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

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Irene Ruiz-Tamayo ◽  
Josep Franch-Nadal ◽  
Manel Mata-Cases ◽  
Dídac Mauricio ◽  
Xavier Cos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Inappropriate Prescribing ◽  
Severe Heart Failure ◽  
Antidiabetic Drugs ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Severe Renal Failure ◽  
Cross Sectional ◽  
Quality Of Prescribing

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.

scholarly journals Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort

2020 ◽  
pp. BJGP.2020.0871
Author(s):  
Clare Elizabeth MacRae ◽  
Stewart Mercer ◽  
Bruce Guthrie
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Large Population ◽  
Inappropriate Prescribing ◽  
Prescribing Patterns ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Stage 4 ◽  
Ckd Stage

Background: Many drugs should be avoided or require dose-adjustment in chronic kidney disease (CKD). Previous estimates of potentially inappropriate prescribing rates have been based on data on a limited number of drugs and mainly in secondary care settings. Aim: To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with CKD. Method: Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD defined using laboratory data. Drugs were organised by British National Formulary advice. Contraindicated (CI) drugs: “avoid”. Potentially high risk (PHR) drugs: “avoid if possible”. Dose inappropriate (DI) drugs: dose exceeded recommended maximums. Results: 28,489 people with CKD were included in analysis, of whom 70.0% had CKD 3a, 22.4% CKD 3b, 5.9% CKD 4, and 1.5% CKD 5. 3.9% (95%CI 3.7-4.1) of people with CKD stages 3a-5 were prescribed one or more CI drug, 24.3% (95%CI 23.8-24.8) PHR drug, and 15.2% (95% CI 14.8-15.62) DI drug. CI drugs differed in prevalence by CKD stage, and were most commonly prescribed in CKD stage 4 with a prevalence of 36.0% (95%CI 33.7–38.2). PHR drugs were commonly prescribed in all CKD stages ranging from 19.4% (95%CI 17.6-21.3) in stage 4 to 25.1% (95%CI 24.5–25.7) in stage 3b. DI drugs were most commonly prescribed in stage 4, 26.4% (95%CI 24.3-28.6). Conclusion: Potentially inappropriate prescribing is common at all stages of CKD. Development and evaluation of interventions to improve prescribing safety in this high-risk populations are needed.

scholarly journals Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

2020 ◽  
Vol 9 (9) ◽  
pp. 2790
Author(s):  
Per Sindahl ◽  
Christian Overgaard-Steensen ◽  
Helle Wallach-Kildemoes ◽  
Marie Louise De Bruin ◽  
Hubert GM Leufkens ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inappropriate Prescribing ◽  
Plasma Sodium ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Scenarios ◽  
Hypotonic Fluids ◽  
Hospital Acquired ◽  
The Impact

Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature

2017 ◽  
Vol 8 (4) ◽  
pp. 507-519 ◽  
Author(s):  
K. Draper ◽  
C. Ley ◽  
J. Parsonnet
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Request ◽  
Definitive Evidence ◽  
Bowel Health

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for ‘general bowel health’ or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

scholarly journals Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

2020 ◽  
Author(s):  
Dan Wang ◽  
Chaojie Liu ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Primary Care Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Latent Profile Analyses ◽  
Broad Spectrum Antibiotics

Abstract Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

2019 ◽  
Vol 129 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Molly N. Huston ◽  
Rouya Kamizi ◽  
Tanya K. Meyer ◽  
Albert L. Merati ◽  
John Paul Giliberto
Keyword(s):  
The United States ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Opioid Analgesia ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

scholarly journals Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

2012 ◽  
Vol 130 (5) ◽  
pp. 289-293 ◽  
Author(s):  
Alexandre Libório ◽  
Russian Uchoa ◽  
João Neto ◽  
Juan Valdivia ◽  
Elizabeth De Francesco Daher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Severe Heart Failure ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Gfr Estimation

CONTEXT AND OBJECTIVE: Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. DESIGN AND SETTING: Cross-sectional observational study at a university reference center. METHODS: GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis. RESULTS: This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). CONCLUSION: Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.

