients to consider obtaining the appropriate insurance coverage for this activity. PMID:25276868

  7. [Overtreatment: Initiatives to identify ineffective and inappropriate medical interventions].

    PubMed

    Wild, Claudia; Mayer, Julia

    2016-04-01

    A growing number of international initiatives rise to the challenge of reduction of medical overuse. Increasingly, these activities are promoted by physicians and clinicians, and aim to identify and avoid inappropriate health interventions. This article places the Choosing Wisely initiative within the context of less well-known activities, 13 all together, and briefly describes their characteristics; in addition, similarities and differences regarding their methods are elaborated. PMID:26883771

  8. Inappropriate use of potent topical glucocorticoids in infants.

    PubMed

    Ozon, Alev; Cetinkaya, Semra; Alikasifoglu, Ayfer; Gonc, E Nazli; Sen, Yaşar; Kandemir, Nurgün

    2007-02-01

    Topical therapy with glucocorticoids (GCs) is used commonly in chronic dermatoses. Side effects are less common compared to systemic use; however, newer potent preparations may have serious side effects. A potential danger is their inappropriate use. Three infants who developed iatrogenic Cushing's syndrome and prolonged adrenal suppression in the course of GC therapy for simple diaper dermatitis are described. One patient also developed steatohepatitis which is uncommon with local GCs. PMID:17396439

  9. Requests for "inappropriate" treatment based on religious beliefs.

    PubMed

    Orr, R D; Genesen, L B

    1997-06-01

    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. PMID:9220325

  10. Reducing inappropriate ESR testing with computerized clinical decision support

    PubMed Central

    Gottheil, Stephanie; Khemani, Ekta; Copley, Katherine; Keeney, Michael; Kinney, Jeff; Chin-Yee, Ian; Gob, Alan

    2016-01-01

    Laboratory test overutilization increases health care costs, leads to unwarranted investigations, and may have a negative impact on health outcomes. The American Society of Clinical Pathology, in its Choosing Wisely Campaign, advocates that inflammation be investigated with C-reactive protein (CRP) instead of Erythrocyte Sedimentation Rate (ESR). London Health Sciences Centre (LHSC), a tertiary care hospital organization in Ontario, Canada, set a goal to reduce inappropriate ESR orders by 50%. After developing appropriateness criteria for ESR, we used a series of PDSA cycles to reduce inappropriate ESR ordering and analyzed our results with an interrupted time series design. Our intervention began with an educational bulletin and moved to city-wide implementation of computerized Clinical Decision Support (CDS). After implementation, ESR orders decreased by 40% from 386 orders per week to 241 orders per week. Our results are supported by previous literature on the effectiveness of CDS in reducing overutilization and suggest that provider habit is a significant contributor to inappropriate ordering. PMID:27096092

  11. Requests for "inappropriate" treatment based on religious beliefs.

    PubMed Central

    Orr, R D; Genesen, L B

    1997-01-01

    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. PMID:9220325

  12. Reducing inappropriate ESR testing with computerized clinical decision support.

    PubMed

    Gottheil, Stephanie; Khemani, Ekta; Copley, Katherine; Keeney, Michael; Kinney, Jeff; Chin-Yee, Ian; Gob, Alan

    2016-01-01

    Laboratory test overutilization increases health care costs, leads to unwarranted investigations, and may have a negative impact on health outcomes. The American Society of Clinical Pathology, in its Choosing Wisely Campaign, advocates that inflammation be investigated with C-reactive protein (CRP) instead of Erythrocyte Sedimentation Rate (ESR). London Health Sciences Centre (LHSC), a tertiary care hospital organization in Ontario, Canada, set a goal to reduce inappropriate ESR orders by 50%. After developing appropriateness criteria for ESR, we used a series of PDSA cycles to reduce inappropriate ESR ordering and analyzed our results with an interrupted time series design. Our intervention began with an educational bulletin and moved to city-wide implementation of computerized Clinical Decision Support (CDS). After implementation, ESR orders decreased by 40% from 386 orders per week to 241 orders per week. Our results are supported by previous literature on the effectiveness of CDS in reducing overutilization and suggest that provider habit is a significant contributor to inappropriate ordering. PMID:27096092

  13. Detecting Inappropriate Access to Electronic Health Records Using Collaborative Filtering.

    PubMed

    Menon, Aditya Krishna; Jiang, Xiaoqian; Kim, Jihoon; Vaidya, Jaideep; Ohno-Machado, Lucila

    2014-04-01

    Many healthcare facilities enforce security on their electronic health records (EHRs) through a corrective mechanism: some staff nominally have almost unrestricted access to the records, but there is a strict ex post facto audit process for inappropriate accesses, i.e., accesses that violate the facility's security and privacy policies. This process is inefficient, as each suspicious access has to be reviewed by a security expert, and is purely retrospective, as it occurs after damage may have been incurred. This motivates automated approaches based on machine learning using historical data. Previous attempts at such a system have successfully applied supervised learning models to this end, such as SVMs and logistic regression. While providing benefits over manual auditing, these approaches ignore the identity of the users and patients involved in a record access. Therefore, they cannot exploit the fact that a patient whose record was previously involved in a violation has an increased risk of being involved in a future violation. Motivated by this, in this paper, we propose a collaborative filtering inspired approach to predicting inappropriate accesses. Our solution integrates both explicit and latent features for staff and patients, the latter acting as a personalized "finger-print" based on historical access patterns. The proposed method, when applied to real EHR access data from two tertiary hospitals and a file-access dataset from Amazon, shows not only significantly improved performance compared to existing methods, but also provides insights as to what indicates an inappropriate access. PMID:24683293

  14. Understanding Antibiotic Use in Minya District, Egypt: Physician and Pharmacist Prescribing and the Factors Influencing Their Practices.

    PubMed

    Dooling, Kathleen L; Kandeel, Amr; Hicks, Lauri A; El-Shoubary, Waleed; Fawzi, Khaled; Kandeel, Yasser; Etman, Ahmad; Lohiniva, Anna Leena; Talaat, Maha

    2014-01-01

    Overuse of antibiotics has contributed to the emergence of antibiotic-resistant bacteria globally. In Egypt, patients can purchase antibiotics without a prescription, and we hypothesized frequent inappropriate antibiotic prescribing and dispensing. We interviewed physicians (n = 236) and pharmacists (n = 483) and conducted focus groups in Minya, Egypt, to assess attitudes and practices regarding antibiotic prescribing for outpatient acute respiratory infections (ARI). Antibiotics were reportedly prescribed most of the time or sometimes for colds by 150 (64%) physicians and 326 (81%) pharmacists. The most commonly prescribed antibiotics were β-lactams. Macrolides were the second most commonly prescribed for colds and sinusitis. The prescription of more than one antibiotic to treat pneumonia was reported by 85% of physicians. Most respondents thought antibiotic overuse contributes to resistance and reported "patient self-medication" as the biggest driver of overuse. Fifty physicians (21%) reported that they had prescribed antibiotics unnecessarily, citing patient over-the-counter access as the reason. Physicians <40 years of age and those who treat adults were more likely to prescribe antibiotics for colds. Overall, we found a high rate of unwarranted outpatient antibiotic prescribing and dispensing for ARIs. Patient access to OTC antibiotics contributes to over-prescribing. National guidelines for ARI treatment, provider education and national policy requiring a physician's prescription for antibiotics may improve appropriate antibiotic use in Egypt. PMID:27025746

  15. Noninsulin Antidiabetic Drugs for Patients with Type 2 Diabetes Mellitus: Are We Respecting Their Contraindications?

    PubMed Central

    Ruiz-Tamayo, Irene; Franch-Nadal, Josep; Mata-Cases, Manel; Mauricio, Dídac; Cos, Xavier; Rodriguez-Poncelas, Antonio; Barrot, Joan; Coll-de-Tuero, Gabriel; Mundet-Tudurí, Xavier

    2016-01-01

    Aim. To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer. Methods. Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination. Results. Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) < 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR < 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure. Conclusion. Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM. PMID:26881258

  16. Adverse drug reactions in special populations - the elderly.

    PubMed

    Davies, E A; O'Mahony, M S

    2015-10-01

    The International Conference on Harmonization considers older people a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations. The majority of ADRs in older people are Type A, potentially avoidable and associated with commonly prescribed medications. Several ADRs are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with benzodiazepines, neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to delirium, another multifactorial syndrome resulting in excess mortality particularly in frail older people. Clostridium difficile associated with use of broad spectrum antibiotics mainly affects frail older people and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of stroke by more than three-fold in patients with dementia. Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing ADRs. PMID:25619317

  17. Existing FDA pathways have potential to ensure early access to, and appropriate use of, specialty drugs.

    PubMed

    Kesselheim, Aaron S; Tan, Yongtian Tina; Darrow, Jonathan J; Avorn, Jerry

    2014-10-01

    Specialty drugs are notable among prescription drugs in that they offer the possibility of substantial clinical improvement, come with important risks of adverse events and mortality, can be complex to manufacture or administer, and are usually extremely costly. The Food and Drug Administration (FDA) plays a critical role in ensuring that patients who could benefit from specialty drugs have access to them in a timely fashion. In this article we review the different strategies that the FDA can use to approve and influence the post-approval prescribing of specialty drugs. When specialty drugs show promise in early clinical trials, the FDA can expedite the drugs' availability to patients through expanded access programs and expedited approval pathways that speed regulatory authorization. After approval, to ensure that specialty drugs are directed to the patients who are most likely to benefit from them, the FDA can limit the scope of the drugs' indications, encourage the development of companion diagnostic tests to indicate which patients should receive the drugs, or require that manufacturers subject them to Risk Evaluation and Mitigation Strategies to ensure that their use is appropriately limited to a restricted population that is aware of the drugs' risks and benefits. Implementing these existing regulatory approaches can promote timely patient access to specialty drugs while preventing expensive and potentially inappropriate overuse. PMID:25288421

  18. Antibiotic Prescribing Review as a Component of an Infectious Disease Course.

    ERIC Educational Resources Information Center

    Speedie, Marilyn K.; And Others

    1979-01-01

    The review of physician-prescribing is recognized as an important function for pharmacists. It is suggested that a course aimed at antibiotic drug prescribing review (DPR) would provide the opportunity to reinforce and apply the principles of DPR and to demonstrate how theoretical knowledge of antibiotics could be applied directly to practice.…

  19. How Medicare Prescription Drug Plans & Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs) Use Pharmacies,...

    MedlinePlus

    ... drug. Example of step therapy Step 1 —Dr. Smith wants to prescribe a new sleeping pill to ... sleeping pill available. Some of the drugs Dr. Smith considers prescribing are brand-name only prescription drugs. ...

  20. Attitudes towards prescribing cognitive enhancers among primary care physicians in Germany

    PubMed Central

    2014-01-01

    Background Primary care physicians are gate keepers to the medical system having a key role in giving information and prescribing drugs to their patients. In this respect they are involved in claims of patients/clients for pharmacological Cognitive Enhancement (CE). Therefore, we studied the knowledge of primary care physicians about CE and their attitudes toward prescribing CE drugs to healthy subjects. Methods A self-report paper-and-pencil questionnaire and case vignettes describing a hypothetical CE drug were sent out to all 2,753 registered primary care physicians in Rhineland Palatine, Germany. 832, i.e. 30.2% filled in the questionnaire anonymously. Results 96.0% of all participating physicians had already heard about CE. However, only 5.3% stated to be very familiar with this subject and 43.5% judged themselves as being not familiar with CE. 7.0% had been asked by their clients to prescribe a drug for CE during the last week, 19.0% during the last month, and 40.8% during the last year. The comfort level to prescribe CE drugs was very low and significantly lower than to prescribe sildenafil (Viagra®). Comfort level was mainly affected by the age of the client asking for prescription of CE drugs, followed by the availability of non-pharmacological alternatives, fear of misuse of the prescribed drug by the client and the missing indication of prescribing a drug. Conclusions Although a relatively high proportion of primary care physicians have been asked by their clients to prescribe CE drugs, only a small proportion are well informed about the possibilities of CE. Since physicians are gate keepers to the medical system and have a key role regarding a drugs’ prescription, objective information should be made available to physicians about biological, ethical and social consequences of CE use. PMID:24397728

  1. Nurse prescribing in mental health: national survey.

    PubMed

    Dobel-Ober, D; Brimblecombe, N; Bradley, E

    2010-08-01

    Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves. PMID:20633075

  2. Nonmedical prescribing: where are we now?

    PubMed Central

    Cope, Louise C.; Abuzour, Aseel S.; Tully, Mary P.

    2016-01-01

    Nonmedical prescribing has been allowed in the United Kingdom (UK) since 1992. Its development over the past 24 years has been marked by changes in legislation, enabling the progression towards independent prescribing for nurses, pharmacists and a range of allied health professionals. Although the UK has led the way regarding the introduction of nonmedical prescribing, it is now seen in a number of other Western-European and Anglophone countries although the models of application vary widely between countries. The programme of study to become a nonmedical prescriber (NMP) within the UK is rigorous, and involves a combination of taught curricula and practice-based learning. Prescribing is a complex skill that is high risk and error prone, with many influencing factors. Literature reports regarding the impact of nonmedical prescribing are sparse, with the majority of prescribing research tending to focus instead on prescribing by doctors. The impact of nonmedical prescribing however is important to evaluate, and can be carried out from several perspectives. This review takes a brief look back at the history of nonmedical prescribing, and compares this with the international situation. It also describes the processes required to qualify as a NMP in the UK, potential influences on nonmedical prescribing and the impact of nonmedical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals. PMID:27493720

  3. Nonmedical prescribing: where are we now?

    PubMed

    Cope, Louise C; Abuzour, Aseel S; Tully, Mary P

    2016-08-01

    Nonmedical prescribing has been allowed in the United Kingdom (UK) since 1992. Its development over the past 24 years has been marked by changes in legislation, enabling the progression towards independent prescribing for nurses, pharmacists and a range of allied health professionals. Although the UK has led the way regarding the introduction of nonmedical prescribing, it is now seen in a number of other Western-European and Anglophone countries although the models of application vary widely between countries. The programme of study to become a nonmedical prescriber (NMP) within the UK is rigorous, and involves a combination of taught curricula and practice-based learning. Prescribing is a complex skill that is high risk and error prone, with many influencing factors. Literature reports regarding the impact of nonmedical prescribing are sparse, with the majority of prescribing research tending to focus instead on prescribing by doctors. The impact of nonmedical prescribing however is important to evaluate, and can be carried out from several perspectives. This review takes a brief look back at the history of nonmedical prescribing, and compares this with the international situation. It also describes the processes required to qualify as a NMP in the UK, potential influences on nonmedical prescribing and the impact of nonmedical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals. PMID:27493720

  4. Prescribing medical cannabis in Canada: Are we being too cautious?

    PubMed

    Lake, Stephanie; Kerr, Thomas; Montaner, Julio

    2015-01-01

    There has been much recent discussion and debate surrounding cannabis in Canada, including the prescribing of medical cannabis for therapeutic purposes. Certain commentators - including the Canadian Medical Association (CMA) - have denounced the prescribing of cannabis for medical purposes due to a perceived lack of evidence related to the drug's efficacy, harms, and mechanism of action. In this commentary, we present arguments in favour of prescribing medical cannabis in Canada. We believe the anti-cannabis position taken by CMA and other commentators is not entirely evidence-based. Using the example of neuropathic pain, we present and summarize the clinical evidence surrounding smoked or vapourized cannabis, including recent evidence pertaining to the effectiveness of cannabis in comparison to existing standard pharmacotherapies for neuropathy. Further, we outline how the concerns expressed regarding cannabis' mechanism of action are inconsistent with current decision-making processes related to the prescribing of many common pharmaceuticals. Finally, we discuss potential secondary public health benefits of prescribing cannabis for pain-related disorders in Canada and North America. PMID:26451996

  5. Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study

    PubMed Central

    2014-01-01

    Background To describe the utilisation of antibiotics in children and adolescents across 5 European countries based on the same drug utilisation measures and age groups. Special attention was given to age-group-specific distributions of antibiotic subgroups, since comparison in this regard between countries is lacking so far. Methods Outpatient paediatric prescriptions of systemic antibiotics during the years 2005-2008 were analysed using health care databases from the UK, the Netherlands, Denmark, Italy and Germany. Annual antibiotic prescription rates per 1,000 person years were estimated for each database and stratified by age (≤4, 5-9, 10-14, 15-18 years). Age-group-specific distributions of antibiotic subgroups were calculated for 2008. Results With 957 prescriptions per 1000 person years, the highest annual prescription rate in the year 2008 was found in the Italian region Emilia Romagna followed by Germany (561), the UK (555), Denmark (481) and the Netherlands (294). Seasonal peaks during winter months were most pronounced in countries with high utilisation. Age-group-specific use varied substantially between countries with regard to total prescribing and distributions of antibiotic subgroups. However, prescription rates were highest among children in the age group ≤4 years in all countries, predominantly due to high use of broad spectrum penicillins. Conclusions Strong increases of antibiotic prescriptions in winter months in high utilising countries most likely result from frequent antibiotic treatment of mostly viral infections. This and strong variations of overall and age-group-specific distributions of antibiotic subgroups across countries, suggests that antibiotics are inappropriately used to a large extent. PMID:24997585

  6. Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: an evaluation of a combined face-to-face workshop and online educational intervention.

    PubMed

    Magin, Parker J; Morgan, Simon; Tapley, Amanda; Davis, Joshua S; McArthur, Lawrie; Henderson, Kim M; Mulquiney, Katie J; Dallas, Anthea; Davey, Andrew R; Scott, John; van Driel, Mieke L

    2016-03-01

    Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs. PMID:27005837

  7. Think INN, prescribe INN, dispense INN: good professional practice.

    PubMed

    2000-12-01

    (1) International nonproprietary names (INN) for drugs were invented about fifty years ago, under the aegis of the World Health Organisation, to provide a common language for health professionals and patients worldwide. (2) No country forbids INN prescriptions. Some countries actively recommend using INNs. (3) INN prescription empowers prescribers and pharmacists in their choice of treatment. (4) The choice between a prescription based on the INN or the brand name will depend on the type of treatment (short term or chronic), the nature of the drug (especially its therapeutic margin) and any specific risks related to the patient (age, disease condition, allergy, and adherence). (5) A pharmacist's decision to dispense a brand name drug from an INN prescription must be based on usual dispensing precautions. (6) Adopting INN prescribing means having to reflect on one's knowledge of drugs, and to challenge the quality of one's initial and continuing education in pharmacology and therapeutics. The INN system is a means of improving prescribing and dispensing practices: it involves paying more attention to the patient, explaining the treatment in greater detail, and respecting his/her choice. PMID:11475502

  8. Prescription Drug Abuse

    MedlinePlus

    ... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that ... purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include narcotic painkillers, ...

  9. Prescription Drug Abuse

    MedlinePlus

    ... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that was ... prescription drugs can lead to addiction. These include narcotic painkillers, sedatives, tranquilizers, and stimulants. Every medicine has ...

  10. Prescribing Medications in Patients with Decompensated Liver Cirrhosis

    PubMed Central

    Amarapurkar, Deepak N.

    2011-01-01

    Patients with decompensated liver cirrhosis have various serious complications which require multiple drugs for therapeutic or prophylactic use. Majority of the drugs are primarily metabolized and excreted by hepatobiliary system; hence, liver cell necrosis contributes to impaired drug handling in liver failure while portosystemic shunt can alter drug action in cirrhosis. Hence, in order to decide drug dosing in liver failure, 3 important factors need to be considered (1) pharmacokinetic alterations of drugs, (2) pharmacodynamic alteration of drugs, and (3) increased susceptibility of patients to adverse events particularly hepatotoxicity. Though there is no predictable test which can be used to determine drug dosage in patients with decompensated liver cirrhosis, drugs with first pass metabolism require reduction in oral dosages, for high clearance drugs both loading and maintenance dosages need adjustment, for low clearance drugs maintenance dose needs adjustment, whenever possible measuring drug level in the blood and monitoring of adverse events frequently should be done. No evidence-based guidelines exist for the use of medication in patients' with liver cirrhosis. There are hardly any prospective studies on the safety of drugs in cirrhotic patients. According to the experts opinion, most of the drugs can be used safely in patients with cirrhosis, but drug-induced hepatotoxicity may be poorly tolerated by patients with cirrhosis; hence, potential hepatotoxins should be avoided in patients with liver cirrhosis. Potentially hepatotoxic drugs may be used in patients with liver cirrhosis based on the clinical needs and when there are no alternatives available. Caveat for the prescribing medications in patients with cirrhosis the drug dosing should be individualized depending on a number of factors like nutritional status, renal function, adherence, and drug interaction. Monitoring of the liver function at frequent intervals is highly recommended. PMID:21994861

  11. Electronic pharmacopoeia: a missed opportunity for safe opioid prescribing information?

    PubMed

    Lapoint, Jeff; Perrone, Jeanmarie; Nelson, Lewis S

    2014-03-01

    Errors in prescribing of dangerous medications, such as extended release or long acting (ER/LA) opioid forlmulations, remain an important cause of patient harm. Prescribing errors often relate to the failure to note warnings regarding contraindications and drug interactions. Many prescribers utilize electronic pharmacopoeia (EP) to improve medication ordering. The purpose of this study is to assess the ability of commonly used apps to provide accurate safety information about the boxed warning for ER/LA opioids. We evaluated a convenience sample of six popular EP apps available for the iPhone and an online reference for the presence of relevant safety warnings. We accessed the dosing information for each of six ER/LA medications and assessed for the presence of an easily identifiable indication that a boxed warning was present, even if the warning itself was not provided. The prominence of precautionary drug information presented to the user was assessed for each app. Provided information was classified based on the presence of the warning in the ordering pathway, located separately but within the prescribers view, or available in a separate screen of the drug information but non-highlighted. Each program provided a consistent level of warning information for each of the six ER/LA medications. Only 2/7 programs placed a warning in line with dosing information (level 1); 3/7 programs offered level 2 warning and 1/7 offered level 3 warning. One program made no mention of a boxed warning. Most EP apps isolate important safety warnings, and this represents a missed opportunity to improve prescribing practices. PMID:24081616

  12. Anaerobic Bacteremia: Impact of Inappropriate Therapy on Mortality

    PubMed Central

    Lee, Yangsoon; Park, Yongjung; Kim, Myungsook; Choi, Jun Yong; Yong, Dongeun; Jeong, Seok Hoon

    2016-01-01

    Background Investigation on incidence and mortality of anaerobic bacteremia (AB) is clinically relevant in spite of its infrequent occurrence and not often explored, which report varies according to period and institutions. Therefore, it is necessary to analyze the incidence and risk factors related to mortality and assess clinical outcomes of AB in current aspect. Materials and Methods Characteristics of AB patients and anaerobic bacteria from blood culture at a university hospital in 2012 were reviewed retrospectively. The correlation between risk factors and 28-day patient mortality was analyzed. Results A total of 70 non-duplicated anaerobic bacteria were isolated from blood of 70 bacteremia patients in 2012. The history of cardiovascular disease as host's risk factor was statistically significant (P = 0.0344) in univariate and multivariate analysis. Although the inappropriate therapy was not statistically significant in univariate and multivariate analysis, the survival rate of bacteremia was significantly worse in patients who had inappropriate therapy compared with those underwent appropriate therapy (hazard ratio, 5.4; 95% confidence interval, 1.7–6.9; P = 0.004). The most frequently isolated organism was Bacteroides fragilis (32 isolates, 46%), followed by Bacteroides thetaiotaomicron (10, 14%), and non-perfringens Clostridium (7, 10%). Conclusion The incidence of AB in 2012 was 2.3% (number of AB patients per 100 positive blood culture patients) and the mortality rate in patients with clinically significant AB was 21.4%. In addition, AB was frequently noted in patients having malignancy and the survival rate of AB was significantly worse in patients who received inappropriate therapy compared with those underwent appropriate therapy. PMID:27433379

  13. Proton Pump Inhibitors and the Prescribing Cascade.

    PubMed

    Rababa, Mohammad; Al-Ghassani, Amal Ali; Kovach, Christine R; Dyer, Elaine M

    2016-04-01

    significant factors related to the use of PPI and H2 receptor blockers. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The current study examined the use of proton pump inhibitor (PPI) drugs in 248 nursing home residents and factors associated with being prescribed a PPI. Ninety-three percent of residents taking a PPI had done so for longer than recommended durations. As anticholinergic burden, vitamin/supplement use, and number of oral products taken daily increased, residents were more likely to be taking a PPI. Higher anticholinergic burden (p = 0.031) and number of oral products taken daily (p = 0.04) were two statistically significant predictors in the final logistic regression model. Significant predictors of PPI use in the current study may be explained by the association between polypharmacy and dyspepsia and the lowering of esophageal sphincter pressure by anticholinergic drugs. High use of PPIs in nursing home residents may represent a prescribing cascade. [Journal of Gerontological Nursing, 42(4), 23-31.]. PMID:26716458

  14. 21 CFR 1301.28 - Exemption from separate registration for practitioners dispensing or prescribing Schedule III, IV...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... practitioners dispensing or prescribing Schedule III, IV, or V narcotic controlled drugs approved by the Food..., or V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in..., IV, or V narcotic controlled drugs or combinations of narcotic controlled drugs which have...