Health-related quality of life of patients with severe heart failure. A cross-sectional multicentre study

2012 ◽  
Vol 27 (3) ◽  
pp. 686-694 ◽  
Author(s):  
Nikolaos V. Fotos ◽  
Konstantinos Giakoumidakis ◽  
Zoi Kollia ◽  
Petros Galanis ◽  
Panagiota Copanitsanou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Multicentre Study ◽  
Severe Heart Failure ◽  
Health Related Quality ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related

Dose Regimen Adjustment for Milrinone in Congestive Heart Failure Patients with Moderate and Severe Renal Failure

1995 ◽  
Vol 47 (8) ◽  
pp. 651-655 ◽  
Author(s):  
S. G. WOOLFREY ◽  
J. HEGBRANT ◽  
H. THYSELL ◽  
P. A. FOX ◽  
D. W. LENDREM ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Failure ◽  
Dose Regimen ◽  
Severe Renal Failure ◽  
Heart Failure Patients

scholarly journals 221. Comparison of dental antibiotic prescribing between Australia, England, the United States and British Columbia in 2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S112-S112
Author(s):  
Leanne Teoh ◽  
Wendy Thompson ◽  
Colin Hubbard ◽  
David M Patrick ◽  
Fawziah Marra ◽  
...  
Keyword(s):  
United States ◽  
British Columbia ◽  
Antibiotic Resistance ◽  
Research Training ◽  
The United States ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Public Health Burden

Abstract Background Antibiotic resistance is recognised as a major public health burden. Dentists overprescribe antibiotics and prescribe for unnecessary indications. Tracking and investigating prescribing practices by healthcare professionals provides insights needed to inform targeted antibiotic stewardship interventions. It is unclear how dental antibiotic prescribing patterns differs between countries. The aim of this study was to compare antibiotic prescribing by dentists in Australia, England the United States (US) and British Columbia (BC). Methods This was a cross-sectional study of dispensed dental antibiotic prescriptions between January 1 and December 31, 2017, from Australia, England, US and BC. Dispensed dental antibiotic prescriptions included those from outpatient pharmacies and healthcare settings. Outcome measures included the proportion of dental antibiotic prescriptions by location and prescribing rates by population. Results English dentists prescribed 1.6 times more antibiotics than those in Australia, and dentists in BC and US prescribed around twice more than Australian dentists. (Australia: 33.2 prescriptions/1000population; England: 53.5 prescriptions/1000population; US: 72.6 prescriptions/1000 population; BC: 65.0 prescriptions/1000 population). The types of antibiotics prescribed were similar across all countries, where penicillins were the predominant class prescribed (66.8–80.5% of antibiotic prescriptions). US dentists and dentists in BC prescribed more clindamycin compared to the dentists in other countries. Conclusion Dentists in the US, England and BC prescribed at relatively higher rates than Australian dentists. The findings from this study should initiate an evaluation by dentists of their prescribing practices and responsibilities regarding their contribution towards antibiotic resistance. Further investigations can be aimed at determining country-specific factors that influence dental antibiotic prescription. Disclosures Leanne Teoh, BDSc(Hons) BPharm(Hons), Australian Government Research Training Program Scholarship (Other Financial or Material Support, Scholarship awarded for the PhD candidature)

scholarly journals Antibiotics prescribing patterns in medical wards of Yangon General Hospital, Myanmar

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Aye Thi Khaing ◽  
Nang Hla Hla Win
Keyword(s):  
General Hospital ◽  
Demographic Data ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Medical Wards ◽  
Pro Forma

Introduction: Irrational and inappropriate prescribing of antimicrobial is common in hospitals and contributes to the development of antibiotic resistance in clinical practice. In Myanmar, there is insufficient information concerning antibiotics prescribing patterns in some hospitals. Therefore, the aim of this study was to determine the prescribing patterns of antibiotics in various infections. Methods: A descriptive cross-sectional study was carried out over a 3- month period in the medical wards of Yangon General Hospital. A total 1054 patients who were prescribed with antibiotics for post-admission day were selected. Relevant demographic data, discharge diagnosis, antibiotic prescribing patterns and outcomes of the patients were collected through pro-forma. Results: The result revealed that the antibiotics prescribing rate in Yangon General Hospital was 49%. Amongst the major indications included acute gastroenteritis (10%), chest infections (6.8%), skin and soft tissue infections (6.5%), pneumonia (6.1%) and spontaneous bacterial peritonitis (6.0%). The most frequently prescribed antibiotics were combination of aminopenicillin with beta lactamase inhibitors (29.4%), metronidazole (28.2%), ceftriaxone (24.4%), azithromycin (15.2%) and cefixime (12.8%). The majority of the patients were discharged from hospital (73.7%) whereas the expired population was 8.6%. Conclusions: This study offers useful information in developing antibiogram for medical wards of Yangon General Hospital, Myanmar. The findings of this study could contribute to improvement in the treatment outcomes.

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