  15. 21 CFR 1301.28 - Exemption from separate registration for practitioners dispensing or prescribing Schedule III, IV...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... practitioners dispensing or prescribing Schedule III, IV, or V narcotic controlled drugs approved by the Food..., or V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in..., IV, or V narcotic controlled drugs or combinations of narcotic controlled drugs which have...

  16. 21 CFR 1301.28 - Exemption from separate registration for practitioners dispensing or prescribing Schedule III, IV...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... practitioners dispensing or prescribing Schedule III, IV, or V narcotic controlled drugs approved by the Food..., or V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in..., IV, or V narcotic controlled drugs or combinations of narcotic controlled drugs which have...

  17. 21 CFR 1301.28 - Exemption from separate registration for practitioners dispensing or prescribing Schedule III, IV...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... practitioners dispensing or prescribing Schedule III, IV, or V narcotic controlled drugs approved by the Food..., or V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in..., IV, or V narcotic controlled drugs or combinations of narcotic controlled drugs which have...

  18. 21 CFR 1301.28 - Exemption from separate registration for practitioners dispensing or prescribing Schedule III, IV...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... practitioners dispensing or prescribing Schedule III, IV, or V narcotic controlled drugs approved by the Food..., or V narcotic controlled drugs approved by the Food and Drug Administration specifically for use in..., IV, or V narcotic controlled drugs or combinations of narcotic controlled drugs which have...

  19. Medically Inappropriate or Futile Treatment: Deliberation and Justification.

    PubMed

    Misak, Cheryl J; White, Douglas B; Truog, Robert D

    2016-02-01

    This paper reframes the futility debate, moving away from the question "Who decides when to end what is considered to be a medically inappropriate or futile treatment?" and toward the question "How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?" It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. PMID:26681796

  20. Attitudes of physicians and pharmacists towards International Non-proprietary Name prescribing in Belgium.

    PubMed

    Van Bever, Elien; Elseviers, Monique; Plovie, Marijke; Vandeputte, Lieselot; Van Bortel, Luc; Vander Stichele, Robert

    2015-03-01

    International Non-proprietary Name (INN) prescribing is the use of the name of the active ingredient(s) instead of the brand name for prescribing. In Belgium, INN prescribing began in 2005 and a major policy change occurred in 2012. The aim was to explore the opinions of Dutch-speaking general practitioners (GPs) and pharmacists. An electronic questionnaire with 39 five-point Likert scale statements and one open question was administered in 2013. Multivariate analysis was performed with multiple linear regression on a sum score for benefit statements and for drawback statements. Answers to the open question were qualitatively analysed. We received 745 valid responses with a representable sample for both subgroups. Participants perceived the motives to introduce INN prescribing as purely economic (to reduce pharmaceutical expenditures for the government and the patient). Participants accepted the concept of INN prescribing, but 88% stressed the importance of guaranteed treatment continuity, especially in older, chronic patients, to prevent patient confusion, medication non-adherence and erroneous drug use. In conclusion, the current way in which INN prescribing is applied in Belgium leads to many concerns among primary health professionals about patient confusion and medication adherence. Slightly adapting the current concept of INN prescribing to these concerns can turn INN prescribing into one of the major policies in Belgium to reduce pharmaceutical expenditures and to stimulate rational drug prescribing. PMID:25155133

  1. Clinical Setting Influences Off-Label and Unlicensed Prescribing in a Paediatric Teaching Hospital

    PubMed Central

    Czarniak, Petra; Bint, Lewis; Favié, Laurent; Parsons, Richard; Hughes, Jeff; Sunderland, Bruce

    2015-01-01

    Purpose To estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia. Methods A 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code. Results A total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were prescribed more off-label drugs than outpatients or Emergency Department patients (p < 0.0001). Most off-label prescribing occurred in infants and children (31.7% and 35.9% respectively) and the highest percentage of unlicensed prescribing (7.2%) occurred in infants (p < 0.0001). There were 25.7% of off-label and 2.6% of unlicensed medications prescribed across all three settings. Common reasons for off-label prescribing were dosage (47.4%) and age (43.2%). Conclusion This study confirmed off-label and unlicensed use of drugs remains common. Further, that prevalence of both is influenced by the clinical setting, which has implications in regards to medication misadventure, and the need to have systems in place to minimise medication errors. Further, there remains a need for changes in the regulatory system in Australia to ensure that manufacturers incorporate, as it becomes available, evidence regarding efficacy and safety of their drugs in children in the

  2. The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

    PubMed Central

    Riordan, David O; Walsh, Kieran A; Galvin, Rose; Sinnott, Carol; Kearney, Patricia M; Byrne, Stephen

    2016-01-01

    Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients. PMID

  3. Prescribing and the core curriculum for tomorrow's doctors: BPS curriculum in clinical pharmacology and prescribing for medical students

    PubMed Central

    Ross, Sarah; Maxwell, Simon

    2012-01-01

    Prescribing is one of the commonest tasks expected of new doctors and is a complex process involving a mixture of knowledge, judgement and skills. Preparing graduates to be prescribers is one of the greatest challenges of modern undergraduate medical education and there is some evidence to suggest that training could be improved. The aims of this article are (i) to review some of the challenges of delivering effective prescribing education, (ii) to provide a clear statement of the learning outcomes in clinical pharmacology and prescribing that should be expected of all medical graduates and (iii) to describe a curriculum that might enable students to achieve these outcomes. We build on the previous curriculum recommendations of the British Pharmacological Society and take into account those of other key bodies, notably the General Medical Council. We have also reviewed relevant evidence from the literature and set our work in the context of recent trends in medical education. We divide our recommended learning objectives into four sections: principles of clinical pharmacology, essential drugs, essential therapeutic problems and prescribing skills. Although these will not necessarily be accepted universally we believe that they will help those who design and map undergraduate curricula to explore potential gaps and identify improvements. PMID:22288524

  4. Reduction of Inappropriate Behavior with Primary Mentally Handicapped Children Using Teacher Praise, Ignoring, and Parental Consequences.

    ERIC Educational Resources Information Center

    Sandeman, M. G.; McLaughlin, T. F.

    1982-01-01

    The effects of teacher praise, ignoring, time-out, and parental contingencies on the number of inappropriate behaviors of two mentally handicapped (IQ's 55 and 51) male students ages seven and nine were investigated in a one-year study. Both students reduced inappropriate noise and behavior, and the frequency of inappropriate behavior remained…

  5. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

    PubMed

    2015-11-01

    The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults. PMID:26446832

  6. Inappropriate preinjury warfarin use in trauma patients: A call for a safety initiative

    PubMed Central

    HH, Hon; Elmously, A; Stehly, CD; Stoltzfus, JC; Granson, MA; Stawicki, SP; Hoey, BA

    2016-01-01

    Introduction: Warfarin continues to be widely prescribed for a variety of conditions. It has been shown that preinjury warfarin may worsen outcomes in trauma patients. We hypothesized that a substantial proportion of injured patients seen at our institution were receiving preinjury warfarin for inappropriate indications and that a significant number of such patients had subtherapeutic or supratherapeutic international normalized ratios as well as increased mortality. Materials and Methods: A retrospective review of registry data from a Level I trauma center was conducted for the period from January 2004 to July 2013. Included were patients aged ≥22 years (based on the youngest recorded patient on warfarin in this study). Abstracted variables included patient age, Injury Severity Score (ISS), Maximum Abbreviated Injury Score for Head (MAISH), mortality, hospital length of stay (HLOS), indication(s) for anticoagulant therapy, admission Glasgow Coma Scale (GCS), and admission international normalized ratio (INR). Suitability of warfarin indication(s) was determined using the most recent American College of Chest Physicians (ACCP) Guidelines. Inappropriate warfarin administration was defined as use inconsistent with these guidelines. For outcome comparisons, a case-control design with 1:1 ratio was used, matching patients taking preinjury warfarin to a random sample of trauma patients who were not taking warfarin. Severe traumatic brain injury (sTBI) was defined as MAISH ≥4. Results: A total of 700 out of 14,583 patients aged ≥22 years were receiving preinjury warfarin (4.8% incidence, WG). This group was age- and ISS-matched with 700 patients (4.8% total sample) who were not taking warfarin (NWG) in a total case-control sample of 1,400. The two groups were similar in age, gender, ISS, and initial GCS. According to the ACCP guidelines, 115/700 (16.4%) patients in the warfarin group were receiving anticoagulation for inappropriate indications. Nearly 65% of the

  7. The product label: how pharmacokinetics and pharmacodynamics reach the prescriber.

    PubMed

    Marroum, Patrick J; Gobburu, Jogarao

    2002-01-01

    The product label, or package insert, is the 'manual' for the safe and effective use of a drug. Important pharmacokinetic and pharmacodynamic properties of a drug product should appear in the label under specific sections, as required in the Code of Federal Regulations (CFR), using a format and language recommended by the Food and Drug Administration (FDA) in various guidances to the industry. The relevant regulations and guidance documents impacting on how this information is conveyed to the healthcare professional are discussed, with special emphasis on how the new proposed rule will impact upon how information is to be conveyed. With the availability of new clinical pharmacology information not available at the time of approval, package inserts for older drugs should be updated to reflect the new data and recommend the proper dosage regimen, enabling prescribers to optimise drug therapy and minimise possible adverse events. PMID:11929317

  8. The problem of automation: Inappropriate feedback and interaction, not overautomation

    NASA Technical Reports Server (NTRS)

    Norman, Donald A.

    1989-01-01

    As automation increasingly takes its place in industry, especially high-risk industry, it is often blamed for causing harm and increasing the chance of human error when failures occur. It is proposed that the problem is not the presence of automation, but rather its inappropriate design. The problem is that the operations are performed appropriately under normal conditions, but there is inadequate feedback and interaction with the humans who must control the overall conduct of the task. When the situations exceed the capabilities of the automatic equipment, then the inadequate feedback leads to difficulties for the human controllers. The problem is that the automation is at an intermediate level of intelligence, powerful enough to take over control that which used to be done by people, but not powerful enough to handle all abnormalities. Moreover, its level of intelligence is insufficient to provide the continual, appropriate feedback that occurs naturally among human operators. To solve this problem, the automation should either be made less intelligent or more so, but the current level is quite inappropriate. The overall message is that it is possible to reduce error through appropriate design considerations.

  9. [Treatment of senile diseases should prescribe Chinese patent medicine scientifically].

    PubMed

    Zhao, Xin-Xiang

    2014-04-01

    Treatment of senile diseases by Chinese patent medicine should prescribe according to physiological and pathological specialty of the aged. It's necessary for treatment according to syndrome differentiation associating with the disease,reasonable combination of drugs avoiding adverse reactions,gentle medicine character but not fierce,small medicine quantity but not great, the use of Chinese patent medicine mild and tonic used properly but not excessively. PMID:24812911

  10. The changing nature of prescribing: pharmacists as prescribers and challenges to medical dominance.

    PubMed

    Weiss, Marjorie C; Sutton, Jane

    2009-04-01

    This paper investigates the potential threat to medical dominance posed by the addition of pharmacists as prescribers in the UK. It explores the role of prescribing as an indicator of professional power, the legitimacy and status of new pharmacist prescribers and the forces influencing professional jurisdictional claims over the task of prescribing. It draws upon 23 interviews with pharmacist supplementary prescribers. Data suggest that the legitimacy of pharmacists as prescribers, as experienced in the workplace, has been aided by: (1) blurred definitions of prescribing; (2) the emphasis on new prescribers' competence urging pharmacist prescribers to limit their areas of clinical practice; and (3) a team approach to patient management. Competence, self-limitation on practice and the benefits of team working as part of the ideology of patient safety were thus an important influence on pharmacists' jurisdictional claim over prescribing. While pharmacists have successfully negotiated a role for themselves as prescribers, medicine has retained its high status, relative to other health professionals and with patients; it controls the knowledge base relevant for prescribing practice and has managed to develop an 'overseer' role over the process of prescribing. Prescribing, as an indicator of medicine's autonomy of control over their work and professional status, has changed. Yet the extent to which new prescribers have been able to threaten the professional dominance of medicine is debatable. PMID:19055585

  11. Antibiotic prescribing practices by dentists: a review

    PubMed Central

    Dar-Odeh, Najla Saeed; Abu-Hammad, Osama Abdalla; Al-Omiri, Mahmoud Khaled; Khraisat, Ameen Sameh; Shehabi, Asem Ata

    2010-01-01

    Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. PMID:20668712

  12. Antibiotic prescribing practices by dentists: a review.

    PubMed

    Dar-Odeh, Najla Saeed; Abu-Hammad, Osama Abdalla; Al-Omiri, Mahmoud Khaled; Khraisat, Ameen Sameh; Shehabi, Asem Ata

    2010-01-01

    Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. PMID:20668712

  13. An evaluation of the Essential Medicines List, Standard Treatment Guidelines and prescribing restrictions, as an integrated strategy to enhance quality, efficacy and safety of and improve access to essential medicines in Papua New Guinea.

    PubMed

    Joshua, Isaac B; Passmore, Phillip R; Sunderland, Bruce V

    2016-05-01

    The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient's living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care. PMID:26378052

  14. Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment.

    PubMed

    Weijer, C; Singer, P A; Dickens, B M; Workman, S

    1998-10-01

    Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. PMID:9805031

  15. Bioethics for clinicians: 16. Dealing with demands for inappropriate treatment

    PubMed Central

    Weijer, C; Singer, P A; Dickens, B M; Workman, S

    1998-01-01

    Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. PMID:9805031

  16. Regulating off-label drug use in India: The arena for concern

    PubMed Central

    Oberoi, Sukhvinder Singh

    2015-01-01

    Off-label use of drugs is relatively common in medical practice, even if it's often not supported by strong scientific evidence. Off-label use of medicine not only involves physicians and pharmaceutical companies, but regulatory agencies and patients as well. Therapeutic options might get restricted without off-label prescribing in some patient population. Off-label uses can be useful to patients with an orphan disease where sometimes it can be the only available treatment. Permitting the promotion of drugs for off-label uses may be appropriate in instances in which a drug can improve the quality (e.g., same or better outcomes at lower cost). Although many controversies exist, experts generally agree that further efforts are needed to increase access to suitable off-label drugs for patients with rare and other diseases. However, they also concur that potential inappropriate promotion, as well as possibly dangerous prescribing practices for these drugs, should be prevented. Proponents argue that the key benefit of allowing manufacturers to distribute off-label information is that it allows more data to be readily available to physicians, enabling them to make better treatment decisions. PMID:26229747

  17. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159459.html Aspirin Often Wrongly Prescribed for Atrial Fibrillation Blood thinners -- not aspirin -- dramatically cut the risk of stroke, researchers say ...

  18. Inappropriate intracranial hemodynamics in the natural course of MELAS.

    PubMed

    Nishioka, Junko; Akita, Yukihiro; Yatsuga, Shuichi; Katayama, Koujyu; Matsuishi, Toyojiro; Ishibashi, Masatoshi; Koga, Yasutoshi

    2008-02-01

    The abnormalities of intracranial hemodynamics associated with strokelike episodes in MELAS are variable depend on the time phase from the onset of strokelike episodes and on the progression of the dementia state. To clarify the regional cerebral blood flows (rCBF) in the natural course of MELAS is very important to understand the pathogenic mechanism of this disorder, either cytopathy, angiopathy or both. We analyzed the serial studies of brain statistical parametric mapping (SPM) 99 single photon emission computed tomography (SPECT) in 5 MELAS patients in maximum 10 years interval, who fulfilled the clinical, pathological and genetic criteria of MELAS, and have an A3243G mutation in the mitochondrial tRNA(Leu(UUR)) gene. SPM is a proven and effective method for the voxel-by-voxel analysis of functional images which show the advantage in its promise of fully automated neurophysiological imaging analysis throughout the whole brain using various statistical analyses. SPECT acquisition was initiated and was reconstructed by iterative algorithm and were processed and analyzed with SPM 99 for Windows software. Statistics were displayed as Z scores (threshold: P < 0.01). The inappropriate intracranial hemodynamics was found not only at the acute but at the interictal phase, and was getting worse as the disease progress. Hypoperfusion in the posterior cingulate cortex was always observed (corrected P < 0.01) in MELAS patients, which is the typical finding reported in Alzheimer's disease. The inappropriate intracranial hemodynamics is a common feature and may be related with mitochondrial angiopathy in the natural course of MELAS. PMID:17664050

  19. Effect of opioid prescribing guidelines in primary care.

    PubMed

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-08-01

    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice. PMID:27583928

  20. Effect of opioid prescribing guidelines in primary care

    PubMed Central

    Chen, Jonathan H.; Hom, Jason; Richman, Ilana; Asch, Steven M.; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-01-01

    Abstract Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting. A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education. We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012–6/1/2013) and postintervention (11/1/2013–6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed. After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed. An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical

  1. BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents.

    PubMed

    Sharma, Aditya N; Arango, Celso; Coghill, David; Gringras, Paul; Nutt, David J; Pratt, Peter; Young, Allan H; Hollis, Chris

    2016-05-01

    The off-label use of medicines for children and adolescents remains a common and important issue for prescribing practice across child and adolescent psychiatry, paediatrics and primary care. This editorial focusses on psychotropic drug treatment, which plays an essential part in the comprehensive management of a range of child and adolescent psychiatric disorders. Despite a growing evidence base for drug treatment in child and adolescent psychiatric disorders, much psychotropic medication continues to be prescribed off-label (i.e. outside the limits of the marketing authorisation or product license). The reasons for and implications of off-label prescribing, including the potential clinical benefits/risks and medico-legal implications, are often poorly understood by both patients and prescribers. An important unintended consequence of the uncertainties and confusion surrounding the status of off-label prescribing for children and adolescents may be that effective drug treatments are being withheld or underused. This BAP Position Statement aims to clarify these issues, challenge some of the myths surrounding off-label prescribing for children and adolescents and offer practical guidance for prescribers. PMID:27098018

  2. Exploring the causes of junior doctors' prescribing mistakes: a qualitative study

    PubMed Central

    Lewis, Penny J; Ashcroft, Darren M; Dornan, Tim; Taylor, David; Wass, Val; Tully, Mary P

    2014-01-01

    Aims Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation. Methods As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data. Results More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs. Conclusions Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential. PMID:24517271

  3. Risk evaluation and mitigation strategies (REMS): educating the prescriber.

    PubMed

    Nicholson, Susan C; Peterson, Janet; Yektashenas, Behin

    2012-02-01

    The US FDA Amendments Act of 2007 was signed into law on 27 September 2007. A provision of this law granted the FDA new powers to enhance drug safety by requiring the pharmaceutical industry to develop Risk Evaluation and Mitigation Strategies (REMS). REMS are deemed necessary when a question exists as to whether the benefits of a drug outweigh its risks. REMS constitute a safety plan with several potential components, including a medication guide, a communication plan, elements to ensure safe use and an implementation system to help guide the prescribers, pharmacists and patients. This applies to existing drugs on the market, new drug applications (NDAs), abbreviated NDAs (generics) and biologics licence applications. REMS represent an 'upgrade' from previously required risk minimization action plans, based on the strengthening of FDA powers of authority and enforceability to incur monetary penalties against individuals representing the pharmaceutical industry who fail to comply. For illustrative purposes, we chose the drug romiplostim (Nplate®) to present an REMS, as all components were utilized to help assuage risks associated with the drug. Romiplostim is an FDA-approved drug used to treat thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura that has a significant adverse safety profile based on the risk of changes in bone marrow reticulin formation and bone marrow fibroses, and other associated risks. This review of current REMS policy is intended to provide the prescriber with a better understanding of current modalities in FDA-mandated drug safety programmes, which will impact day-to-day healthcare provider practices. PMID:22171604

  4. Buprenorphine Prescribing Availability in a Sample of Ohio Specialty Treatment Organizations

    PubMed Central

    Molfenter, Todd; Sherbeck, Carol; Zehner, Mark; Starr, Sandy

    2015-01-01

    Objective Buprenorphine, a medication for treating opioid dependence, is underutilized in specialty addiction treatment organizations. Only physicians who have obtained a buprenorphine prescribing license or “waiver” may administer this medication. A limited number of physicians are pursuing this waiver, and a concern in the substance use disorder treatment field is that the shortage of prescribers could be contributing to the low use of buprenorphine at specialty addiction treatment centers. The objective of this study is to assess Ohio specialty treatment organizations’ access to buprenorphine prescribers and the barriers they encounter when seeking new physician prescribing capacity. Methods Forty-one Ohio specialty addiction treatment organizations were invited to complete a survey of their buprenorphine practices and availability of buprenorphine prescribers during August–October 2014. Data was collected on pharmacotherapies used in the treatment of opioid dependence, arrangements treatment organizations have with prescribing physicians, buprenorphine prescribing capacity, and barriers encountered in recruiting new physician prescribers. Results Thirty-seven treatment organizations responded, for a response rate of 90.2%. Seventy-eight percent (n=29) of the sample provided buprenorphine therapy. Of those treatment organizations, 48.3% (n=14) reported insufficient prescribing capacity. Of those, 50% (n=7) indicated they had to turn patients away from buprenorphine therapy due to limited physician prescribing capacity. Conclusion The study suggests that buprenorphine use is constrained by limited physician prescribing capacity, to the degree that 24.1% of the organizations surveyed using buprenorphine therapy had to turn patients away. Potential remedies include encouraging more specialty treatment organizations to have physicians on staff, removing the Drug Addiction Treatment Act (DATA 2000) cap that limits physician buprenorphine caseloads at 100

  5. Predicting the use of electronic prescribing among early adopters in primary care

    PubMed Central

    Sicotte, Claude; Taylor, Laurel; Tamblyn, Robyn

    2013-01-01

    Abstract Objective To identify the factors that can predict physicians’ use of electronic prescribing. Design All primary care physicians who practised in a single geographic region in Quebec were invited to use a free, advanced, research-based electronic prescribing and drug management system. This natural experiment was studied with an expansion of the Technology Acceptance Model (TAM), which was used to explain early adopters’ use of this electronic prescribing technology. Setting Quebec city region. Participants A total of 61 primary care physicians who practised in a single geographic region where there was no electronic prescribing. Main outcome measures Actual use of electronic prescribing; physicians’ perceptions of and intentions to use electronic prescribing; physician and practice characteristics. Results During the 9-month study period, 61 primary care physicians located in 26 practice sites used electronic prescribing to write 15 160 electronic prescriptions for 18 604 patients. Physician electronic prescribing rates varied considerably, from a low of 0 to a high of 75 per 100 patient visits, with a mean utilization rate of 30 per 100 patient visits. Overall, 34% of the variance in the use of electronic prescribing was explained by the expanded TAM. Computer experience (P = .001), physicians’ information-acquisition style (P = .01), and mean medication use in the practice (P = .02) were significant predictors. Other TAM factors that generally predict new technology adoption (eg, intention to use, perceived ease of use, and perceived usefulness) were not predictive in this study. Conclusion The adoption of electronic prescribing was a highly challenging task, even among early adopters. The insight that this pilot study provides into the determinants of the adoption of electronic prescribing suggests that novel physician-related factors (eg, information-acquisition style) and practice-related variables (eg, prevalence of medication use) influence

  6. Recent Literature on Medication Errors and Adverse Drug Events in Older Adults.

    PubMed

    Naples, Jennifer G; Hanlon, Joseph T; Schmader, Kenneth E; Semla, Todd P

    2016-02-01

    Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article is to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals working with older adults. A comprehensive literature search for studies published in 2014 was conducted, and 51 potential articles were identified. After critical review, 17 studies were selected for inclusion based on innovation; rigorous observational or experimental study designs; and use of reliable, valid measures. Four articles characterizing potentially inappropriate prescribing and interventions to optimize medication regimens were annotated and critiqued in detail. The authors hope that health policy-makers and clinicians find this information helpful in improving the quality of care for older adults. PMID:26804210

  7. Recent Literature on Medication Errors and Adverse Drug Events in Older Adults

    PubMed Central

    Naples, Jennifer G.; Hanlon, Joseph T.; Schmader, Kenneth E.; Semla, Todd P.

    2015-01-01

    Medication errors and adverse drug events are common in older adults, but locating literature addressing these issues is often challenging. The objective of this article was to summarize recent studies addressing medication errors and adverse drug events in a single location to improve accessibility for individuals working with older adults. The authors conducted a comprehensive literature search for studies published in 2014 and identified 51 potential articles. After critical review, 17 studies were selected for inclusion based on innovation, rigorous observational or experimental study designs, and use of reliable, valid measures. Four articles characterizing potentially inappropriate prescribing and interventions to optimize medication regimens were annotated and critiqued in detail. We hope that health policy makers and clinicians find this information helpful in improving the quality of care for older adults. PMID:26804210

  8. [Onset of Syndrome of Inappropriate Secretion of Antidiuretic Hormone in a Gastric Cancer Patient on SOX Treatment].

    PubMed

    Goto, Yoshinori; Wakita, Shigenori; Yoshimitsu, Masashi; Inagaki, Satoko; Kobayashi, Takeshi; Kaneko, Shuichi

    2015-12-01

    A 78-year-old man with advanced gastric cancer was treated with S-1 and oxaliplatin chemotherapy. He developed hiccups and nausea, and was diagnosed with hyponatremia (serum Na: 120 mEq/L) on day 6 of the first treatment course. Because of his increased urinary Na excretion and relatively high ADH values, he was subsequently diagnosed with chemotherapy-induced syndrome of inappropriate secretion of antidiuretic hormone. The patient recovered after an infusion of hypertonic saline. Although S-1 was restarted, hyponatremia did not recur. We suspected adverse drug reactions to ACE inhibitors and K-sparing diuretics in our case of hyponatremia. PMID:26809306

  9. 8 CFR 299.1 - Prescribed forms.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1 Prescribed forms. A listing of USCIS, ICE, and CBP approved forms referenced in chapter I can be viewed...

  10. 8 CFR 299.1 - Prescribed forms.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1 Prescribed forms. A listing of USCIS, ICE, and CBP approved forms referenced in chapter I can be viewed...

  11. 8 CFR 299.1 - Prescribed forms.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1 Prescribed forms. A listing of USCIS, ICE, and CBP approved forms referenced in chapter I can be viewed...

  12. 27 CFR 4.3 - Forms prescribed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Forms prescribed. 4.3 Section 4.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF WINE Scope § 4.3 Forms prescribed. (a)...

  13. 27 CFR 7.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 7.3 Section 7.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF MALT BEVERAGES Scope § 7.3 Forms prescribed. (a)...

  14. 27 CFR 71.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Forms prescribed. 71.3 Section 71.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... and Construction of Regulations § 71.3 Forms prescribed. (a) The appropriate TTB officer is...

  15. 27 CFR 25.3 - Forms prescribed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate...

  16. 27 CFR 25.3 - Forms prescribed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate...

  17. 27 CFR 25.3 - Forms prescribed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate...

  18. 27 CFR 25.3 - Forms prescribed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate...

  19. 27 CFR 25.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate...

  20. Prescribing for people in custody

    PubMed Central

    Hampton, Stephen; Blomgren, Donna; Roberts, Jill; Mackinnon, Tobias; Nicholls, Gary

    2015-01-01

    SUMMARY People who are, or have been, in custody often have multiple morbidities and multi-dimensional disadvantage. A thorough clinical evaluation and multidisciplinary approach will assist in managing these patients. Treatment plans should be pragmatic and simple, and explained in an understandable manner. Caution should be used in the prescription of any medicines that have the potential for abuse. There is also a risk of drug diversion. There is an increase in mortality after prisoners are released into the community. Preparations should therefore be made before release to ensure continuity of care. PMID:26648653

  1. Restrictions on pharmaceutical detailing reduced off-label prescribing of antidepressants and antipsychotics in children.

    PubMed

    Larkin, Ian; Ang, Desmond; Avorn, Jerry; Kesselheim, Aaron S

    2014-06-01

    The treatment of pediatric depression is controversial because it includes substantial prescribing of drugs for uses that have not been approved by the Food and Drug Administration ("off label") and are not evidence based. Some academic medical centers (AMCs) restrict "detailing" by pharmaceutical sales representatives, or the promoting of drugs directly to physicians via sales calls, to reduce the effect of such marketing on physician prescribing. With data from thirty-one geographically diverse AMCs and their affiliated hospitals, we used a difference-in-differences model to estimate the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006-June 2009. We found that after the introduction of such policies, prescriptions for off-label use of promoted drugs fell by 11 percent, consistent with the ongoing presence of off-label marketing to physicians. Prescriptions for on-label use of promoted drugs fell by 34 percent after the adoption of the policies. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for off-label use of nonpromoted drugs rose by 35 percent. These results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing. PMID:24889951

  2. Inappropriate publication of trial results and potential for allegations of illegal share dealing.

    PubMed

    Freestone, D S; Mitchell, H

    1993-04-24

    There is increasing evidence of fraud in clinical research, and one aspect concerns trading in pharmaceutical company shares by people who may have confidential information about the results of clinical trials. Plainly this has implications for honest investigators, who may find themselves exposed to such allegations. In this paper Dr D S Freestone and Mr H Mitchell, QC, identify three interlinked issues which they think underlie the potential for these allegations. They are pressure for premature or inappropriate communication of research results; trading in pharmaceutical company shares by academic clinical investigators; and the possibility that clinical investigators might succumb to temptation. Dr Freestone and Mr Mitchell suggest that whenever possible results of clinical studies should be published in appropriate medical journals without prior public disclosure. This conflicts with Stock Exchange rules, which require that price sensitive information should be published at the earliest opportunity and preclude priority of publication in medical journals. Freestone and Mitchell believe that rarely rapid public disclosure is acceptable if it is to protect patients' interests but that it must not prejudice publication in the medical or scientific press. When rapid public disclosure is needed, they say, every attempt should be made to inform prescribers before patients. Dr Freestone and Mr Mitchell warn that academic clinical investigators who have access to unpublished price sensitive information about pharmaceutical companies whose shares they trade in will almost certainly be in breach of the Company Securities (Insider Dealing) Act 1985. Furthermore, disclosing such information to third parties, they say, exposes those people also to potential criminal liability. Freestone and Mitchell advise that when potential for allegations of conflict of interest exists clinical investigators should consider declaring their position to ethics committees and any

  3. A crash course in Chinese herbology for the psychopharmocological prescriber.

    PubMed

    White, Kathryn P

    2009-12-01

    Given the unparalleled popularity of botanicals in the United States, it is safe to say that almost every psychopharmacological prescriber will see some patients using Chinese herbs. Data show that between 36% and 42% of Americans use complementary and alternative medicine (CAM) each year and that persons suffering from depression and anxiety (67%) use CAM services significantly more than do their nonanxious and nondepressed counterparts (39%). This article gives an overview of several classical Chinese medical single herbs and herbal formulas commonly used for persons with psychiatric disorders and discusses some of the herbs that have the potential to interact with various pharmaceutical drugs. In addition, the article reviews scientific evidence and, at times, the lack thereof to validate the use of Chinese herbs and formulas in treating psychiatric conditions. Overall, the article seeks to prepare the pharmacological prescriber for working with patients concomitantly taking psychiatric medications and Chinese herbs. PMID:19968403

  4. E-Prescribing Errors in Community Pharmacies: Exploring Consequences and Contributing Factors

    PubMed Central

    Stone, Jamie A.; Chui, Michelle A.

    2014-01-01

    Objective To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. Methods Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. Results Pharmacy staff detected 75 e-prescription errors during the 45 hour observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. Conclusion Study findings suggest that a wide range of e-prescribing errors are encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies. PMID:24657055

  5. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior

    PubMed Central

    Tang, Yan; Chang, Chung-Chou H.; Lave, Judith R.; Gellad, Walid F.; Huskamp, Haiden A.; Donohue, Julie M.

    2016-01-01

    Background Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. Aims of the Study To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Methods Using 2011 data from Pennsylvania’s Medicaid program, IMS Health’s HCOS™ database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to ≥10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. Results There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Discussion Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians

  6. When is diagnostic testing inappropriate or irrational? Acceptable regret approach.

    PubMed

    Hozo, Iztok; Djulbegovic, Benjamin

    2008-01-01

    The authors provide a new model within the framework of theories of bounded rationality for the observed physicians' behavior that their ordering of diagnostic tests may not be rational. Contrary to the prevailing thinking, the authors find that physicians do not act irrationally or inappropriately when they order diagnostic tests in usual clinical practice. When acceptable regret (i.e., regret that a decision maker finds tolerable upon making a wrong decision) is taken into account, the authors show that physicians tend to order diagnostic tests at a higher level of pretest probability of disease than predicted by expected utility theory. They also show why physicians tend to overtest when regret about erroneous decisions is extremely small. Finally, they explain variations in the practice of medicine. They demonstrate that in the same clinical situation, different decision makers might have different acceptable regret thresholds for withholding treatment, for ordering a diagnostic test, or for administering treatment. This in turn means that for some decision makers, the most rational strategy is to do nothing, whereas for others, it may be to order a diagnostic test, and still for others, choosing treatment may be the most rational course of action. PMID:18480041

  7. Between two beds: inappropriately delayed discharges from hospitals.

    PubMed

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

    2013-12-01

    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care. PMID:24122364

  8. Inappropriate eating behavior: a longitudinal study with female adolescents

    PubMed Central

    Fortes, Leonardo de Sousa; Almeida, Sebastião de Sousa; Cipriani, Flávia Marcele; Ferreira, Maria Elisa C.

    2014-01-01

    Objective: To evaluate the inappropriate eating behaviors (IEB) of female adolescents over a one-year period. Methods: 290 adolescents aged between 11 and 14 years old participated in the three research stages (T1: first four months, T2: second four months and T3: third four months). The Eating Attitudes Test (EAT-26) was applied to assess the IEB. Weight and height were measured to calculate body mass index (BMI) in the three study periods. Analysis of variance for repeated measures was used to analyze the data, adjusted for the scores of the Body Shape Questionnaire and the Brazil Economic Classification Criteria. Results: Girls at T1 showed a higher frequency of IEB compared to T2 (p=0.001) and T3 (p=0.001). The findings also indicated higher values for BMI in T3 in relation to T1 (p=0.04). The other comparisons did not show statistically significant differences. Conclusions: IEB scores of female adolescents declined over one year. PMID:24676195

  9. The Prevalence of Inappropriate Image Duplication in Biomedical Research Publications

    PubMed Central

    Casadevall, Arturo; Fang, Ferric C.

    2016-01-01

    ABSTRACT Inaccurate data in scientific papers can result from honest error or intentional falsification. This study attempted to determine the percentage of published papers that contain inappropriate image duplication, a specific type of inaccurate data. The images from a total of 20,621 papers published in 40 scientific journals from 1995 to 2014 were visually screened. Overall, 3.8% of published papers contained problematic figures, with at least half exhibiting features suggestive of deliberate manipulation. The prevalence of papers with problematic images has risen markedly during the past decade. Additional papers written by authors of papers with problematic images had an increased likelihood of containing problematic images as well. As this analysis focused only on one type of data, it is likely that the actual prevalence of inaccurate data in the published literature is higher. The marked variation in the frequency of problematic images among journals suggests that journal practices, such as prepublication image screening, influence the quality of the scientific literature. PMID:27273827

  10. Turkish high school students' definitions for parallelograms: appropriate or inappropriate?

    NASA Astrophysics Data System (ADS)

    Cansiz Aktaş, Meral

    2016-05-01

    The aim of this study was to investigate the appropriateness of high school students' definitions. The participants in this study were 269 high school students from a public school in Ordu city, which is on the Black Sea coast of Turkey. The participants were asked to write their definitions with no time constraints. In the analysis of the definitions, students' ability to distinguish necessary and sufficient conditions and their ability to use appropriate mathematical terminology were taken into account. The task used in this study enabled us to mirror students' difficulties and inadequacies about their definitions of a parallelogram. The findings indicated that most of the students defined parallelogram inappropriately because they had used incomplete or incorrect statements. On the other hand, for the appropriate definitions, it was found that the number of uneconomical definitions was almost the same as the number of economical ones. At the end of the study, it was suggested that defining activities should be integrated into curriculums explicitly and should be given importance in our mathematic lessons.

  11. The spectrum of inappropriate pituitary thyrotropin secretion associated with hyperthyroidism

    SciTech Connect

    Gharib, H.; Carpenter, P.C.; Scheithauer, B.W.; Service, F.J.

    1982-09-01

    Two patients with overproduction of thyroid-stimulating hormone (TSH) are described. The first patient, a 25-year-old man with recurrent hyperthyroidism, had a pituitary adenoma and highly elevated levels of TSH. While the patient was receiving 0.3 mg of thyroid daily, and basal TSH level was 161 microM/ml. Despite an increase in the thyroid hormone therapy, serum TSH levels remained elevated. The administration of thyrotropin-releasing hormone (TRH) or dexamethasone resulted in no changes in TSH level. The second patient was an 18-year-old man who had inappropriately elevated levels of TSH 3 months after radioiodine therapy for hyperthyroidism. A gradual increase in thyroid hormone replacement therapy decreased the serum TSH levels from 250 to 14.8 microM/ml. The administration of TRH led to huge increases of TSH. Dexamethasone inhibited basal TSH but not TRH-stimulated TSH levels. The overproduction of TSH was attributed to autonomous, neoplastic secretion in the first case and to partial, selective pituitary thyrotroph resistance to thyroid hormone in the second.

  12. Study of Drug Utilization Pattern for Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital - A Prescription Survey

    PubMed Central

    Pathak, Anuj Kumar; Kumar, Subodh; Kumar, Manish; Dikshit, Harihar

    2016-01-01

    Introduction Skin diseases are the major contributors of disease burden in society. It affects individuals of all ages, neonates to elderly. Owing to its chronic nature, it causes serious impact on quality of life and financial status of the sufferer and his family. The problem gets compounded with the inappropriate and irrational use of medicines. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and curb the menace of irrational prescribing which has become a global phenomenon. Aim This study aims to determine the drug utilization pattern and assess the economic burden of the patient with skin disease. Materials and Methods It was a prospective, cross-sectional study conducted over a period of three months from January to March 2015 in newly diagnosed cases attending outpatient department of Skin and VD, IGIMS, Patna. The prescriptions were analysed with the help of descriptive statistics and results were expressed in percentage. Results Total 752 prescriptions were analysed during the study. Male patients were lesser as compared to female as male to female ratio was 0.88. Over 50% of patients were in adolescent age group i.e. 21-40 years. Acne (17.95%) was most common disease in the study population followed by eczema and Dermatophytosis. Among the drugs, antihistaminics (24.13%) were prescribed most frequently followed by antifungals and antibiotics. Topical agents constituted almost 60% of the total prescription and average number of drugs per prescription was 5.13, irrespective of the dosage forms prescribed. Conclusion This drug utilization study provides an insight to the prescriber regarding various issues related to polypharmacy, cost analysis and prevalent disease pattern in the region. This study also suggests periodic evaluation of prescription pattern to monitor and improve quality of prescription in other departments of the hospital. PMID:27042479

  13. Implementing nurse prescribing within the haemodialysis unit.

    PubMed

    Gerrish, M

    2005-01-01

    Patients within satellite haemodialysis units do not always have access to a medical practitioner. This may cause problems when prescriptions are required. Amendments to UK law to allow the introduction of supplementary prescribing came into force in 2003 allowing nurses with the appropriate experience, training and qualification to prescribe for their patients. Within a 14-station satellite unit a prescribing partnership has been successfully established. Clinical Management Plans have been implemented for haemodialysis patients. These include areas such as dialysis adequacy, access management, anti-coagulation, anaemia management, MRSA treatment and prophylaxis, antihypertensive therapy, calcium and phosphate control and exit site or line infection. 100% of patients within the unit have consented to the nurse prescribing for them under the Clinical Management Plan. Supplementary prescribing enhances nursing practice by empowering those who are best placed to make decisions regarding care and treatment for their patients. Patients appear confident in the ability of the nurse within the haemodialysis unit to prescribe competently. Nurse prescribing is of benefit to patient care, meeting the demands of an expanding patient population. It is recognition of the skill and experience required of haemodialysis nurses. PMID:16363416

  14. Systemic antifungal prescribing in neonates and children: outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study.

    PubMed

    Lestner, J M; Versporten, A; Doerholt, K; Warris, A; Roilides, E; Sharland, M; Bielicki, J; Goossens, H

    2015-02-01

    The appropriate use of systemic antifungals is vital in the prevention and treatment of invasive fungal infection (IFI) in immunosuppressed children and neonates. This multicenter observational study describes the inpatient prescribing practice of antifungal drugs for children and neonates and identifies factors associated with prescribing variability. A single-day point prevalence study of antimicrobial use in hospitalized neonates and children was performed between October and December 2012. The data were entered through a study-specific Web-based portal using a standardized data entry protocol. Data were recorded from 17,693 patients from 226 centers. A total of 136 centers recorded data from 1,092 children and 380 neonates receiving at least one antifungal agent. The most frequently prescribed systemic antifungals were fluconazole (n=355) and amphotericin B deoxycholate (n=195). The most common indications for antifungal administration in children were medical prophylaxis (n=325), empirical treatment of febrile neutropenia (n=122), and treatment of confirmed or suspected IFI (n=100 [14%]). The treatment of suspected IFI in low-birthweight neonates accounted for the majority of prescriptions in the neonatal units (n=103). An analysis of variance (ANOVA) demonstrated no significant effect of clinical indication (prophylaxis or treatment of systemic or localized infection) on the total daily dose (TDD). Fewer than one-half of the patients (n=371) received a TDD within the dosing range recommended in the current guidelines. Subtherapeutic doses were prescribed in 416 cases (47%). The predominance of fluconazole and high incidence of subtherapeutic doses in participating hospitals may contribute to suboptimal clinical outcomes and an increased predominance of resistant pathogenic fungi. A global consensus on antifungal dosing and coordinated stewardship programs are needed to promote the consistent and appropriate use of antifungal drugs in neonates and children

  15. Dispensing physicians and prescribing pharmacists: economic considerations for the UK.

    PubMed

    Ryan, M; Bond, C

    1994-01-01

    Recent years have seen an increase in the number of dispensing physicians in the UK. There have also been suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed and that pharmacists should take a more active role in the provision of drugs. General medical practitioners and pharmacists have common ancestry in the medieval spicers, who dispensed medicines and offered medical advice. Rural practitioners have been allowed to dispense drugs since 1911. Physician dispensing can benefit patients via savings in time and the monetary cost of visiting a pharmacist, but it restricts drug choice, can compromise safety, and encourages overprescribing except for physicians with drugs budgets. The effects of physician dispensing on government costs are not yet clear. Over-the-counter (OTC) purchase can save patients the cost of a physician visit and reduce drug costs to some patients, but it can also provide an incentive to pharmacists to profit twice from a drug, at government expense. Switching drugs from prescription-only to OTC reduces the government drug bill, but provides an incentive to pharmacists to overprescribe, and may not be as safe for patients. Liberalising prescribing by doctors would discourage community pharmacies which provide an advisory service to patients. Liberalising OTC switches would reduce opportunistic assessment of patients by doctors and could compromise patient safety. Separation of physician and pharmacist functions is probably safer for patients. It is concluded that the current situation in the UK, whereby most dispensing is done by pharmacists, is the preferred option other than for those patients who do not live within easy access of a pharmacy. A reassessment of the legal status of drugs and subsequent OTC switch of drugs used to treat minor self-limiting illnesses is also favoured. PMID:10146862

  16. Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data

    PubMed Central

    Guthrie, Bruce; Treweek, Shaun; Petrie, Dennis; Barnett, Karen; Ritchie, Lewis D; Robertson, Chris; Bennie, Marion

    2012-01-01

    Introduction High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback. Methods and analysis The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94% of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a ‘usual care’ arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93% power to detect a 25% difference in the percentage of high-risk prescribing (from 6.1% to 4.5%) between the usual care arm and each intervention arm. The primary outcome is a composite of six high-risk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices. Ethics and dissemination The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be

  17. Drivers for inappropriate fever management in children: a systematic review.

    PubMed

    Kelly, M; McCarthy, S; O'Sullivan, R; Shiely, F; Larkin, P; Brenner, M; Sahm, L J

    2016-08-01

    Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever

  18. Off-label drug use in Psychiatry Outpatient Department: A prospective study at a Tertiary Care Teaching Hospital

    PubMed Central

    Kharadi, Darshan; Patel, Kamlesh; Rana, Devang; Patel, Varsha

    2015-01-01

    Introduction: Off-label drug prescribing is very common in Psychiatry. US-Food and Drug Administration has defined off-label drug as “use of drugs for the indication, dosage form, regimen, patient or other use constraint not mentioned in the approved labeling.” Objective: The objective was to evaluate off-label drug use in patients attending Outpatient Department of Psychiatry. Materials and Methods: One year prospective, cross sectional study was conducted on patients attending Psychiatry Outpatient Department. Demographic data, clinical history, and complete prescription were noted in the predesigned proforma and prescriptions were analyzed for off-label drug use as per British National Formulary-2011. Result: A total of 250 patients were enrolled with mean age 40.36 ± 12.3 years. Most common diagnosis was major depressive disorder 101 (40.4%). A total of 980 drugs (mean 3.68 ± 1.42) were prescribed out of which 387 (39.5%) were off-label. Of 250 patients, 198 (79.2%) received at least one off-label drug. Psychopharmacological agents most frequently used in off-label manner were clonazepam 31 (12.4%), lorazepam 30 (12%), and trihexyphenidyl HCl 25 (10%). Prevalence of off-label use of these three drugs was significantly higher than other off-label drugs (P < 0.0001, P < 0.0001 and P < 0.0001 respectively). Inappropriate indication was the most common category of off-label use. There was positive and significant correlation between off-label prescribing and number of drugs (r = 0.722, P ≤ 0.000). Off-label prescribing was statistically significantly higher in 21–40 year age group, but no difference was seen in any co-morbid condition or in between any psychiatric disorder. Conclusion: Off-label drugs use is common in psychiatric OPD in our setup. Clonazepam, lorazepam, and trihexyphenidyl HCl were the most frequently used drugs in off-label manner. PMID:25767363

  19. 27 CFR 45.27 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... (a) The appropriate TTB officer is authorized to prescribe all forms required by this part. You must... instructions for the form, and as required by this part. You must file each form in accordance with...

  20. 27 CFR 46.22 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... officer is authorized to prescribe all forms required by this part. You must furnish all of the..., and as required by this part. You must file each form in accordance with its instructions. (b)...

  1. The Web site your doctor prescribes

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues The Web site your doctor prescribes Past Issues / Summer 2008 ... gov® is a free, comprehensive, up-to-date Web site with health information from the world's largest ...

  2. The Web site your doctor prescribes

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues The Web site your doctor prescribes Past Issues / Summer 2006 ... gov ® is a free, comprehensive, up-to-date Web site with health information from the world's largest ...

  3. Nurse prescribing ethics and medical marketing.

    PubMed

    Adams, J

    This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers. PMID:21500692

  4. Modeling of Outpatient Prescribing Process in Iran: A Gateway Toward Electronic Prescribing System

    PubMed Central

    Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

    2014-01-01

    Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling “As-Is” business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems. PMID:25237369

  5. Decreasing Inappropriate Behaviors for Adolescents with Autism Spectrum Disorders Using Modified Social Stories

    ERIC Educational Resources Information Center

    Graetz, Janet E.; Mastropieri, Margo A.; Scruggs, Thomas E.

    2009-01-01

    A multiple baseline design study was implemented to assess the effects of a modified social story intervention on inappropriate social behaviors of three adolescents with moderate autism. Baseline data were collected on inappropriate behaviors that included refusal to stand, use of a high-pitched voice, and placing hands/objects in mouth.…

  6. Impact of a Cybernetic System of Feedback to Physicians on Inappropriate Hospital Use.

    ERIC Educational Resources Information Center

    Studnicki, James; And Others

    1985-01-01

    A cybernetic control program was designed to reduce inappropriate days of hospitalization for Medicare patients in four Western Maryland counties. Hospital stays for patients of 282 physicians were reviewed by physician advisers, with attention to the physician's volume of hospitalized patients and the number of inappropriate days of care.…

  7. Differential Effects of Classroom Lighting on Inappropriate Behaviors in a Severely Mentally Retarded Boy.

    ERIC Educational Resources Information Center

    Fletcher, Donna; Grey, Teresa

    1985-01-01

    A severely mentally retarded 9-year-old boy with a history of inappropriate classroom behaviors was videotaped in his classroom under normal cool white fluorescent and full spectrum florescent lighting. Inappropriate behaviors were considerably less frequent under full spectrum fluorescent lighting. (Author/CL)

  8. Functional Analysis of Inappropriate Social Interactions in Students with Asperger's Syndrome

    ERIC Educational Resources Information Center

    Roantree, Christina F.; Kennedy, Craig H.

    2012-01-01

    We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of…

  9. Controlled Substances Add New Layer to E-Prescribing.

    PubMed

    Kaldy, Joanne

    2016-01-01

    The Electronic Prescriptions for Controlled Substances (EPCS) program was established by the Drug Enforcement Administration to allow health facilities to use electronic transmission and other modern technology for prescribing controlled substances and replacing old technology such as fax. Its goal is to eliminate fraud, abuse, and diversion of controlled medications while streamlining the processes of making them more easily available to patients in need. While rules regarding EPCS have the potential to improve care and give practitioners more data for quality improvement, they also may create new challenges for practitioners, facilities, and vendors alike. All stakeholders need to work together to ensure effective, efficient EPCS systems. PMID:27056356

  10. Evaluation of factors affecting prescribing behaviors, in iran pharmaceutical market by econometric methods.

    PubMed

    Tahmasebi, Nima; Kebriaeezadeh, Abbas

    2015-01-01

    Prescribing behavior of physicians affected by many factors. The present study is aimed at discovering the simultaneous effects of the evaluated factors (including: price, promotion and demographic characteristics of physicians) and quantification of these effects. In order to estimate these effects, Fluvoxamine (an antidepressant drug) was selected and the model was figured out by panel data method in econometrics. We found that insurance and advertisement respectively are the most effective on increasing the frequency of prescribing, whilst negative correlation was observed between price and the frequency of prescribing a drug. Also brand type is more sensitive to negative effect of price than to generic. Furthermore, demand for a prescription drug is related with physician demographics (age and sex). According to the results of this study, pharmaceutical companies should pay more attention to the demographic characteristics of physicians (age and sex) and their advertisement and pricing strategies. PMID:25901174

  11. Evaluation of Factors Affecting Prescribing Behaviors, in Iran Pharmaceutical Market by Econometric Methods

    PubMed Central

    Tahmasebi, Nima; Kebriaeezadeh, Abbas

    2015-01-01

    Prescribing behavior of physicians affected by many factors. The present study is aimed at discovering the simultaneous effects of the evaluated factors (including: price, promotion and demographic characteristics of physicians) and quantification of these effects. In order to estimate these effects, Fluvoxamine (an antidepressant drug) was selected and the model was figured out by panel data method in econometrics. We found that insurance and advertisement respectively are the most effective on increasing the frequency of prescribing, whilst negative correlation was observed between price and the frequency of prescribing a drug. Also brand type is more sensitive to negative effect of price than to generic. Furthermore, demand for a prescription drug is related with physician demographics (age and sex). According to the results of this study, pharmaceutical companies should pay more attention to the demographic characteristics of physicians (age and sex) and their advertisement and pricing strategies. PMID:25901174

  12. Interventions to Improve Suboptimal Prescribing in Nursing Homes: A Narrative Review

    PubMed Central

    Marcum, Zachary A.; Handler, Steven M.; Wright, Rollin; Hanlon, Joseph T.

    2010-01-01

    Background Appropriate medication prescribing for nursing home residents remains a challenge. Objective The purpose of this study was to conduct a narrative review of the published literature describing randomized controlled trials that used interventions to improve suboptimal prescribing in nursing homes. Methods The PubMed, International Pharmaceutical Abstracts, and EMBASE databases were searched for articles published in the English language between January 1975 and December 2009, using the terms drug utilization, pharmaceutical services, aged, long-term care, nursing homes, prescribing, geriatrics, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors’ files, book chapters, and recent review articles was also conducted. Abstracts and posters from meetings were not included in the search. Studies were included if they: (1) had a randomized controlled design; (2) had a process measure outcome for quality of prescribing or a distal outcome measure for medication-related adverse patient events; and (3) involved nursing home residents. Results Eighteen studies met the inclusion criteria for this review. Seven of those studies described educational approaches using various interventions (eg, outreach visits) and measured suboptimal prescribing in different manners (eg, adherence to guidelines). Two studies described computerized decision-support systems to measure the intervention’s impact on adverse drug events (ADEs) and appropriate drug orders. Five studies described clinical pharmacist activities, most commonly involving a medication review, and used various measures of suboptimal prescribing, including a measure of medication appropriateness and the total number of medications prescribed. Two studies each described multidisciplinary and multifaceted approaches that included heterogeneous interventions and measures of prescribing. Most (15/18; 83.3%) of these studies reported statistically significant

  13. Discounted drug prices for hospitals: result in prescriptions for expensive drugs in the community.

    PubMed

    2015-09-01

    Hospital prescribing has a major influence on community prescribing. In France, pharmaceutical companies can sell drugs to hospitals at dramatically reduced prices in the expectation of increasing sales in community pharmacies. PMID:26417639

  14. Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study

    PubMed Central

    Agrawal, Shantanu; King, Marissa; Venkatesh, Arjun K; Krumholz, Harlan M; McKee, Douglas; Brown, Douglas; Ross, Joseph S

    2016-01-01

    Objective To examine the association between payments made by the manufacturers of pharmaceuticals to physicians and prescribing by physicians within hospital referral regions. Design Cross sectional analysis of 2013 and 2014 Open Payments and Medicare Part D prescribing data for two classes of commonly prescribed, commonly marketed drugs: oral anticoagulants and non-insulin diabetes drugs, overall and stratified by physician and payment type. Setting 306 hospital referral regions, United States. Participants 45 949 454 Medicare Part D prescriptions written by 623 886 physicians to 10 513 173 patients for two drug classes: oral anticoagulants and non-insulin diabetes drugs. Main outcome measures Proportion, or market share, of marketed oral anticoagulants and non-insulin diabetes drugs prescribed by physicians among all drugs in each class and within hospital referral regions. Results Among 306 hospital referral regions, there were 977 407 payments to physicians totaling $61 026 140 (£46 174 600; €54 632 500) related to oral anticoagulants, and 1 787 884 payments totaling $108 417 616 related to non-insulin diabetes drugs. The median market share of the hospital referral regions was 21.6% for marketed oral anticoagulants and 12.6% for marketed non-insulin diabetes drugs. Among hospital referral regions, one additional payment (median value $13, interquartile range, $10-$18) was associated with 94 (95% confidence interval 76 to 112) additional days filled of marketed oral anticoagulants and 107 (89 to 125) additional days filled of marketed non-insulin diabetes drugs (P<0.001). Payments to specialists were associated with greater prescribing of marketed drugs than payments to non-specialists (212 v 100 additional days filled per payment of marketed oral anticoagulants, 331 v 114 for marketed non-insulin diabetes drugs, P<0.001). Payments for speaker and consulting fees for non-insulin diabetes drugs were associated with

  15. Calculating drug doses.

    PubMed

    2016-09-01

    Numeracy and calculation are key skills for nurses. As nurses are directly accountable for ensuring medicines are prescribed, dispensed and administered safely, they must be able to understand and calculate drug doses. PMID:27615351

  16. Why do paediatricians prescribe antibiotics? Results of an Italian regional project

    PubMed Central

    Moro, Maria Luisa; Marchi, Massimiliano; Gagliotti, Carlo; Di Mario, Simona; Resi, Davide

    2009-01-01

    Background To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate. Methods A two-step survey was performed: in phase I, knowledge, and attitudes were explored involving all family and hospital paediatricians of Emilia-Romagna and a sample of parents. In phase II, patient care practices were explored in a stratified random sample of visits, both in hospitals and family physician's clinics; parent expectations were investigated in a sub-sample of these visits. Results Out of overall 4352 visits for suspected RTIs, in 38% of children an antibiotic was prescribed. Diagnostic uncertainty was perceived by paediatricians as the most frequent cause of inappropriate prescription (56% of 633 interviewed paediatricians); but, rapid antigen detecting tests was used in case of pharyngitis/pharyngotonsillitis by 36% and 21% of family and hospital paediatricians only. More than 50% of paediatricians affirmed to not adopt a "wait and see strategy" in acute otitis. The perceived parental expectation of antibiotics was not indicated by paediatricians as a crucial determinant of prescription, but this perception was the second factor most strongly associated to prescription (OR = 12.8; 95% CI 10.4 - 15.8), the first being the presence of othorrea. Regarding parents, the most important identified factors, potentially associated to overprescribing, were the lack of knowledge of RTIs and antibiotics (41% of 1029 parents indicated bacteria as a possible cause of common cold), and the propensity to seek medical care for trivial infections (48% of 4352 children accessing ambulatory practice presented only symptoms of common cold). Conclusion A wide gap between perceived and real determinants of antibiotic prescription exists. This can promote antibiotic overuse. Inadequate parental

  17. [Inappropriately ordered tests from hepatitis B vaccinated subjects].

    PubMed

    Ozbek, Ozgen Alpay; Oktem, Ibrahim Mehmet Ali

    2010-04-01

    Laboratory testing for viral hepatitis B constitutes a vast burden regarding the cost and the workload for health care system for many countries including ours. There are several reports stating that the cost in question is not always necessary. As a consequence of larger scale vaccination programmes, an increase in unnecessary hepatitis B testing is expected in vaccinated individuals. The present retrospective study aims to determine the rate of inappropriately ordered tests from vaccinated individuals and to discuss the causes and possible solutions of this problem. Laboratory records of 56.349 subjects admitted to Dokuz Eylul University Hospital, Izmir, during 2007 and 2009, were evaluated retrospectively for hepatitis B serological test results. Unnecessary testing was defined as the requests for HBsAg, anti-HBc, anti-HBc IgM, HBeAg and anti-HBe tests from those who had positive anti-HBs and negative anti-HBc results. The cost burden was calculated by taking account the prices recommended by the Department of Social Security. The appropriateness of anti-HBs test orders were not taken into evaluation since specific clinical conditions (immune response disorders, HIV infection, chronic hemodialysis, newborns of HBsAg positive mothers, contact with HBsAg carriers) were not clarified. It was found that among the 17.869 samples tested for both anti-HBs and anti-HBc, 4402 (24.6%) were ordered from subjects who were vaccinated against hepatitis B virus (anti-HBs positive, anti-HBc negative status). Thus, 11.405 (12.9%) tests out of a total of 88.174 hepatitis B tests (HBsAg, anti-HBc, anti-HBc IgM, HBeAg, anti-HBe) were unnecessarily ordered. Social security services and/or individuals paid approximately 59.000 USD for these unnecessary tests in three years, leading to an economic loss of approximately 20.000 USD yearly. Providing appropriate feedback to clinicians and reflex test application (to order a test according to the results of previous tests in accordance to

  18. The relative merits of therapies being developed to tackle inappropriate ('self'-directed) complement activation.

    PubMed

    Antwi-Baffour, Samuel; Kyeremeh, Ransford; Adjei, Jonathan Kofi; Aryeh, Claudia; Kpentey, George

    2016-12-01

    The complement system is an enzyme cascade that helps defend against infection. Many complement proteins occur in serum as inactive enzyme precursors or reside on cell surfaces. Complement components have many biologic functions and their activation can eventually damage the plasma membranes of cells and some bacteria. Although a direct link between complement activation and autoimmune diseases has not been found, there is increasing evidence that complement activation significantly contributes to the pathogenesis of a large number of inflammatory diseases that may have autoimmune linkage. The inhibition of complement may therefore be very important in a variety of autoimmune diseases since their activation may be detrimental to the individual involved. However, a complete and long-term inhibition of complement may have some contra side effects such as increased susceptibility to infection. The site of complement activation will, however, determine the type of inhibitor to be used, its route of application and dosage level. Compared with conventional drugs, complement inhibitors may be the best option for treatment of autoimmune diseases. The review takes a critical look at the relative merits of therapies being developed to tackle inappropriate complement activation that are likely to result in sporadic autoimmune diseases or worsen already existing one. It covers the complement system, general aspects of complement inhibition therapy, therapeutic strategies and examples of complement inhibitors. It concludes by highlighting on the possibility that a better inhibitor of complement activation when found will help provide a formidable treatment for autoimmune diseases as well as preventing one. PMID:26935316

  19. The effectiveness and limitations of regulatory warnings for the safe prescribing of citalopram

    PubMed Central

    Friesen, Kevin J; Bugden, Shawn C

    2015-01-01

    Background Citalopram is the most commonly prescribed antidepressant in Canada. Concerns have been raised about its cardiac safety, and a dose-dependent prolongation of the QT interval has been documented. Drug interactions involving concomitant use of other medications that prolong the QT interval or increase citalopram levels by interfering with its metabolism increase the cardiac risk. Regulatory bodies (Health Canada and the US Food and Drug Administration) issued warnings and required labeling changes in 2011/2012, suggesting maximum citalopram doses (<40 mg for those <65 years; <20 mg for those ≥65 years) and avoiding drug interactions that increase cardiac risk. The purpose of this study is to assess the impact of these warnings on citalopram prescribing practices. Methods A quasi-experimental interrupted time series analysis was conducted using all citalopram prescribing data from the population of Manitoba, Canada from 1999 to 2014. This allowed for the examination of high-dose prescribing (above regulatory warning levels) and the number of interacting medications per citalopram prescription. Results There was a dramatic decline in the prescribing of high doses in both age groups, with a 64.8% decline in those <65 years and 33.6% in those ≥65 years. Segmented regression models indicated significant breakpoints in the third quarter of 2011 for both age groups (P<0.0001), corresponding to the time the regulatory warnings were issued. There appeared to be no impact of the warnings on the prescribing of interacting medications. The number of interacting medications actually increased in the postwarning period (<65, 0.78–0.81 interactions per citalopram prescription; ≥65, 0.93–0.94, P<0.001). Conclusion Regulatory changes appear to have produced an important reduction in the high-dose prescribing of citalopram. In contrast to this relatively simple dosage change, there was no indication that the more complex issue of resolving drug–drug interactions

  20. Practice Gaps: Drug Reactions.

    PubMed

    Wolverton, Stephen E

    2016-07-01

    The term "drug reactions" is relevant to dermatology in three categories of reactions: cutaneous drug reactions without systemic features, cutaneous drug reactions with systemic features, and systemic drugs prescribed by the dermatologist with systematic adverse effects. This article uses examples from each of these categories to illustrate several important principles central to drug reaction diagnosis and management. The information presented will help clinicians attain the highest possible level of certainty before making clinical decisions. PMID:27363888

  1. Potentially inappropriate medications (PIMs) and anticholinergic levels in the elderly: a population based study in a French region.

    PubMed

    Beuscart, Jean-Baptiste; Dupont, Corinne; Defebvre, Marie-Margueritte; Puisieux, Francois

    2014-01-01

    Prescriptions of PIMs and anticholinergic drugs lead to adverse events and hospitalizations in the elderly. The objective of this study was to determine the prevalence of PIMs and prescriptions with a high anticholinergic effect in a French region. All prescriptions dispensed at community pharmacies in patients aged 75 and older between January 1 and March 31, 2012 were extracted from French Health Insurance information System - Nord-Pas-de-Calais Region for patients affiliated to the Social Security. Prescription of PIMs was defined according to the Laroche list. The anticholinergic score for each prescription was calculated using the Anticholinergic Drug Scale (ADS). 65.6% (n=207,979) of people aged over 75 years, living in the Nord-Pas-de-Calais Region were included, of which 4.5% (n=9284) living in nursing homes. Patients received an average of 8.3 drugs over the 3-month study period. In 32.6% (n=67,863) of patients, at least one PMI was prescribed. According to the ADS, 10.0% (n=20,978) of patients in the general population and 24.0% (n=2231) of patients living in nursing homes was exposed to a prescription with a high or very high anticholinergic score (ADS≥3). Hydroxyzine prescribed in 51.4% (n=10,792) of them ranked first among drugs most often reported. In conclusion, PMIs and anticholinergic drugs were commonly prescribed in elderly living in the Nord-Pas-de-Calais Region. Improving the quality of prescriptions in the elderly appears necessary. PMID:25192614

  2. Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment

    PubMed Central

    Kasmi, Irena; Sallabanda, Sashenka; Kasmi, Gentian

    2015-01-01

    BACKGROUND: Acetaminophen is a drug widely used in children because of its safety and efficacy. Although the risk of its toxicity is lower in children such reactions occur in pediatric patients from intentional overdoses and less frequently attributable to unintended inappropriate dosing. The aim of reporting this case is to attract the attention to the risk of the acetaminophen toxicity when administered in high doses. CASE PRESENTATION: We report here a 5 year old girl who developed fulminate liver failure with renal impairment and acute pancreatitis, as a result of acetaminophen toxicity caused from unintentional repeated supratherapeutic ingestion, with a total administered dose of 4800 mg in three consecutive days, 1600 mg/day, approximately 90 mg/kg/day. The blood level of acetaminophen after 10 hours of the last administered dose was 32 mg/l. The patient presented with high fever, jaundice, lethargic, agitating with abdominal pain accompanied by encephalopathy. The liver function test revealed with high level of alanine aminotransferase 5794 UI/l and aspartate aminotransferase 6000 UI/l. Early initiation of oral N-acetylcysteine (NAC) after biochemical evidence of liver toxicity was beneficial with rapid improvement of liver enzymes, hepatic function and encephalopathy. During the course of the illness the child developed acute pancreatitis with hyperamylasemia 255 UI/L and hyperlypasemia 514 UI/L. Patient totally recovered within 29 days. CONCLUSION: Healthcare providers should considered probable acetaminophen toxicity in any child who has received the drug and presented with liver failure. When there is a high index of suspicion of acetaminophen toxicity NAC should be initiated and continued until there are no signs of hepatic dysfunction.

  3. The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents.

    PubMed

    Lee, Sang Ah; Jang, Suk Yong; Shin, Jaeyong; Ju, Yeong Jun; Nam, Jin Young; Park, Eun Cheol

    2016-10-01

    Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative. PMID:27550479

  4. Learning to prescribe – pharmacists' experiences of supplementary prescribing training in England

    PubMed Central

    Cooper, Richard J; Lymn, Joanne; Anderson, Claire; Avery, Anthony; Bissell, Paul; Guillaume, Louise; Hutchinson, Allen; Murphy, Elizabeth; Ratcliffe, Julie; Ward, Paul

    2008-01-01

    Background The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice. Methods A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP. Results After one follow-up, 411 (51%) of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP) should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice. Conclusion Pharmacists appeared to value their SP training and suggested improvements that could

  5. Timing of Administration: For Commonly-Prescribed Medicines in Australia.

    PubMed

    Kaur, Gagandeep; Phillips, Craig L; Wong, Keith; McLachlan, Andrew J; Saini, Bandana

    2016-01-01

    Chronotherapy involves the administration of medication in coordination with the body's circadian rhythms to maximise therapeutic effectiveness and minimise/avoid adverse effects. The aim of this study is to investigate the "time of administration" recommendations on chronotherapy for commonly-prescribed medicines in Australia. This study also aimed to explore the quality of information on the timing of administration presented in drug information sources, such as consumer medicine information (CMI) and approved product information (PI). Databases were searched for original research studies reporting on the impact of "time of administration" of the 30 most commonly-prescribed medicines in Australia for 2014. Further, time of administration recommendations from drug information sources were compared to the evidence from chronotherapy trials. Our search revealed 27 research studies, matching the inclusion and exclusion criteria. In 56% (n = 15) of the research studies, the therapeutic effect of the medicine varied with the time of administration, i.e., supported chronotherapy. For some medicines (e.g., simvastatin), circadian-based optimal administration time was evident in the information sources. Overall, dedicated studies on the timing of administration of medicines are sparse, and more studies are required. As it stands, information provision to consumers and health professionals about the optimal "time" to take medications lags behind emerging evidence. PMID:27092523

  6. Timing of Administration: For Commonly-Prescribed Medicines in Australia

    PubMed Central

    Kaur, Gagandeep; Phillips, Craig L.; Wong, Keith; McLachlan, Andrew J.; Saini, Bandana

    2016-01-01

    Chronotherapy involves the administration of medication in coordination with the body’s circadian rhythms to maximise therapeutic effectiveness and minimise/avoid adverse effects. The aim of this study is to investigate the “time of administration” recommendations on chronotherapy for commonly-prescribed medicines in Australia. This study also aimed to explore the quality of information on the timing of administration presented in drug information sources, such as consumer medicine information (CMI) and approved product information (PI). Databases were searched for original research studies reporting on the impact of “time of administration” of the 30 most commonly-prescribed medicines in Australia for 2014. Further, time of administration recommendations from drug information sources were compared to the evidence from chronotherapy trials. Our search revealed 27 research studies, matching the inclusion and exclusion criteria. In 56% (n = 15) of the research studies, the therapeutic effect of the medicine varied with the time of administration, i.e., supported chronotherapy. For some medicines (e.g., simvastatin), circadian-based optimal administration time was evident in the information sources. Overall, dedicated studies on the timing of administration of medicines are sparse, and more studies are required. As it stands, information provision to consumers and health professionals about the optimal “time” to take medications lags behind emerging evidence. PMID:27092523

  7. No evidence or no alternative? Taking responsibility for off-label prescribing.

    PubMed

    Ghinea, N; Lipworth, W; Kerridge, I; Day, R

    2012-03-01

    Recombinant activated factor VII (rFVIIa) is registered for patients with rare haematological disorders, but is used 'off-label' in many other situations, including intracranial haemorrhage, cardiac surgery, trauma, transplantation and prostatectomy. Lack of systematic evidence to support these off-label uses has not slowed the growth of off-label prescribing of rFVIIa. We use the case of rFVIIa to illustrate the issues raised by off-label prescribing, and the kind of impasse that can arise when views about evidence, expertise and clinical necessity are in conflict. We argue that clinicians, hospital drug committees and regulators all need to acknowledge the complexity of prescribing decisions, and ensure that decisions to prescribe off-label are sufficiently justified. PMID:22432984

  8. Polypharmacy Patterns: Unravelling Systematic Associations between Prescribed Medications

    PubMed Central

    Calderón-Larrañaga, Amaia; Gimeno-Feliu, Luis A.; González-Rubio, Francisca; Poblador-Plou, Beatriz; Lairla-San José, María; Abad-Díez, José M.; Poncel-Falcó, Antonio; Prados-Torres, Alexandra

    2013-01-01

    Objectives The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. Methods A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. Results Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI), chronic obstructive pulmonary disease (COPD), rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns). Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors—such as hypertension or dyslipidemia—were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents). Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. Conclusions The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical patient guidelines

  9. Design of materials with prescribed nonlinear properties

    NASA Astrophysics Data System (ADS)

    Wang, F.; Sigmund, O.; Jensen, J. S.

    2014-09-01

    We systematically design materials using topology optimization to achieve prescribed nonlinear properties under finite deformation. Instead of a formal homogenization procedure, a numerical experiment is proposed to evaluate the material performance in longitudinal and transverse tensile tests under finite deformation, i.e. stress-strain relations and Poissons ratio. By minimizing errors between actual and prescribed properties, materials are tailored to achieve the target. Both two dimensional (2D) truss-based and continuum materials are designed with various prescribed nonlinear properties. The numerical examples illustrate optimized materials with rubber-like behavior and also optimized materials with extreme strain-independent Poissons ratio for axial strain intervals of εi∈[0.00, 0.30].

  10. Inappropriate shocks delivered by implantable cardiac defibrillators during oversensing of activity of diaphagmatic muscle

    PubMed Central

    Babuty, D; Fauchier, L; Cosnay, P

    1999-01-01

    Two cases are reported (both men, one 72 and one 54 years old) of inappropriate shocks delivered by an implantable cardiac defibrillator (ICD) device, which oversensed the myopotentials induced by deep breathing and Valsalva manoeuvre. No damage to leads was associated with the oversensing of myopotentials. The mechanism of the inappropriate shocks was determined using real time electrograms. Modification of the duration of ventricular detection and decrease in sensitivity made it possible to avoid the oversensing of myopotentials and to deliver ICD treatment.

 Keywords: implantable cardiac defibrillator;  inappropriate shocks;  myopotentials PMID:10220554

  11. General Practitioners' intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project.

    PubMed

    Tsiantou, Vasiliki; Moschandreas, Joanna; Bertsias, Antonis; Papadakaki, Maria; Saridaki, Aristoula; Agius, Dominic; Alper, Zuleyha; Faresjo, Tomas; Klimkova, Martina; Martinez, Luc; Samoutis, George; Vlček, Jiří; Lionis, Christos

    2015-09-01

    The aim of this paper is to explore general practitioners' (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs' prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. PMID:26188356

  12. Impact of a target drug monitoring program on the usage of clindamycin.

    PubMed

    Gin, A S; Lipinski, L A; Honcharik, N

    1994-04-01

    The use of parenteral clindamycin at the Health Sciences Centre had not been amendable to traditional cost containment strategies. Clindamycin was targeted through a Target Drug Monitoring (TDM) Program to improve its appropriate use. A retrospective audit was conducted to serve as a baseline. In the concurrent phase, the TDM pharmacist reviewed and assessed clindamycin cases based on approved criteria. Those cases which failed to meet the criteria were targeted in order to convert clindamycin to alternative agents. The concurrent TDM program reviewed 339 cases of clindamycin over a 32-week period, of which 76 cases (22.4%) failed to meet the criteria and were targeted. Of the 76 recommendations, 48 (63.2%) were accepted. Cost-avoidance due to direct intervention was approximately $16,000 annualized compared to $28,000 estimated from the retrospective audit. Fiscal year-end antibiotic usage indicated a dramatic decline (32%) in clindamycin use. Net savings of $37,600 were attributed to modification of physician prescribing. The TDM program was successful in identifying areas of inappropriate clindamycin use and correcting them by direct interaction with the prescriber(s). PMID:10134127

  13. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    PubMed Central

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended. PMID:24826198

  14. Exploring the ethics of prescribing medicines.

    PubMed

    Jackson, Jan

    2010-05-01

    The delivery of holistic care should incorporate patient empowerment through the promotion of health and self-help measures, including pain relief. In this article, the author, a newly qualified independent prescriber, explains why she believes that encouraging patients to buy over-the-counter medication is morally acceptable and based on the principles of beneficence and non-malevolence. She also reflects on her prescribing decisions in the context of ethics, health economics and personal perspective for four patients with similar injuries. The author works in Wales, where prescriptions are free to residents. PMID:20527454

  15. Determinants of HIV drug resistance and public health implications in low- and middle-income countries.

    PubMed

    Bertagnolio, Silvia; De Luca, Andrea; Vitoria, Marco; Essajee, Shaffiq; Penazzato, Martina; Hong, Steven Y; McClure, Craig; Duncombe, Chris; Jordan, Michael R

    2012-01-01

    Global scale-up of antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is an unprecedented public health achievement. With planned efforts of expanded ART access including earlier treatment initiation and the use of antiretroviral (ARV) drugs for prophylaxis, increasing levels of HIV drug resistance (HIVDR) are expected.Several factors may lead to selection and transmission of significant HIVDR in LMICs, which will lead to decreased population-level efficacy of standard first- and second-line ART regimens. These factors include low genetic barrier of some ARVs to resistance development, drug-drug interactions, inappropriate prescribing practices, interruption of drug supply, poor retention in care and lack of routine viral load monitoring.To maximize long-term effectiveness of available ARVs, policy makers and programme managers in LMICs should routinely monitor programme factors associated with emergence and transmission of HIVDR and implement routine HIVDR surveillance following standardized methods. When surveillance results suggest the need for action, specific public health interventions must be taken to adjust ART programme functioning to minimize further emergence and transmission of HIVDR.In this paper, we review ARV drug, HIV, patient and programme-related determinants of HIVDR. Additionally, we summarize the World Health Orgnization's global HIVDR surveillance and prevention strategy and describe resulting public health and policy implications. PMID:22898622

  16. Excipients and additives: hidden hazards in drug products and in product substitution.

    PubMed Central

    Napke, E; Stevens, D G

    1984-01-01

    The excipients and additives in drug formulations have been described as inert because they do not have an active role in the prevention or treatment of particular ailments. This has led to the misconception among physicians, pharmacists, drug manufacturers and the public that excipients are harmless and unworthy of mention. In fact, pharmacists are allowed to substitute drug formulations, without regard to the excipients, as long as they ensure that the active ingredients in the substitute are the same as those in the formulation prescribed. The inappropriateness of the term inert is becoming increasingly apparent as evidence of adverse reactions--some fatal--to excipients mounts. The likelihood that some "active" constituents, particularly erythromycin, have been blamed for such reactions deserves to be investigated. The public deserves to be better protected. For example, the United States has legislation requiring complete labelling of all food, drugs and cosmetics that incorporate more than one ingredient, no matter how innocuous the constituents are believed to be. In Canada, drug manufacturers are not even required to share this information with physicians or pharmacists when they introduce a new drug or reformulate a product already being marketed, nor are pharmacists required to disclose the contents of formulations that they prepare in the absence of commercially available products. PMID:6498699

  17. Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

    PubMed

    Davis, P B; Yee, R L; Millar, J

    1994-08-01

    Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7939853

  18. Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs

    PubMed Central

    Perlis, Roy H.; Perlis, Clifford S.

    2016-01-01

    Background The U.S. Physician Payments Sunshine Act mandates the reporting of payments or items of value received by physicians from drug, medical device, and biological agent manufacturers. The impact of these payments on physician prescribing has not been examined at large scale. Methods We linked public Medicare Part D prescribing data and Sunshine Act data for 2013. Physician payments were examined descriptively within specialties, and then for association with prescribing costs and patterns using regression models. Models were adjusted for potential physician-level confounding features, including sex, geographic region, and practice size. Results Among 725,169 individuals with Medicare prescribing data, 341,644 had documented payments in the OPP data (47.1%). Among all physicians receiving funds, mean payment was $1750 (SD $28336); median was $138 (IQR $48-$394). Across the 12 specialties examined, a dose-response relationship was observed in which greater payments were associated with greater prescribing costs per patient. In adjusted regression models, being in the top quintile of payment receipt was associated with incremental prescribing cost per patient ranging from $27 (general surgery) to $2931 (neurology). Similar associations were observed with proportion of branded prescriptions written. Conclusions While distribution and amount of payments differed widely across medical specialties, for each of the 12 specialties examined the receipt of payments was associated with greater prescribing costs per patient, and greater proportion of branded medication prescribing. We cannot infer a causal relationship, but interventions aimed at those physicians receiving the most payments may present an opportunity to address prescribing costs in the US. PMID:27183221

  19. Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses.

    PubMed

    Lansang, M A; Lucas-Aquino, R; Tupasi, T E; Mina, V S; Salazar, L S; Juban, N; Limjoco, T T; Nisperos, L E; Kunin, C M

    1990-01-01

    The purchase of antimicrobial agents in drugstores in a district in Manila. The Philippines was examined in order to determine how these agents might be used. Most antimicrobial agents are imported as bulk products and repackaged by a large number of small firms into 1491 different preparations including 206 marketed as combinations with other drugs. Antimicrobial agents accounted for 20.1% of all drug purchases. Purchases were made without prescription in 66.3% of 1608 transactions. Most of these were aminopenicillins or penicillins G or V (40.0%). The most common perceived indications were respiratory tract infections (20.2%), tuberculosis (8.8%), "prophylaxis" (8.6%) and gastrointestinal infection (8.3%). Almost 90% of purchases were for 10 or less capsules or tablets. The median number of units purchased was 3. Customers with written prescriptions purchased a mean of 8 while those who self-prescribed purchased a mean of 4 units (p = less than 0.05). We believe that these practices can provide only limited clinical efficacy and should favor emergence of resistant bacteria. PMID:2319282

  20. The Effects of a Token Economy on First Grade Students Inappropriate Social Behavior.

    ERIC Educational Resources Information Center

    Shook, Suzan C.; And Others

    1990-01-01

    Studies the effectiveness of a token economy on specific inappropriate social behaviors of three first grade students. Suggests that token economy systems can be very effective in decreasing disruptive behaviors of primary aged students. (MG)

  1. 27 CFR 478.21 - Forms prescribed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION...

  2. Energy-storage of a prescribed impedance

    NASA Technical Reports Server (NTRS)

    Smith, W. E.

    1969-01-01

    General mathematical expression found for energy storage shows that for linear, passive networks there is a minimum possible energy storage corresponding to a prescribed impedance. The electromagnetic energy storage is determined at different excitation frequencies through analysis of the networks terminal and reactance characteristics.

  3. 27 CFR 1.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 1.3 Section 1.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF..., NONINDUSTRIAL USE OF DISTILLED SPIRITS AND WINE, BULK SALES AND BOTTLING OF DISTILLED SPIRITS Scope § 1.3...

  4. 27 CFR 5.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 5.3 Section 5.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF...) or by mailing a request to the Alcohol and Tobacco Tax and Trade Bureau, National Revenue Center,...

  5. 27 CFR 4.3 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 4.3 Section 4.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF... mailing a request to the Alcohol and Tobacco Tax and Trade Bureau, National Revenue Center, 550...

  6. 27 CFR 18.16 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative...

  7. 27 CFR 18.16 - Forms prescribed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative...

  8. 27 CFR 22.21 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 22.21 Section 22.21 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Administrative...

  9. 27 CFR 22.21 - Forms prescribed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Forms prescribed. 22.21 Section 22.21 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Administrative...

  10. 27 CFR 22.21 - Forms prescribed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Forms prescribed. 22.21 Section 22.21 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Administrative...

  11. 16 CFR 315.5 - Prescriber verification.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription requirement. A seller may sell contact lenses only in accordance with a contact lens prescription for the patient that is: (1) Presented to the seller by...

  12. 16 CFR 315.5 - Prescriber verification.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription requirement. A seller may sell contact lenses only in accordance with a contact lens prescription for the patient that is: (1) Presented to the seller by...

  13. 16 CFR 315.5 - Prescriber verification.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription requirement. A seller may sell contact lenses only in accordance with a contact lens prescription for the patient that is: (1) Presented to the seller by...

  14. 16 CFR 315.5 - Prescriber verification.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription requirement. A seller may sell contact lenses only in accordance with a contact lens prescription for the patient that is: (1) Presented to the seller by...

  15. 16 CFR 315.5 - Prescriber verification.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription requirement. A seller may sell contact lenses only in accordance with a contact lens prescription for the patient that is: (1) Presented to the seller by...

  16. 27 CFR 26.2 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 26.2 Section 26.2 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Scope...

  17. 27 CFR 479.21 - Forms prescribed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  18. 27 CFR 479.21 - Forms prescribed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  19. 27 CFR 479.21 - Forms prescribed.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  20. 27 CFR 479.21 - Forms prescribed.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  1. 27 CFR 479.21 - Forms prescribed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND...

  2. Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study

    PubMed Central

    Deplanque, Dominique; Leys, Didier; Parnetti, Lucilla; Schmidt, Reinhold; Ferro, Jose; De Reuck, Jacques; Mas, Jean-Louis; Gallai, Virgilio

    2004-01-01

    Aims The aim of the Stroke and Atrial Fibrillation Ensemble (SAFE) II study was to identify the reasons underlying the under-utilization of oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (NVAF). Methods We investigated from all available sources the reasons why patients hospitalized for a stroke, who had a previously known NVAF, were not receiving OAC beforehand. We interviewed general practitioners (GPs) and cardiologists with a structured questionnaire, to identify the reasons for their therapeutic choice. Results Of 370 patients, 257 were theoretically eligible for OAC according to guidelines and the presence of contra-indications, but only 82 (22.2%) of them had actually received OAC before. We found that factors independently associated with the prescription of OAC were being followed-up by a cardiologist and having a younger GP. The leading reason evoked by GPs or cardiologists to explain why patients were not treated with OAC was the presence of a ‘potential contra-indication’, which was often inappropriate, followed by ‘there was no indication’, ‘low compliance’ and ‘fear of bleeding’. Conclusions An important reason for not prescribing OAC was the lack of knowledge about trials and guidelines. Medical education about OAC in NVAF should therefore be improved. PMID:15151526

  3. Reduction in inappropriate hospital use based on analysis of the causes

    PubMed Central

    2012-01-01

    Background To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement. Methods Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain. Results Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease. Conclusions It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital. PMID:23075150

  4. Inappropriate Postural Habits of High School Students from the Municipality of Ceres, Brazil.

    PubMed

    Noll, M; Noll, P Rs; Santos, E M; Silva Neto, A R; Candotti, C T

    2016-02-01

    This study aims to evaluate the prevalence of inappropriate postural habits in students. 827 Brazilian students aged 14 to 19 were evaluated with a self-administered questionnaire. A high prevalence of (>90%) inappropriate habits in sitting postures (on a chair, to write, and at a computer) and picking up an object off the floor was observed, suggesting the need to develop preventive programs. PMID:26897159

  5. Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision

    PubMed Central

    Haffey, Faye; Brady, Richard R W; Maxwell, Simon

    2014-01-01

    Junior doctors write the majority of hospital prescriptions but many indicate they feel underprepared to assume this responsibility and around 10% of prescriptions contain errors. Medical smartphone apps are now widely used in clinical practice and present an opportunity to provide support to inexperienced prescribers. This study assesses the contemporary range of smartphone apps with prescribing or related content. Six smartphone app stores were searched for apps aimed at the healthcare professional with drug, pharmacology or prescribing content. Three hundred and six apps were identified. 34% appeared to be for use within the clinical environment in order to aid prescribing, 14% out with the clinical setting and 51% of apps were deemed appropriate for both clinical and non-clinical use. Apps with drug reference material, such as textbooks, manuals or medical apps with drug information were the commonest apps found (51%), followed by apps offering drug or infusion rate dose calculation (26%). 68% of apps charged for download, with a mean price of £14.25 per app and a range of £0.62–101.90. A diverse range of pharmacology-themed apps are available and there is further potential for the development of contemporary apps to improve prescribing performance. Personalized app stores may help universities/healthcare organizations offer high quality apps to students to aid in pharmacology education. Users of prescribing apps must be aware of the lack of information regarding the medical expertise of app developers. This will enable them to make informed choices about the use of such apps in their clinical practice. PMID:23488599

  6. Improving Interoperability in ePrescribing

    PubMed Central

    Åstrand, Bengt; Petersson, Göran

    2012-01-01

    Background The increased application of eServices in health care, in general, and ePrescribing (electronic prescribing) in particular, have brought quality and interoperability to the forefront. The application of standards has been put forward as one important factor in improving interoperability. However, less focus has been placed on other factors, such as stakeholders’ involvement and the measurement of interoperability. An information system (IS) can be regarded to comprise an instrument for technology-mediated work communication. In this study, interoperability refers to the interoperation in the ePrescribing process, involving people, systems, procedures and organizations. We have focused on the quality of the ePrescription message as one component of the interoperation in the ePrescribing process. Objective The objective was to analyze how combined efforts in improving interoperability with the introduction of the new national ePrescription format (NEF) have impacted interoperability in the ePrescribing process in Sweden, with the focus on the quality of the ePrescription message. Methods Consecutive sampling of electronic prescriptions in Sweden before and after the introduction of NEF was undertaken in April 2008 (pre-NEF) and April 2009 (post-NEF). Interoperability problems were identified and classified based on message format specifications and prescription rules. Results The introduction of NEF improved the interoperability of ePrescriptions substantially. In the pre-NEF sample, a total of 98.6% of the prescriptions had errors. In the post-NEF sample, only 0.9% of the prescriptions had errors. The mean number of errors was fewer for the erroneous prescriptions: 4.8 in pre-NEF compared to 1.0 in post-NEF. Conclusions We conclude that a systematic comprehensive work on interoperability, covering technical, semantical, professional, judicial and process aspects, involving the stakeholders, resulted in an improved interoperability of e

  7. Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting

    PubMed Central

    Porterfield, Amber; Engelbert, Kate; Coustasse, Alberto

    2014-01-01

    Electronic prescribing (e-prescribing) is an important part of the nation's push to enhance the safety and quality of the prescribing process. E-prescribing allows providers in the ambulatory care setting to send prescriptions electronically to the pharmacy and can be a stand-alone system or part of an integrated electronic health record system. The methodology for this study followed the basic principles of a systematic review. A total of 47 sources were referenced. Results of this research study suggest that e-prescribing reduces prescribing errors, increases efficiency, and helps to save on healthcare costs. Medication errors have been reduced to as little as a seventh of their previous level, and cost savings due to improved patient outcomes and decreased patient visits are estimated to be between $140 billion and $240 billion over 10 years for practices that implement e-prescribing. However, there have been significant barriers to implementation including cost, lack of provider support, patient privacy, system errors, and legal issues. PMID:24808808

  8. The Study of Prescribing Errors Among General Dentists

    PubMed Central

    Araghi, Solmaz; Sharifi, Rohollah; Ahmadi, Goran; Esfehani, Mahsa; Rezaei, Fatemeh

    2016-01-01

    Introduction: In dentistry, medicine often prescribed to relieve pain and remove infections. Therefore, wrong prescription can lead to a range of problems including lack of pain, antimicrobial treatment failure and the development of resistance to antibiotics. Materials and Methods: In this cross-sectional study, the aim was to evaluate the common errors in written prescriptions by general dentists in Kermanshah in 2014. Dentists received a questionnaire describing five hypothetical patient and the appropriate prescription for the patient in question was asked. Information about age, gender, work experience and the admission in university was collected. The frequency of errors in prescriptions was determined. Data by SPSS 20 statistical software and using statistical t-test, chi-square and Pearson correlation were analyzed (0.05> P). Results: A total of 180 dentists (62.6% male and 37.4% female) with a mean age of 8.23 ± 39.199 participated in this study. Prescription errors include the wrong in pharmaceutical form (11%), not having to write therapeutic dose (13%), writing wrong dose (14%), typos (15%), error prescription (23%) and writing wrong number of drugs (24%). The most frequent errors in the administration of antiviral drugs (31%) and later stages of antifungal drugs (30%), analgesics (23%) and antibiotics (16%) was observed. Males dentists compared with females dentists showed more frequent errors (P=0.046). Error frequency among dentists with a long work history (P>0.001) and the acceptance in the university except for the entrance examination (P=0.041) had a statistically significant relationship. Conclusion: This study showed that the written prescription by general dentists examined contained significant errors and improve prescribing through continuing education of dentists is essential. PMID:26573049

  9. Effect of reactive pharmacy intervention on quality of hospital prescribing.

    PubMed Central

    Hawkey, C J; Hodgson, S; Norman, A; Daneshmend, T K; Garner, S T

    1990-01-01

    OBJECTIVE--To evaluate the medical impact of reactive pharmacy intervention. DESIGN--Analysis of all interventions during 28 days by all 35 pharmacists in hospitals in Nottingham. SETTING--All (six) hospitals in the Nottingham health authority (a teaching district), representing 2530 mainly acute beds, 781 mental illness beds, and 633 mainly health care of the elderly beds. PATIENTS--Hospital inpatients and outpatients. INTERVENTIONS--Recording of every important intervention made by pharmacists to prescriptions for both inpatients and outpatients when they perceived inadequacies of drug prescription or administration, including characterisation of the problem, coding of outcome, recording of time taken to initiate and resolve intervention, and grade of prescribing doctor. The problems were independently assessed for their potential to cause medical harm. RESULTS--769 Interventions (about 2.9% of prescriptions) were made, of which 60 concerned prescriptions rated as having a major potential for medical harm. The commonest problems concerned dosage, which was wrong in 280 prescriptions (102 for antibiotics) and not stated in 50 (one for antibiotics), especially those associated with a major potential for medical harm (32 prescriptions). These concerned sedatives; analgesics; cardiovascular drugs or diuretics; and iron, vitamin, or mineral preparations. Also common were overprolonged prescription of antibiotics (48 prescriptions), confusion of drug names (nine), and inadvertent coprescription of excessive quantities of aspirin or paracetamol in plain and compound preparations (seven). The pharmacist's recommendation was accepted in 639 instances (86%), and the prescription was altered in 575, leading to an appreciable (246 cases) or minor (231 cases) improvement. Interventions had little effect on costs; 427/646 had no effect and 130 produced savings less than 50p. Pharmacy intervention (730/769 interventions) occupied on average 41 minutes per pharmacist per week

  10. Impact of Inappropriate Empiric Antimicrobial Therapy on Mortality of Septic Patients with Bacteremia: A Retrospective Study

    PubMed Central

    Lueangarun, Saoraya; Leelarasamee, Amorn

    2012-01-01

    Background. Inappropriate empiric antimicrobials could be a major cause of unfavorable mortality rates in co-morbid patients. This study aimed to assess the prevalence and impact of first-dose and 24-hour inappropriate antimicrobials on mortality rates of bacteremic septic patients. Methods. A retrospective cohort study was employed. Case record forms of patients diagnosed as sepsis, severe sepsis, or septic shock with positive hemoculture during 2009 were retrieved from the medical wards, Siriraj Hospital. Demographic data, antimicrobial use, types of bacteria isolated from blood and susceptibilities, patients' comorbidities, 28-day and overall mortality rates were collected and analyzed. Results. There were 229 cases, mean age (SD) of 63.5 (17.2) years and mean (SD) APACHE II score of 24.7 (6.8). The prevalence of first-dose and 24-hour inappropriate antimicrobials was 29.7% and 25.3%, respectively. The 28-day and overall mortality rates between first-dose inappropriate and appropriate antimicrobial were 67.6% versus 60.2% (P = 0.301) and 75.0% versus 68.3% (P = 0.345), consequently. Patients with septic shock and inappropriate first-dose antimicrobials significantly had higher 28-day mortality rate (61.6% versus 41.9%; P = 0.017). Conclusion. Higher mortality rates in bacteremic septic patients were substantially associated with inappropriate first-dose antimicrobials and 3-hour delayed antimicrobial administration after sepsis diagnosis. PMID:22919379

  11. Emotion Knowledge and Attentional Differences in Preschoolers Showing Context-Inappropriate Anger.

    PubMed

    Locke, Robin L; Lang, Nichole J

    2016-08-01

    Some children show anger inappropriate for the situation based on the predominant incentives, which is called context-inappropriate anger. Children need to attend to and interpret situational incentives for appropriate emotional responses. We examined associations of context-inappropriate anger with emotion recognition and attention problems in 43 preschoolers (42% male; M age = 55.1 months, SD = 4.1). Parents rated context-inappropriate anger across situations. Teachers rated attention problems using the Child Behavior Checklist-Teacher Report Form. Emotion recognition was ability to recognize emotional faces using the Emotion Matching Test. Anger perception bias was indicated by anger to non-anger situations using an adapted Affect Knowledge Test. 28% of children showed context-inappropriate anger, which correlated with lower emotion recognition (β = -.28) and higher attention problems (β = .36). Higher attention problems correlated with more anger perception bias (β = .32). This cross-sectional, correlational study provides preliminary findings that children with context-inappropriate anger showed more attention problems, which suggests that both "problems" tend to covary and associate with deficits or biases in emotion knowledge. PMID:27417387

  12. Drug Interaction and Pharmacist

    PubMed Central

    Ansari, JA

    2010-01-01

    The topic of drug–drug interactions has received a great deal of recent attention from the regulatory, scientific, and health care communities worldwide. Nonsteroidal anti-inflammatory drugs, antibiotics and, in particular, rifampin are common precipitant drugs prescribed in primary care practice. Drugs with a narrow therapeutic range or low therapeutic index are more likely to be the objects for serious drug interactions. Object drugs in common use include warfarin, fluoroquinolones, antiepileptic drugs, oral contraceptives, cisapride, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action should they occur. With their detailed knowledge of medicine, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy. PMID:21042495

  13. Using Standardized Patients in Continuing Medical Education Courses on Proper Prescribing of Controlled Substances

    ERIC Educational Resources Information Center

    Swiggart, William H.; Ghulyan, Marine V.; Dewey, Charlene M.

    2012-01-01

    Controlled prescription drug (CPD) abuse is an increasing threat to patient safety and health care providers (HCPs) are not adequately prepared nor do they routinely employ proper screening techniques. Using standardized patients (SPs) as an instructional strategy, the trained physicians on proper prescribing practices and SBIRT (Screening, Brief…

  14. Off-Label Prescribing, Polypharmacy, and Black-Box Warnings: A Primer for School Psychologists

    ERIC Educational Resources Information Center

    Shahidullah, Jeffrey D.

    2012-01-01

    Psychotropic medications are increasingly used to treat children and adolescents with mental health conditions. Between the years 1994 and 2001, there was a 191.7% increase in number of office visits resulting in a psychotropic medication prescription among children and adolescents. Many drugs are prescribed to children "off-label", whereby they…

  15. Use of PharmaCALogy Software in a PBL Programme to Teach Nurse Prescribing

    ERIC Educational Resources Information Center

    Coleman, Iain P. L.; Watts, Adam S.

    2007-01-01

    Pharmacology is taught on a dedicated module for nurse prescribers who have a limited physical science background. To facilitate learning a problem-based approach was adopted. However, to enhance students' knowledge of drug action a PharmaCALogy software package from the British Pharmacological Society was used. Students were alternately given a…

  16. Physician practices, e-prescribing and accessing information to improve prescribing decisions.

    PubMed

    Grossman, Joy M; Boukus, Ellyn R; Cross, Dori A; Cohen, Genna R

    2011-05-01

    Hoping to reduce medication errors and contain health care costs, policy makers are promoting electronic prescribing through Medicare and Medicaid financial incentives. Many e-prescribing systems provide electronic access to important information--for example, medications prescribed by physicians in other practices, patient formularies and generic alternatives--when physicians are deciding what medications to prescribe. However, physician practices with e-prescribing face challenges using these features effectively, according to a new qualitative study by the Center for Studying Health System Change (HSC) funded by the Agency for Healthcare Research and Quality (AHRQ). While most of the 24 practices studied reported that physicians had access to patient formulary information, only slightly more than half reported physician access to patient medication histories, and many physicians did not routinely review these sources of information when making prescribing decisions. Study respondents highlighted two barriers to use: (1) tools to view and import the data into patient records were cumbersome to use in some systems; and (2) the data were not always perceived as useful enough to warrant the additional time to access and review them, particularly during time-pressed patient visits. To support generic prescribing, practices typically set their system defaults to permit pharmacist substitution of generics; many practices also used other tools to more proactively identify and select generic alternatives at the point of prescribing. Overall, physicians who more strongly perceived the need for third-party data, those in practices with greater access to complete and accurate data, and those with easier-to-use e-prescribing systems were more likely to use these features consistently. PMID:21545050

  17. Long-term Cognitive and Functional Effects of Potentially Inappropriate Medications in Older Women

    PubMed Central

    2014-01-01

    Background. The use of potentially inappropriate medications in older adults can lead to known adverse drug events, but long-term effects are less clear. We therefore conducted a prospective cohort study of older women to determine whether PIM use is associated with risk of functional impairment or low cognitive performance. Methods. We followed up 1,429 community-dwelling women (≥75 years) for a period of 5 years at four clinical sites in the United States. The primary predictor at baseline was PIM use based on 2003 Beers Criteria. We also assessed anticholinergic load using the Anticholinergic Cognitive Burden scale. Outcomes included scores on a battery of six cognitive tests at follow-up and having one or more incident impairments in instrumental activities of daily living. Regression models were adjusted for baseline age, race, education, smoking, physical activity, a modified Charlson Comorbidity Index, and cognitive score. Results. The mean ± SD age of women at baseline was 83.2 ± 3.3. In multivariate models, baseline PIM use and higher ACB scores were significantly associated with poorer performance in category fluency (PIM: p = .01; ACB: p = .02) and immediate (PIM: p = .04; ACB: p = .03) and delayed recall (PIM: p = .04). Both PIM use (odds ratio [OR]: 1.36 [1.05–1.75]) and higher ACB scores (OR: 1.11 [1.04–1.19]) were also strongly associated with incident functional impairment. Conclusions. The results provide suggestive evidence that PIM use and increased anticholinergic load may be associated with risk of functional impairment and low cognitive performance. More cautious selection of medications in older adults may reduce these potential risks. PMID:24293516

  18. Prescribing patterns of target-specific oral anticoagulants: an academic hospital perspective

    PubMed Central

    Johnson, Stacy A.; Yarbrough, Peter M.; Rose, Richard S.; Lanspa, Michael J.

    2015-01-01

    Target-specific oral anticoagulants have been rapidly adopted into clinical practice for stroke prophylaxis and venous thromboembolism treatment, raising concerns about off-label prescribing practices. We conducted a retrospective review of consecutive patients prescribed dabigatran, rivaroxaban or apixaban prior to inpatient hospitalization over an 18-month period to examine the off-label prescribing frequency, contraindications and related complications. Chart review included baseline demographics, hospital admitting service, outpatient prescribing service, renal function, therapeutic indication, echocardiographic findings, contraindications, major bleeding events and vital status. We identified 160 patients who received a target-specific oral anticoagulant prior to hospitalization. Over half (53.1%) of the patients received rivaroxaban, 43.7% received dabigatran and 3.1% received apixaban. Atrial fibrillation (68.1%) and venous thromboembolism treatment (25.6%) were the most common indications. Ninety percent of patients had a U.S. Foods and Drugs Administration (FDA)-approved indication for therapy. Major bleeding events occurred in 4.4% of patients. Cardiology was the most common prescribing and admitting service (43.8 and 31.3%), and more frequently adhered to FDA-approved indications (97 vs. 84%, P = 0.01). There were no significant differences between prescribing services regarding major contraindications (P = 0.14) and major bleeding events (P = 0.77). Off-label prescription rates for target-specific oral anticoagulants were infrequent and not associated with increased adverse events. PMID:26414695

  19. Even when physicians adopt e-prescribing, use of advanced features lags.

    PubMed

    Grossman, Joy M

    2010-07-01

    Physician practice adoption of electronic prescribing has not guaranteed that individual physicians will routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study from the Center for Studying Health System Change (HSC). Slightly more than two in five physicians providing office-based ambulatory care reported that information technology (IT) was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives. Among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all. Moreover, fewer than 60 percent of physicians with e-prescribing had access to three advanced features included as part of the Medicare and Medicaid incentive programs--identifying potential drug interactions, obtaining formulary information and transmitting prescriptions to pharmacies electronically--and less than a quarter routinely used all three features. Physicians in practices using electronic medical records exclusively were much more likely to report routine use of e-prescribing than physicians with stand-alone e-prescribing. systems. Other gaps in adoption and routine use of e-prescribing also exist, most notably between physicians in larger and smaller practices PMID:20653118

  20. Effect of computer-generated prompts on physician prescribing of multiple daily doses.

    PubMed

    Atkinson, V; Andrews, J D

    1987-06-01

    Cost containment of health care costs and computerization of pharmacy services are two trends that have become evident in recent years. The work described here was an attempt to reduce the prescribing of multiple daily doses of medications that could be prescribed once or twice daily by utilizing a pharmacy computer system. Ten drugs were identified as being prescribed more than 30% of the time in more frequent dosing schedules than recommended in the literature. Five of the drugs were randomly assigned to an experimental group and five to a control group. The computer system included a reminder with all experimental drug group orders for drugs effective given once or twice daily for maintenance therapy. This reminder was printed on both the physician's active medication profile and the nurse's medication administration record. The control period was designated as being the four month period prior to the initiation of the study. The experimental period was identified as the following four months where reminders were included with the drugs. No information concerning the study was circulated to the physicians or nursing staff. The results revealed no trend of fewer orders for multiple doses in the experimental group. In fact, all drugs in both the experimental and control groups showed random fluctuations in the number of orders for multiple doses. Possible reasons for the failure of this project include the impact of the reminders on the physicians, the timing of the study, and the medical condition of the patients. PMID:10282583

  1. In with the new: the determinants of prescribing innovation by general practitioners in Ireland.

    PubMed

    Bourke, Jane; Roper, Stephen

    2012-08-01

    An important element of the process by which new drugs achieve widespread use is their adoption by GPs. In this paper, we explore the factors that shape the timing of the first prescription of six new drugs by General Practitioners in Ireland. Our analysis is based on a dataset that matches prescription data with data on GP characteristics. We then use duration analysis to explore both equilibrium and non-equilibrium determinants of prescribing innovation. Our study highlights a range of commonalities across all of the drugs considered and suggests the importance of GP and practice characteristics in shaping prescribing decisions. We also find strongly significant, and consistently signed, stock and order effects across these drugs: GPs who have a track record of early adoption tend also to be early adopters of other new drugs; and, the larger the proportion of GPs which have already adopted a new drug the slower is subsequent adoption. Epidemic and learning effects are also evident with slower adoption by rural practices and among those GPs with narrower prescribing portfolios. PMID:21503785

  2. Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

    PubMed

    Barton, Lorna; Futtermenger, Judith; Gaddi, Yash; Kang, Angela; Rivers, Jon; Spriggs, David; Jenkins, Paul F; Thompson, Campbell H; Thomas, Josephine S

    2012-04-01

    This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation. PMID:22586784

  3. The effect of the withdrawal of rofecoxib on prescribing patterns of COX-2 inhibitors in Scotland

    PubMed Central

    Williams, D; Singh, M; Hind, C

    2006-01-01

    Background Concerns have been raised regarding the cardiovascular safety of the COX-2 inhibitors. In September 2004, rofecoxib was withdrawn from the market as a result of concerns regarding its cardiovascular safety. Aims & Methods We set out to examine the effect of the withdrawal of rofecoxib on the prescription of other COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) in Scotland, using a national prescription database. Results The withdrawal of rofecoxib led to an initial increase in the prescription of celecoxib as prescribers presumably switched to this alternative agent. However, this rise was short-lived, presumably as a result of concerns that the safety concerning rofecoxib may be a class effect. A parallel increase in the prescription of diclofenac and ibuprofen was also noted, suggesting that prescribers were prescribing these medications as alternatives to COX-2 inhibitors. Conclusions While prescribers and their patients may have initially interpreted safety concerns regarding rofecoxib to be drug specific, prescribers appear to have interpreted this effect to be class specific. PMID:16934053

  4. Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

    PubMed Central

    Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

    2015-01-01

    Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

  5. Prescribing new medications: A taxonomy of physician–patient communication

    PubMed Central

    TARN, DERJUNG M.; HERITAGE, JOHN; PATERNITI, DEBORA A.; HAYS, RON D.; KRAVITZ, RICHARD L.; WENGER, NEIL S.

    2009-01-01

    Physician-patient communication about new medications can influence patient medication adherence. Little is known about the detailed content of conversations about new medications, or about how physicians and patients word information when discussing new medications. Yet nuances in communication may influence patient comprehension and affect behaviour. A comprehensive coding framework delineating the intricacies of physician-patient discussions is needed to better understand the range of communication about new prescriptions. This study used analytic induction to analyse 185 audiotaped outpatient encounters, during which 243 new medications were prescribed by family physicians, internists and cardiologists in two healthcare settings. Seventy-six codes were developed to demonstrate the range of physician counselling about information concerning new prescriptions, such as medication name, purpose, directions for use, side effects, acquisition and monitoring. The conversational content represented by the codes can be used to understand the breadth of conversations regarding new medications, identify sources of potential patient misunderstandings when medication instructions are conveyed, and inform recommendations for desired communication content. The coding system also can be used to measure the quality of new medication discussions for linkage to outcomes and can inform interventions to improve communication when prescribing new drugs. PMID:19644569

  6. Educational interventions to improve prescribing competency: a systematic review

    PubMed Central

    Kamarudin, Gritta; Penm, Jonathan; Chaar, Betty; Moles, Rebekah

    2013-01-01

    Objective To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers. Design A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013. Setting Primary and secondary care. Participants Medical and non-medical prescribers. Intervention Education-based interventions to aid improvement in prescribing competency. Primary outcome Improvements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines. Results A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area. Conclusions A broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation

  7. Analysis of Out Door Patients’ Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India

    PubMed Central

    Kumbar, Shivaprasad Kalakappa

    2015-01-01

    Background: Prescription is document through which doctor, patient and pharmacist are communicated. Many a times if these documents are not properly written or misinterpreted it can affect management of patients. WHO established prescribing indicators to analyse prescription and promoted rational use of drugs and better management of patients. Aim: To study the prescription pattern according to WHO prescribing indicators among private hospitals. Settings and Design: The observational, prospective study carried out at different private hospitals at metro city in Western India to study the prescription pattern among private hospital. Materials and Methods: Study was conducted at different private hospitals of metro city. A total of 250 prescriptions of outdoor patients from various departments of private hospitals were collected for a period of three months (August to October) 2012 and evaluated. Statistical analysis: The study was analysed using Z-test. Results: Patient details like age and gender was not written in all (100%) prescriptions. It was noticed that dose, direction of drug and duration of treatment was not completely written in 90%, 74% and 80% of prescriptions respectively. Abbreviations were used in all (100%) prescriptions. Doctor’s medical registration number was mentioned in 0% prescriptions. Total 869 drugs were prescribed in 250 prescriptions. Average number of drug prescribed was 3.38±1.79 (Mean±SD). It was reported that Group II (3 to 4 encoutner) was significantly higher as compared to Group I (less than or equal to 2 encoutner) and Group III( more than four encounter). It was significantly (p<0.05) prescribed brand name prescriptions (93.33%) as compared to generic name prescriptions (6.7%). Percentage of encounter with antibiotics and injections was 54% and 18% respectively. Approximately 70% drugs were prescribed according to Essential Medicine List (EML) of State. Antibiotics accounted 30% of prescribed drugs which was significantly

  8. Predicting and detecting adverse drug reactions in old age: challenges and opportunities.

    PubMed

    Mangoni, Arduino A

    2012-05-01

    Increased, often inappropriate, drug exposure, pharmacokinetic and pharmacodynamic changes, reduced homeostatic reserve and frailty increase the risk of adverse drug reactions (ADRs) in the older population, thereby imposing a significant public health burden. Predicting and diagnosing ADRs in old age presents significant challenges for the clinician, even when specific risk scoring systems are available. The picture is further compounded by the potential adverse impact of several drugs on more 'global' health indicators, for example, physical function and independence, and the fragmentation of care (e.g., increased number of treating doctors and care transitions) experienced by older patients during their clinical journey. The current knowledge of drug safety in old age is also curtailed by the lack of efficacy and safety data from pre-marketing studies. Moreover, little consideration is given to individual patients' experiences and reporting of specific ADRs, particularly in the presence of cognitive impairment. Pending additional data on these issues, the close review and monitoring of individual patients' drug prescribing, clinical status and biochemical parameters remain essential to predict and detect ADRs in old age. Recently developed strategies, for example, medication reconciliation and trigger tool methodology, have the potential for ADRs risk mitigation in this population. However, more information is required on their efficacy and applicability in different healthcare settings. PMID:22512705

  9. Evaluation of a national programme to reduce inappropriate use of antibiotics for upper respiratory tract infections: effects on consumer awareness, beliefs, attitudes and behaviour in Australia.

    PubMed

    Wutzke, Sonia E; Artist, Margaret A; Kehoe, Linda A; Fletcher, Miriam; Mackson, Judith M; Weekes, Lynn M

    2007-03-01

    The over-use of antibiotics, in particular, inappropriate use to treat upper respiratory tract infections (URTIs), is a global public health concern. In an attempt to reduce inappropriate use of antibiotics for URTIs, and, in particular, to modify patient misconceptions about the effectiveness of antibiotics for URTIs, Australia's National Prescribing Service Ltd (NPS) has undertaken a comprehensive, multistrategic programme for health professionals and the community. Targeted strategies for the community, via the NPS common colds community campaign, commenced in 2000 and have been repeated annually during the winter months. Community strategies were closely integrated, using the same tagline, key messages and visual images, and were delivered in numerous settings including general practice, community pharmacy, child-care centres and community groups. Strategies included written information via newsletters and brochures, mass media activity using billboards, television, radio and magazines and small grants to promote local community education. The evaluation used multiple methods and data sources to measure process, impact and outcomes. Consistent with intervention messages, the integrated nationwide prescriber and consumer programme is associated with modest but consistent positive changes in consumer awareness, beliefs, attitudes and behaviour to the appropriate use of antibiotics for URTIs. These positive changes among the community are corroborated by a national decline in total antibiotic prescriptions dispensed in the community (from 23.08 million prescriptions in 1998-99 to 21.44 million in 2001-02) and, specifically, by a decline among the nine antibiotics commonly used for URTI such that by 2003 nationally 216,000 fewer prescriptions for URTI are written each year by general practitioners. PMID:17046966

  10. Factors associated with the inappropriate use of antimicrobials.

    PubMed

    McIntosh, W; Dean, W

    2015-04-01

    Antimicrobial resistance continues to grow and antimicrobial use in food animal production and to a lesser extent in human patients is under fire. Much of the criticism has to do with the misapplication of these drugs in both settings. Research indicates that patients, food animal producers, physicians and veterinarians have all played a part in misusing antimicrobials, often because of mistaken beliefs. This paper reviews this research and introduces a theoretical perspective, the Theory of Planned Behavior (TPB), which broadens our understanding of the motivations for misuse. In particular this approach shows that individuals making decisions about antimicrobial use take into account social pressures from and a sense of obligation to significant others in their social networks. Our own work summarized in this paper indicates that both feedlot veterinarians and feedlot managers' antimicrobial decisions are influenced by both expectations from and obligations to a variety of actors in the feedlot network (other veterinarians, feedlot clients, consumers, pharmaceutical companies, and regulatory bodies). Generally across 4 circumstances of antimicrobial use (for acutely sick cattle, chronically-sick cattle, at-risk cattle, high-risk cattle), it is largely the perception that peers and clients expect feedlot veterinarians to use antimicrobials and feedlot veterinarians sense of obligation to these groups that have the most influence on their decisions to recommend antimicrobials. Based on these findings, the question of engaging in changing the choices made by those working with food animals must start with those who influence the decision to proscribe or use antimicrobials. As our data come from the United States and may be unique relative to other countries, these efforts should begin by ascertaining who influences these decisions. The next step is to then change the beliefs of these significant others. PMID:25470319

  11. The Documentation of Health Problems in Relation to Prescribed Medication in People with Profound Intellectual and Multiple Disabilities

    ERIC Educational Resources Information Center

    van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

    2009-01-01

    Background: Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed. Method: Persons with PIMD with an…

  12. Making pharmacogenomic-based prescribing alerts more effective: A scenario-based pilot study with physicians.

    PubMed

    Overby, Casey Lynnette; Devine, Emily Beth; Abernethy, Neil; McCune, Jeannine S; Tarczy-Hornoch, Peter

    2015-06-01

    To facilitate personalized drug dosing (PDD), this pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. We employed a conceptual framework and measurement model to access the impact of physician characteristics (previous experience, awareness, relative advantage, perceived usefulness), technology characteristics (methods of implementation-semi-active/active, actionability-low/high) and a task characteristic (drug prescribed) on communication effectiveness (usefulness, confidence in prescribing decision), and clinical impact (uptake, prescribing intent, change in drug dosing). Physicians performed prescribing tasks using five simulated clinical case scenarios, presented in random order within the prototype PGx-CDS system. Twenty-two physicians completed the study. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83% at the start and 94% at the conclusion of our study. Physicians used semi-active alerts 74-88% of the time. There was no association between previous experience with, awareness of, and belief in a relative advantage of using PGx-CDS and improved uptake. The proportion of physicians reporting confidence in their prescribing decisions decreased significantly after using the prototype PGx-CDS system (p=0.02). Despite decreases in confidence, physicians perceived a relative advantage to using PGx-CDS, viewed semi-active alerts on most occasions, and more frequently changed doses toward doses supported by published evidence. Specifically, sixty-five percent of physicians reduced their dosing, significantly for capecitabine (p=0.002) and mercaptopurine/thioguanine (p=0.03). These findings suggest a need to improve our prototype such that PGx CDS content is more useful and delivered in a way that improves physician's confidence in their prescribing

  13. Perceptions of Standards-based Electronic Prescribing Systems as Implemented in Outpatient Primary Care: A Physician Survey

    PubMed Central

    Wang, C. Jason; Patel, Mihir H.; Schueth, Anthony J.; Bradley, Melissa; Wu, Shinyi; Crosson, Jesse C.; Glassman, Peter A.; Bell, Douglas S.

    2009-01-01

    Objective To compare the experiences of e-prescribing users and nonusers regarding prescription safety and workload and to assess the use of information from two e-prescribing standards (for medication history and formulary and benefit information), as they are implemented. Design Cross-sectional survey of physicians who either had installed or were awaiting installation of one of two commercial e-prescribing systems. Measurements Perceptions about medication history and formulary and benefit information among all respondents, and among e-prescribing users, experiences with system usability, job performance impact, and amount of e-prescribing. Results Of 395 eligible physicians, 228 (58%) completed the survey. E-prescribers (n = 139) were more likely than non-e-prescribers (n = 89) to perceive that they could identify clinically important drug–drug interactions (83 versus 67%, p = 0.004) but not that they could identify prescriptions from other providers (65 versus 60%, p = 0.49). They also perceived no significant difference in calls about drug coverage problems (76 versus 71% reported getting 10 or fewer such calls per week; p = 0.43). Most e-prescribers reported high satisfaction with their systems, but 17% had stopped using the system and another 46% said they sometimes reverted to handwriting for prescriptions that they could write electronically. The volume of e-prescribing was correlated with perceptions that it enhanced job performance, whereas quitting was associated with perceptions of poor usability. Conclusions E-prescribing users reported patient safety benefits but they did not perceive the enhanced benefits expected from using standardized medication history or formulary and benefit information. Additional work is needed for these standards to have the desired effects. PMID:19390106

  14. Exercise and older patients: prescribing guidelines.

    PubMed

    McDermott, Ann Yelmokas; Mernitz, Heather

    2006-08-01

    A combination of aerobic activity, strength training, and flexibility exercises, plus increased general daily activity can reduce medication dependence and health care costs while maintaining functional independence and improving quality of life in older adults. However, patients often do not benefit fully from exercise prescriptions because they receive vague or inappropriate instructions. Effective exercise prescriptions include recommendations on frequency, intensity, type, time, and progression of exercise that follow disease-specific guidelines. Changes in physical activity require multiple motivational strategies including exercise instruction as well as goal-setting, self-monitoring, and problem-solving education. Helping patients identify emotionally rewarding and physically appropriate activities, contingencies, and social support will increase exercise continuation rates and facilitate desirable health outcomes. Through patient contact and community advocacy, physicians can promote lifestyle patterns that are essential for healthy aging. PMID:16913163

  15. Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department, a Novel Multicomponent Interdisciplinary Quality Improvement Initiative.

    PubMed

    Stevens, Melissa B; Hastings, Susan Nicole; Powers, James; Vandenberg, Ann E; Echt, Katharina V; Bryan, William E; Peggs, Kiffany; Markland, Alayne D; Hwang, Ula; Hung, William W; Schmidt, Anita J; McGwin, Gerald; Ikpe-Ekpo, Edidiong; Clevenger, Carolyn; Johnson, Theodore M; Vaughan, Camille P

    2015-05-01

    Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED-targeted interventions aimed at reducing the use of potentially inappropriate medications (PIMs). Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the ED (EQUiPPED) is an ongoing multicomponent, interdisciplinary quality improvement initiative in eight Department of Veterans Affairs EDs. The project aims to decrease the use of PIMs, as identified by the Beers criteria, prescribed to veterans aged 65 and older at the time of ED discharge. Interventions include provider education; informatics-based clinical decision support with electronic medical record-embedded geriatric pharmacy order sets and links to online geriatric content; and individual provider education including academic detailing, audit and feedback, and peer benchmarking. Poisson regression was used to compare the number of PIMs that staff providers prescribed to veterans aged 65 and older discharged from the ED before and after the initiation of the EQUiPPED intervention. Initial data from the first implementation site show that the average monthly proportion of PIMs that staff providers prescribed was 9.4±1.5% before the intervention and 4.6±1.0% after the initiation of EQUiPPED (relative risk=0.48, 95% confidence interval=0.40-0.59, P<.001). Preliminary evaluation demonstrated a significant and sustained reduction of ED-prescribed PIMs in older veterans after implementation of EQUiPPED. Longer follow-up and replication at collaborating sites would allow for an assessment of the effect on health outcomes and costs. PMID:25945692

  16. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    PubMed Central

    2012-01-01

    providers towards external stakeholders and limit the use of PQI in external quality improvement programs. Conclusion Prescribing quality indicators are considered to be an important tool for assessing quality of provided diabetes care by all participants, although the preferences for specific types of indicators may differ by stakeholder depending on their user aim. Introduction of information systems to register the reasons for deviating from the recommended drug treatment may contribute to a more widespread use of PQI for assessment of provided health care quality to diabetic patents. This study identified the potential preferences regarding quality indicators for diabetes care, and this could be used for development of questionnaires to conduct a survey among a larger group of participants. PMID:22769967

  17. Prescribing benzodiazepines in general practice: a new view of an old problem.

    PubMed

    Rogers, Anne; Pilgrim, David; Brennan, Susie; Sulaiman, Ilyas; Watson, Gareth; Chew-Graham, Carolyn

    2007-04-01

    General practitioner (GP) prescribing has been identified as an arena that has broad social and political implications, which stretch beyond individual outcomes for patients. This article revisits aspects of the controversy about prescribing benzodiazepines (or 'minor tranquillizers') through an exploration of contemporary views of GPs. In the 1980s the prescribing of these drugs was considered to be both a clinical and social problem, which brought medical decision making under public scrutiny. The legacy of this controversy for recent GPs remains a relatively under-explored topic. This article describes a qualitative study of GPs practising in the north-west of England about their views of prescribing benzodiazepines. The accounts of the respondents highlight a number of points about: blame allocation, past and present; clinical challenges about risk management; and deserving and undeserving patients. These GP views are then discussed in the wider context of psychotropic drug use. It is concluded that, while there has been a recent consensus that the benzodiazepines have been problematic, when they are placed in a longer historical context, a different picture is apparent because other psychotropic drugs have raised similar problems. PMID:17344271

  18. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery.

    PubMed

    Bifulco, Paolo; Argenziano, Luigi; Romano, Maria; Cesarelli, Mario; Sansone, Mario; Casella, Stefano; Nardi, Stefano

    2014-01-01

    Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients' quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients. PMID:24592279

  19. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis.

    PubMed

    Fenske, W; Sandner, B; Christ-Crain, M

    2016-03-01

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH), also referred to as syndrome of inappropriate antidiuresis (SIAD), is the most common cause of hyponatremia characterized by extracellular hypotonicity and impaired urine dilution in the absence of any recognizable nonosmotic stimuli for the antidiuretic hormone arginine vasopressin (AVP). Hyponatremia in SIADH is primarily the result of excessive water retention caused by a combination of inappropriate antidiuresis and persistent fluid intake in the presence of impaired osmoregulated inhibition of thirst. It is sometimes aggravated by a sodium deficiency caused by a decreased intake or a secondary natriuresis in response to elevated extracellular volume. Inappropriate antidiuresis usually results from endogenous production of AVP that can be either ectopic (from a malignancy) or eutopic (from the hypothalamus/neurohypophysis). Regardless of its origin, different types of osmotic dysregulation of AVP have been reported with possibly fundamental deviations in treatment need and efficacy. A recent quantitative analysis of 50 patients with SIADH, which underwent serial measurements of copeptin during hypertonic saline infusion, revealed five distinct types of osmoregulatory defect ("type A to E") without affiliation to specific underlying diseases. In addition to apparently impaired osmoregulated inhibition of AVP release in the majority of patients, 12% of patients showed an AVP-independent mechanism of inappropriate antidiuresis, whilst 20% of them presented a reverse relation between hormone release and serum osmolality, presumably related to interrupted nonosmotic inhibitory pathways. The interference of these different types of SIAD with clinical presentation and therapy response will be a relevant subject for future research. PMID:27156760

  20. Herb-drug, food-drug, nutrient-drug, and drug-drug interactions: mechanisms involved and their medical implications.

    PubMed

    Sørensen, Janina Maria

    2002-06-01

    Adverse drug reactions (ADRs) and iatrogenic diseases have been identified as significant factors responsible for patient morbidity and mortality. Significant studies on drug metabolism in humans have been published during the last few years, offering a deeper comprehension of the mechanisms underlying adverse drug reactions and interactions. More understanding of these mechanisms, and of recent advances in laboratory technology, can help to evaluate potential drug interactions when drugs are prescribed concurrently. Increasing knowledge of interindividual variation in drug breakdown capacity and recent findings concerning the influence of environment, diet, nutrients, and herbal products can be used to reduce ADRs and iatrogenic diseases. Reviewed data suggest that drug treatment should be increasingly custom tailored to suit the individual patient and that appropriately co-prescribed diet and herbal remedies, could increase drug efficacy and lessen drug toxicity. This review focuses mainly on recently published research material. The cytochrome p450 enzymes, their role in metabolism, and their mechanisms of action are reviewed, and their role in drug-drug interactions are discussed. Drug-food and drug-herb interactions have garnered attention. Interdisciplinary communication among medical herbalists, medical doctors, and dietetic experts needs to be improved and encouraged. Internet resources for obtaining current information regarding drug-drug, drug-herb, and drug-nutrient interactions are provided. PMID:12165187

  1. Myasthenia Gravis: Drugs to be Avoided

    MedlinePlus

    ... explanation) on this drug in MG patients. • The fluoroquinolones , including Ciprofloxacin and Levofloxacin – commonly prescribed antibiotics that ... drugs that carry black box warnings include the fluoroquinolones (e.g. Ciprofloxacin , Levafloxacin ; see above) and Telethromycin ( ...

  2. Role of Computerized Physician Order Entry Usability in the Reduction of Prescribing Errors

    PubMed Central

    Zakaria, Mohamad Shanudin; Yasin, Norjaya M.; Shah, Mahmood Hussain; Elhissi, Abdelbary

    2013-01-01

    Objectives Some hospitals have implemented computerized physician order entry (CPOE) systems to reduce the medical error rates. However, research in this area has been very limited, especially regarding the impact of CPOE use on the reduction of prescribing errors. Moreover, the past studies have dealt with the overall impact of CPOE on the reduction of broadly termed "medical errors", and they have not specified which medical errors have been reduced by CPOE. Furthermore, the majority of the past research in this field has been either qualitative or has not used robust empirical techniques. This research examined the impacts of usability of CPOE systems on the reduction of doctors' prescribing errors. Methods One hundred and sixty-six questionnaires were used for quantitative data analyses. Since the data was not normally distributed, partial least square path modelling-as the second generation of multivariate data analyses-was applied to analyze data. Results It was found that the ease of use of the system and information quality can significantly reduce prescribing errors. Moreover, the user interface consistency and system error prevention have a significant positive impact on the perceived ease of use. More than 50% of the respondents believed that CPOE reduces the likelihood of drug allergy, drug interaction, and drug dosing errors thus improving patient safety. Conclusions Prescribing errors in terms of drug allergy, drug interaction, and drug dosing errors are reduced if the CPOE is not error-prone and easy to use, if the user interface is consistent, and if it provides quality information to doctors. PMID:23882414

  3. Homoeopathic and herbal prescribing in general practice in Scotland

    PubMed Central

    Ross, Sarah; Simpson, Colin R; McLay, James S

    2006-01-01

    What is already known about this subject Homoeopathy and herbalism are increasingly popular among the public and prescribed by general practitioners in the NHS. Doctors and regulatory authorities have expressed concerns about their efficacy and safety. Studies from the 1990s suggest that between 5.9 and 7.5% of English NHS general practitioners have prescribed homoeopathy, while less than 1% have prescribed herbal remedies. Current levels of prescribing are unknown but are thought to have increased. What this study adds Sixty percent of Scottish general practices now prescribe homoeopathic or herbal remedies. The prevalence of homoeopathic prescribing in those under 16 years has doubled since 2000 and is maximal in children < 1 year old, of whom 1% are prescribed a homoeopathic remedy. Recognized drug–herb interactions were identified in 4% of patients prescribed oral herbal remedies. Aims To investigate the current levels of homoeopathic and herbal prescribing in Scottish general practice. Methods Prescribing of homoeopathic and herbal remedies in primary care was assessed in 1891 669 patients for the year 2003–2004, using computerized prescribing data retrieved from 323 general practices in Scotland. Results Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies. A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of practices accounting for 46% of patients and 50% of remedies. Four thousand one hundred and sixty patients (2.2/1000 registered patients) were prescribed at least one homoeopathic remedy during the study period, with the highest prevalence to children under 12 months of age (9.5/1000 children of that age). Children under the age of 16 made up 16% of the population prescribed homoeopathic remedies (2.2/1000 registered patients of that age). Three hundred and sixty-one patients (0.2/1000 registered patients) were prescribed at least one herbal remedy during the study period, 44 of whom were children

  4. Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study

    PubMed Central

    Westbrook, Johanna I.; Reckmann, Margaret; Li, Ling; Runciman, William B.; Burke, Rosemary; Lo, Connie; Baysari, Melissa T.; Braithwaite, Jeffrey; Day, Richard O.

    2012-01-01

    Background Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error. Methods and Results We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system) at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e-prescribing system, acted as controls. In Hospital B, the iSoft MedChart system was implemented on two wards and we compared before and after error rates. Procedural (e.g., unclear and incomplete prescribing orders) and clinical (e.g., wrong dose, wrong drug) errors were identified. Prescribing error rates per admission and per 100 patient days; rates of serious errors (5-point severity scale, those ≥3 were categorised as serious) by hospital and study period; and rates and categories of postintervention “system-related” errors (where system functionality or design contributed to the error) were calculated. Use of an e-prescribing system was associated with a statistically significant reduction in error rates in all three intervention wards (respectively reductions of 66.1% [95% CI 53.9%–78.3%]; 57.5% [33.8%–81.2%]; and 60.5% [48.5%–72.4%]). The use of the system resulted in a decline in errors at Hospital A from 6.25 per admission (95% CI 5.23–7.28) to 2.12 (95% CI 1.71–2.54; p<0.0001) and at Hospital B from 3.62 (95% CI 3.30–3.93) to 1.46 (95% CI 1.20–1.73; p<0

  5. Make a lasting impression: the neural consequences of re-encountering people who emote inappropriately.

    PubMed

    Bayliss, Andrew P; Naughtin, Claire K; Lipp, Ottmar V; Kritikos, Ada; Dux, Paul E

    2012-12-01

    We can learn about the affective content of the environment by observing the behavior of others; their responses to stimuli tend to be appropriate to the context. To investigate the impact of observing such appropriate, compared with inappropriate, behaviors, we developed a novel behavioral task where participants observed different faces reacting to emotional scenes. We found that affective categorization of a scene was facilitated when it was presented alongside an appropriate facial expression (Experiment 1). Further, we observed that several brain areas in the right hemisphere-the putamen, insula, orbitofrontal cortex, and dorsal anterior cingulate cortex-were more activate when viewing faces that were previously observed emoting inappropriately (Experiment 2). We contend that these areas form a network that codes for the retrieval of affective conflict information generated by observing individuals producing inappropriate emotions. PMID:23095146

  6. Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD.

    PubMed

    Corzani, Alessandro; Ziacchi, Matteo; Biffi, Mauro; Diemberger, Igor; Martignani, Cristian; Boriani, Giuseppe

    2015-01-01

    Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD). A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles. PMID:25820052

  7. A questionnaire study of injections prescribed and dispensed for patients diagnosed with mild/moderate community-acquired pneumonia in Mongolia

    PubMed Central

    Hendrie, Delia; Parsons, Richard W.; Sunderland, Bruce

    2015-01-01

    Purpose. The study aimed to determine the extent of and factors influencing the prescribing of injections for the treatment of mild/moderate community acquired pneumonia (CAP) in Mongolia. Methods. Questionnaires were developed and administered to medication providers (34 Pharmacists, 27 pharmacy technicians) and prescribers (22 general doctors and 49 medical specialists) working in Mongolia. Results. Cefalosporins were prescribed for patients with mild pneumonia and doctors tended to prescribe injectable cefalosporins (cefazolin) rather than oral dosage forms. This was supported by the questionnaire study with pharmacists and pharmacy technicians. Additionally, 23 pharmacists and pharmacy technicians indicated that OTC injectable cefalosporins (37.7%) and injectable aminopenicillins (33,9%) were frequently sold by pharmacies for the treatment of mild/moderate CAP. Doctors and particularly pharmacists in the questionnaire studies indicated choosing an injection was to avoid non-compliance problems. Conclusion. High levels of injectable prescribing of antibiotics were found in non-hospitalized patients with CAP in Mongolia. This prevalence level indicated that inappropriate injection prescribing is a public health hazard for Mongolia and requires consideration by the appropriate authorities. PMID:26644968

  8. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    PubMed

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level. PMID:26924486

  9. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA)

    PubMed Central

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J; Stoop, José E; Neven, Arie Knuistingh; Penninx, Brenda W J H; Zitman, Frans G

    2011-01-01

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODS We included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. RESULTS BZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%). BZD use was independently associated with older age, singleness, unemployment, treatment in secondary care, higher medical consumption (more severe) anxiety, depression (OR [95% CI]= 1.95 [1.29, 2.93]), comorbidity, insomnia, SSRI (OR [95% CI]= 2.05 [1.55, 2.70]), TCA and other antidepressant (OR [95% CI]= 2.44 [1.64, 3.62]) use. Overall, BZD use was rarely in accordance with all guidelines, mainly because most users (82.5%) exceeded the recommended duration of safe use. Inappropriate use was independently associated with older age (β= 0.130) and chronic illnesses (β= 0.120). Higher scores on agreeableness were associated with less inappropriate use. CONCLUSIONS Mentally or physically vulnerable subjects were most likely to use BZDs. The most vulnerable (i.e. the old and physically ill) BZD users were at highest risk of inappropriate BZD use. Without further evidence of the effectiveness of BZDs in long-term use, caution in initiating BZD prescriptions is recommended, particularly when patients are chronically ill and old, as those are most likely to display inappropriate use. PMID:21219408

  10. Operational and customer relationship management considerations of electronic prescribing among pharmacists.

    PubMed

    Smith, Alan D; Motley, Darlene

    2009-01-01

    Technology in healthcare environments has increasingly become a vital way to communicate vital information in a safe, reliable, precise and secure manner. Healthcare is an arena that is constantly changing and very fast paced, but adoption of electronic prescribing (e-prescribing) has been comparatively slow and painful in the USA. Medical professionals need a system to communicate medications and diagnosis, with patients' safety as the major consideration, especially with the many complexities associated with drug-interactions and allergies. Via multivariate analysis and linear regression analysis, it was found that degree of e-prescribing acceptance is highly predictable by constructs of Technological Sophistication, Operational Factors and Maturity Factors, which are very stable ease-of-use variables derived from the TAM Model by Davis (1989). PMID:20643640

  11. Soil heating and impact of prescribed burning

    NASA Astrophysics Data System (ADS)

    Stoof, Cathelijne

    2016-04-01

    Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.

  12. Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.

    ERIC Educational Resources Information Center

    Klein, Lawrence E.; And Others

    1981-01-01

    Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)

  13. Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope

    PubMed Central

    Raj, Satish

    2016-01-01

    Postural tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST) and vasovagal syncope (VVS) are relatively common clinical syndromes that are seen by physicians in several disciplines. They are often not well recognised and are poorly understood by physicians, are associated with significant morbidity and cause significant frustration for both patients and their physicians. The 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope provides physicians with an introduction to these disorders and initial recommendations on their investigation and treatment. Here we summarise the consensus statement to help physicians in the management of patients with these frequently distressing problems.

  14. Inappropriate implantable cardioverter defibrillator shocks in fractured Sprint Fidelis leads associated with 'appropriate' interrogation.

    PubMed

    Farwell, David; Redpath, Calum; Birnie, David; Gollob, Michael; Lemery, Robert; Posan, Emoke; Green, Martin

    2008-06-01

    We present two patients with fractures within the pace-sense circuit of their Medtronic Sprint Fidelis leads who received inappropriate shocks from their Medtronic defibrillators during device interrogation. This was not simply a coincidence, but due to electromagnetic interference induced within the Sprint Fidelis lead by the device programmer during two-way communication with the defibrillator. Our subsequent investigations have uncovered at least two other similar incidents in Canada. We have also discovered that the Medtronic 'Auto-resume' feature may leave future patients uniquely vulnerable to such inappropriate shocks in the future. PMID:18456645

  15. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer)

    PubMed Central

    Ilett, Kenneth F; Johnson, Sarah; Greenhill, Graham; Mullen, Lenette; Brockis, Jennifer; Golledge, Clayton L; Reid, Donald B

    2000-01-01

    Aims This was a pilot study of the use of a clinical pharmacist as a therapeutics adviser (academic detailer) to modify antibiotic prescribing by general practitioners. Methods Following a visit by the adviser (March-May), 112 general practitioners were recruited and randomised to control or active groups. A panel of experts prepared a best practice chart of recommended drugs for upper and lower respiratory tract infections, otitis media and urinary tract infections. The adviser made a 10–15 min visit to each prescriber in the active group (June–July), gave them the chart and discussed its recommendations briefly. Doctors in the control group were not visited nor given the chart. Prescription numbers for all prescribers were obtained from the Commonwealth Health Insurance Commission for the pre(March-May) and postdetailing (August–September) periods using a three month lag time for data collection. Data for total numbers of prescriptions and for selected individual antibiotics used in these two periods were analysed using nonparametric statistics. Results Prescribing patterns were similar for the control and active groups in the predetailing period. For both groups, there were significant (P < 0.03) increases (45% for control and 40% for active) in total number of antibiotic prescriptions in the post compared with the predetailing period. This trend was anticipated on the basis of the winter seasonal increase in respiratory infections. In line with the chart recommendations for first-line treatment, doctors in the active group prescribed significantly more amoxycillin (P < 0.02) and doxycycline (P < 0.001) in the post vs predetailing periods. By contrast, doctors in the control group prescribed significantly more cefaclor (P < 0.03) and roxithromycin (P < 0.03), drugs that were not recommended. The total cost of antibiotics prescribed by doctors in the control group increased by 48% ($37 150) from the preto postdetailing periods. In the same time period, the

  16. Magnetic reconnection in collisionless plasmas - Prescribed fields

    NASA Technical Reports Server (NTRS)

    Burkhart, G. R.; Drake, J. F.; Chen, J.

    1990-01-01

    The structure of the dissipation region during magnetic reconnection in collisionless plasma is investigated by examining a prescribed two-dimensional magnetic x line configuration with an imposed inductive electric field E(y). The calculations represent an extension of recent MHD simulations of steady state reconnection (Biskamp, 1986; Lee and Fu, 1986) to the collisionless kinetic regime. It is shown that the structure of the x line reconnection configuration depends on only two parameters: a normalized inductive field and a parameter R which represents the opening angle of the magnetic x lines.

  17. Analyzing transaction workflows in an ePrescribing system.

    PubMed

    Virk, Pushwaz; Bates, David W; Halamka, John; Fournier, Gail A; Rothschild, Jeffrey M

    2006-01-01

    Electronic Prescribing (ePrescribing) is the process of prescribing medications using an outpatient computerized physician order entry (CPOE) system that electronically exchanges prescriptions directly with the pharmacy and/or pharmacy benefits manager (PBM). Our project aims to evaluate proposed ePrescription transmission standards and a community utility for ePrescribing called the eRx Gateway for safety, quality and efficiency. PMID:17238748

  18. Repeat prescribing — a study in one practice

    PubMed Central

    Parker, E. John C.; Schrieber, Victor

    1980-01-01

    A survey of the prescribing habits of a group practice of 10,500 patients was conducted during a three-month period to compare the pattern of repeat prescribing with that practised during consultations. Further analysis into therapeutic groups and categories depending on the length of treatment prescribed was performed. The results obtained were compared with annual prescribing rates and it was found that monthly figures could not be accurately extrapolated. ImagesFigure 1.Figure 2.Figure 3. PMID:6779000

  19. Off-label psychotropic prescribing for young persons in medium security.

    PubMed

    Haw, C; Stubbs, J

    2010-10-01

    Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed. PMID:19423609

  20. Antibiotic Prescribing Pattern in a Tertiary Level Neonatal Intensive Care Unit

    PubMed Central

    Pandit, Vijaya; Suryawanshi, Pradeep; Panditrao, Aditi

    2015-01-01

    Introduction Neonatal sepsis is a major cause of morbidity and mortality worldwide especially in developing countries, which justifies early diagnosis and prompt treatment with antibiotics. Antibiotics are the most frequently used medicines in Neonatal Intensive care units. Data regarding rational antibiotic use in neonates is very limited. Hence, it is essential that the antibiotic prescribing patterns be evaluated periodically for its rational use. Therefore, the present study been carried out to identify the prescribing patterns of antibiotics in neonatal intensive care unit of a tertiary care hospital, Western Maharashtra, India. Materials and Methods A prospective observational study was carried out for 6 months between April to September 2014. The data regarding patient demographics and antibiotic use was collected daily in a structured proforma. Collected data was subjected to statistical analysis. Results Out of total 528 neonates with male preponderance (62%), 370 received antibiotics. Mean gestational age and birth weight were 35±3.2 weeks and 2±0.7 kg respectively. Mean length of hospital stay was 14.26±15.36 days (range 1 to 136 days). A total of 1123 antibiotics were prescribed to 370 neonates. The majority of neonates (55.9%) received between 1-2 antibiotics, 37.3% had 3 to 5 antibiotics prescribed, while 6.7% neonates were prescribed more than 5 antibiotics. Number of antibiotics used had statistically significant inverse relationship with gestational age. Among antibiotics; Amikacin, Cefotaxime and Levofloxacin were the drugs most often prescribed. Amikacin and Cefotaxime were given more to term infants whereas other antibiotics like Levofloxacin, Pipercillin- tazobactam and Meropenem were prescribed more to preterm and outborn neonates. Conclusion The use of a high number of antibiotics is a common practice. Although the indications for use of most antibiotics could be justified, the increased frequency of anbiotics use in some neonates was of

  1. E-prescribing errors identified in a compounding pharmacy: a quality-improvement project.

    PubMed

    Reed-Kane, Dana; Kittell, Katrina; Adkins, Jacquelyn; Flocks, Sarah; Nguyen, Thu

    2014-01-01

    Errors during the prescribing process can cause problems for patients. When the pharmacist intercepts a prescribing error, it can cause a delay, as the patient may not receive the medication until the problem is resolved. Electronic prescriptions are purported to reduce prescribing errors. However, studies have shown that electronic prescriptions can be prone to certain types of errors. Compounding pharmacies may present an additional obstacle for e-prescribing, as the prescribed medications are not commercially available and may not be listed in the e-prescribing software. The objectives of this study were to estimate the electronic prescription error rate in a compounding pharmacy, determine the most common error types, list the most common interventions pharmacists made, and estimate how long it took to resolve these errors. The study design was quality improvement with descriptive data. During the four weeks of data collection, the pharmacists were trained to complete a standardized data collection form when they identified an electronic prescription error. Percentages were calculated for new prescriptions, electronic prescriptions with errors, error types, and error resolution methods. In the four-week period of the study, there were 982 new prescriptions, 111 of which were electronic prescriptions. Of those 111 electronic prescriptions, 70 had errors. The electronic prescriptions error rate was 63%. The most common type of error was wrong entry field (70.3%). For this project, wrong entry field was defined to mean that the drug name was in the wrong field (81%) or that multiple entries were in the wrong field (7%). Pharmacists usually used their own judgment to resolve an error (67%). Many e-prescription errors were identified in this compounding pharmacy. When prescription errors happen, workflow and patient care are disrupted. Our goal is to discuss these findings with Surescripts and e-prescribing software companies to seek systems-based solutions. PMID

  2. Identification of an updated set of prescribing-safety indicators for GPs

    PubMed Central

    Spencer, Rachel; Bell, Brian; Avery, Anthony J; Gookey, Gill; Campbell, Stephen M

    2014-01-01

    Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety. PMID:24686882

  3. Adverse ocular reactions to drugs.

    PubMed Central

    Spiteri, M. A.; James, D. G.

    1983-01-01

    Drugs acting on various parts of the body may also affect the eye insidiously. Increased awareness of such drug toxicity by the prescribing doctor should encourage him to consider effects on the cornea, lens, retina, optic nerve and elsewhere when checking the patient's progress. The following review concerns adverse ocular effects of systemic drug administration. PMID:6356101

  4. 42 CFR 414.92 - Electronic Prescribing Incentive Program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Electronic Prescribing Incentive Program. 414.92... Other Practitioners § 414.92 Electronic Prescribing Incentive Program. Link to an amendment published at... fee schedule which are furnished by an eligible professional. Electronic Prescribing Incentive...

  5. Efficacy of prescribed grazing depends on timing intensity and frequency

    Technology Transfer Automated Retrieval System (TEKTRAN)

    1. Exotic weeds and woody plants are degrading the World’s grasslands, and ecologists are attempting to reverse the degradation with prescribed grazing. Prescribed grazing entails introducing livestock (e.g. sheep, goats) that eat unwanted plants. Prescribed grazing has shown modest potential in ...

  6. Undergraduate Medical Students' Reasoning with Regard to the Prescribing Process

    ERIC Educational Resources Information Center

    Harries, C. S.; Botha, J.

    2007-01-01

    When final year medical students reporting poor prescribing confidence were tested, key prescribing weaknesses emerged. This study aimed to characterize student variability in both the experience of and cognitive levels displayed during prescribing. Blooms Taxonomy cognitive categories were assigned to each question of a student test measuring…

  7. PRIORITIZING FUTURE RESEACH ON OFF-LABEL PRESCRIBING: RESULTS OF A QUANTITATIVE EVALUATION

    PubMed Central

    Walton, Surrey M.; Schumock, Glen T.; Lee, Ky-Van; Alexander, G. Caleb; Meltzer, David; Stafford, Randall S.

    2015-01-01

    Background Drug use for indications not approved by the Food and Drug Administration exceeds 20% of prescribing. Available compendia indicate that a minority of off-label uses are well supported by evidence. Policy makers, however, lack information to identify where systematic reviews of the evidence or other research would be most valuable. Methods We developed a quantitative model for prioritizing individual drugs for future research on off-label uses. The base model incorporated three key factors, 1) the volume of off-label use with inadequate evidence, 2) safety, and 3) cost and market considerations. Nationally representative prescribing data were used to estimate the number of off-label drug uses by indication from 1/2005 through 6/2007 in the United States, and these indications were then categorized according to the adequacy of scientific support. Black box warnings and safety alerts were used to quantify drug safety. Drug cost, date of market entry, and marketing expenditures were used to quantify cost and market considerations. Each drug was assigned a relative value for each factor, and the factors were then weighted in the final model to produce a priority score. Sensitivity analyses were conducted by varying the weightings and model parameters. Results Drugs that were consistently ranked highly in both our base model and sensitivity analyses included quetiapine, warfarin, escitalopram, risperidone, montelukast, bupropion, sertraline, venlafaxine, celecoxib, lisinopril, duloxetine, trazodone, olanzapine, and epoetin alfa. Conclusion Future research into off-label drug use should focus on drugs used frequently with inadequate supporting evidence, particularly if further concerns are raised by known safety issues, high drug cost, recent market entry, and extensive marketing. Based on quantitative measures of these factors, we have prioritized drugs where targeted research and policy activities have high potential value. PMID:19025425

  8. Drug misuse.

    PubMed

    Waller, T

    1992-12-01

    1. Assessment by history and examination should include: a history of all drugs taken during each day for the previous 7 days (including alcohol), length of drug use and route (including the sharing of needles or syringes), the possibility of pregnancy if female, previous psychiatric history and treatment of drug misuse, social factors (including employment, family, friends, involvement in prostitution, legal problems), medical problems, including evidence of hepatitis, injection abscesses and other infections, suicide attempts, and weight loss. 2. Notification to the Chief Medical Officer of the Drug Branch of the Home Office is a legal obligation. 3. Investigations include: liver function tests (LFTs), hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis C antibody, full blood count (FBC), and urine for drug screening. Consider HIV testing if at risk but it is usually better arranged at a later stage. 4. Prescribing may be considered for a variety of drugs but objectives will differ according to drug type and individual. 5. In the case of opioid users, prescribing may be useful to stabilize their lives and to promote attendance for professional help. It may reduce high risk behaviour for contracting and spreading HIV. 6. If medication is given to opioid users, methadone mixture 1 mg/ml given once a day is the prescription of choice. Dispensing should be on a daily basis and the blue prescription form FP10 (MDA) allows the chemist to dispense daily for up to 14 days. A maximum ceiling of 100 mg methadone/day should not be exceeded. The initial dose will depend on the amount of opioid consumed in the previous week.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1345155

  9. Bibliographic search of publication patterns in rational use of drugs in Iran: a systematic approach.

    PubMed

    Mousavi, Sarah; Mansouri, Ava; Jahangard-Rafsanjani, Zahra; Sarayani, Amir; Hadjibabaie, Molouk; Gholami, Kheirollah

    2014-01-01

    Inappropriate use of drugs is a widespread problem with serious consequences such as increased adverse drug reaction and antimicrobial resistance. Proper interventions would have important financial and public health benefits. Several studies have been performed about Rational Drug Use (RUD) in Iran. To provide a picture of researches were done about RUD and highlight the existing gaps in practice in Iran, a systematic search was conducted by reviewing all papers (English and Persian) found by searching keywords in Pubmed, Web of Science, Google Scholar, CINAHL, Proquest, International Pharmaceutical Abstract (IPA), SID, Iran Medex and MagIran. Retrieved articles were extracted in Access form and exported to Excel for further analysis. After excluding duplicate and irrelevant articles, 466 related articles were remained. Number of publications increased dramatically after 2001. About 73% of studies were cross-sectional. Evaluation of prescribing pattern (15%), self-medication (11.3%) and adverse drug reaction (9.1%) were among the top topics which were studied. Despite an increasing trend in RUD publications in Iran, still large gaps remain to be investigated. Knowing the existing gaps is crucial for policy makers to make investments to solve the problems. PMID:24658992

  10. A comparison of psychotropic medication prescribing patterns in East of England prisons and the general population.

    PubMed

    Hassan, Lamiece; Senior, Jane; Frisher, Martin; Edge, Dawn; Shaw, Jenny

    2014-04-01

    While the prevalence of mental illness is higher in prisons than in the community, less is known about comparative rates of psychotropic medicine prescribing. This is the first study in a decade to determine the prevalence and patterns of psychotropic medication prescribing in prisons. It is also the first study to comprehensively adjust for age when making comparisons with the general population. Four East of England prisons, housing a total of 2222 men and 341 women were recruited to the study. On census days, clinical records were used to identify and collect data on all prisoners with current, valid prescriptions for hypnotic, anxiolytic, antipsychotic, antimanic, antidepressant and/or stimulant medication, as listed in chapters 4.1 to 4.4 of the British National Formulary. Data on 280,168 patients were obtained for comparison purposes from the Clinical Practice Research Datalink. After adjusting for age, rates of psychotropic prescribing in prison were 5.5 and 5.9 times higher than in community-based men and women, respectively. We also found marked differences in the individual psychotropic drugs prescribed in prison and community settings. Further work is necessary to determine whether psychotropic prescribing patterns in prison reflect an appropriate balance between managing mental illness, physical health risks and medication misuse. PMID:24569096

  11. Malpractice aspects of medically prescribed exercise.

    PubMed

    Sagall, E L

    1975-01-01

    Stress exercise testing of suspected or known cardiacs and medical recommendations to patients to undertake physical fitness conditioning exercise programs constitute medical treatment in the eyes of the law and as such render the prescribing and supervising physicians legally responsible for harmful consequences to the patient to the same degree and under the same legal principles applicable for other medically prescribed diagnostic and therapeutic procedures. The physician who employs a stress exercise test or who recommends that a patient engage in exercise as part of a prophylactic, rehabilitative, or therapeutic program must be alert to those aspects of his recommendations which possess potential malpractice hazards. In particular, he should direct his attention to recognized indications and contraindications of exercise test and exercise programs. Furthermore, he should perform an adequate preexercise screening examination and he must make sure that the exercise is properly monitored; that it is immediately terminated upon onset of signs or symptoms of impending serious reactions; that adequate advance preparations have been made for the treatment of foreseeable emergencies, particularly those requiring cardiopulmonary resuscitation and advanced life support; and that such treatment is in full accord with generally accepted and proper medical standards. Finally, the physician must make certain that he adequately informs the patient of the potential risks and hazards associated with exercise stress testing and exercise programs so that the consent to such procedures can be classified legally as valid and "informed". PMID:1221239

  12. Does prescribed fire benefit wetland vegetation?

    USGS Publications Warehouse

    Flores, C.; Bounds, D.L.; Ruby, D.E.

    2011-01-01

    The effects of fire on wetland vegetation in the mid-Atlantic region of the United States are poorly known, despite the historical use of fire by federal, state, and private landowners in the Chesapeake Bay Region. Prescribed fire is widely used by land managers to promote vegetation that is beneficial to migratory waterfowl, muskrats, and other native wildlife and to reduce competition from less desirable plant species. We compared vegetative response to two fire rotations, annual burns and 3-year burns, and two control sites, Control 1 and Control 2. We tested the effects of fire within six tidal marsh wetlands at Blackwater National Wildlife Refuge and Fishing Bay Wildlife Management Area in Maryland. We examined changes in total live biomass (all species), total stem density, litter, and changes in live biomass and stem density of four dominant wetland plant species (11 variables). Our results suggest that annual prescribed fires will decrease the accumulation of litter, increase the biomass and stem densities of some wetland plants generally considered less desirable for wildlife, and have little or no effect on other wetland plants previously thought to benefit from fire. ?? 2011 US Government.

  13. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

    PubMed Central

    2011-01-01

    Background Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. Methods The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. Results HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data

  14. Misguided Intentions in Drug-Abuse Prevention.

    ERIC Educational Resources Information Center

    Katz, Lilian G.

    1994-01-01

    Many drug abuse prevention programs and materials, such as the "Smart Choices" newsletter for kindergartners, are developmentally inappropriate for young children. Successful preventive measures need to address the mixed messages that society itself gives to children about alcohol and other drugs and present developmentally appropriate instruction…

  15. Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America.

    PubMed

    Mendoza, Sonia; Rivera-Cabrero, Allyssa S; Hansen, Helena

    2016-08-01

    Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists. PMID:27488225

  16. Inappropriate and excessive guilt: instrument validation and developmental differences in relation to depression.

    PubMed

    Tilghman-Osborne, Carlos; Cole, David A; Felton, Julia W

    2012-05-01

    Inappropriate or excessive guilt is listed as a symptom of depression by the American Psychiatric Association (1994). Although many measures of guilt have been developed, definitional and operational problems exist, especially in the application of such measures in childhood and adolescence. To address these problems, the current study introduces the Inappropriate and Excessive Guilt Scale (IEGS), assesses its validity for use with children and adolescents, and tests its relation to depression across development. From a sample of 370 children between 7 and 16 years old, results provided (1) evidence that items designed to assess inappropriate and excessive guilt converged onto a single underlying factor, (2) support for the convergent, discriminant, and construct validity of the IEGS in a general youth population, and (3) evidence of incremental validity of the IEGS over-and-above other measures of guilt. Results also supported the hypothesis that inappropriate and excessive guilt as well as negative cognitive errors become less normative and more depressotypic with age. PMID:22086497

  17. Case of inappropriate ADH syndrome: hyponatremia due to polyethylene glycol bowel preparation.

    PubMed

    Ko, Sun-Hye; Lim, Chul-Hyun; Kim, Jae-Young; Kang, Seung Hun; Baeg, Myong Ki; Oh, Hyun Jin

    2014-09-14

    Colonoscopic screening has been reported to reduce deaths from colorectal cancer. Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods. Polyethylene glycol (PEG) is regarded as a safe method for cleansing, especially compared with oral sodium phosphate. Here, we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone (ADH) syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures. A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing. While waiting for the colonoscopy, she developed a stuporous mentality and generalized tonic-clonic seizures, which did not correlate with brain magnetic resonance imaging. Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome. Her thyroid and adrenal functions were normal. There were no malignancies, infections, respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications, which might have caused inappropriate ADH syndrome. She was treated with 3% hypertonic saline and showed a complete neurological recovery as her sodium levels recovered. Follow-up visits showed the patient to have a normal sodium level without neurologic deficits. This case shows that inappropriate ADH syndrome can be caused by PEG preparation, which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms. PMID:25232272

  18. Inappropriate and Excessive Guilt: Instrument Validation and Developmental Differences in Relation to Depression

    ERIC Educational Resources Information Center

    Tilghman-Osborne, Carlos; Cole, David A.; Felton, Julia W.

    2012-01-01

    Inappropriate or excessive guilt is listed as a symptom of depression by the American Psychiatric Association ("1994"). Although many measures of guilt have been developed, definitional and operational problems exist, especially in the application of such measures in childhood and adolescence. To address these problems, the current study…

  19. Deceleration Procedures for Inappropriate Social Behaviors with Severely Retarded Ss. Two Papers.

    ERIC Educational Resources Information Center

    Spangler, Robert S.; And Others

    Two papers describe studies to decrease inappropriate social behaviors of severely retarded students. R. Spangler and others in "The Effect of a Time-Out Procedure on the Duration of Tantrum Behavior in a 13-Year-Old Severely Retarded Male S" report on a three phase study in which a combination of verbal instructions and a timeout procedure…

  20. Improving Inappropriate Social Behavior of Autistic Students Using the LISTEN Intervention Strategy

    ERIC Educational Resources Information Center

    Al-Shammari, Zaid; Daniel, Cathy; Faulkner, Paula; Yawkey, Thomas D.

    2010-01-01

    A case study was conducted on the development of the LISTEN intervention strategy for use with autistic students to improve inappropriate social behaviors. The study was conducted in a special education classroom in an autism school in Kuwait. Examination of LISTEN Intervention Strategy applications included: duration of targeted behavior; methods…