Higher frequency of administration of biotherapic T. cruzi 17DH decreases parasitemia and increases survival in mice infected with Trypanosoma cruzi

Introduction: The study of the effect of different ways of treatment using highly diluted substances is rare in the literature. Some authors consider the dose irrelevant, justifying that the action of the medication highly diluted is qualitative [1-3]. Others emphasize the importance of quantity and frequency of administration of the highly diluted substance for a successful treatment [4,5]. The model of murine infection by T. cruzi is widely studied and it is an excellent tool to study the effect of highly diluted substances. Aim: To evaluate, in vivo, the effect of different amounts and frequency of administration of the biotherapic 17 dH T. cruzi in the evolution of the parasitemia curve and survival of mice infected with Trypanosoma cruzi. Materials and methods: A blind randomised controlled trial was performed, using 30 swiss male mice, aged 28 days, divided into groups according to treatment: CONTROL - mice treated with 7% water-alcohol solution diluted in water given ad libitum in an amber bottle; GAVAGE – mice treated with medication highly diluted 17 DH T. cruzi from 4 th to 9 th day of infection by gavage; WATER - mice treated with highly diluted medication 17 DH T. cruzi in water ad libitum offered in an amber bottle until the end of the study period. The groups were infected with the Y strain of T. cruzi, intraperitoneal, 1400 blood trypomastigotes. The medicines was handled according to the Brazilian Homeopathic Pharmacopoeia [6] with microbiological test according to RDC n°. 67 and in vivo biological risk. Parasitemic curve was determined by daily counting of the parasites [7], the total parasitemia, peak parasites and survival. Data were compared using the BioEstat 5.0, ANOVA, with significance of 5%. The experiment was approved under the protocol n° 030/2008 - Ethics in Animal Experimentation of the Universidade Estadual de Maringá. Results: Animals treated with the medication highly diluted in water had lower level of total parasitemia and a lower peak of parasites compared to animals treated by gavage, or control group of infection (p = 0.0103 p = 0.0008). In the group treated by gavage both the total parasitemia and the peak of parasites were higher than the control group. Survival was greater in animals treated with biotherapic diluted with water (p = 0.0003) and by gavage (p = 0.0016) when compared with the control group. Among the different ways of treatment the use of medication diluted in water increased the survival of animals (p = 0.0013). The treatment by gavage once a day until the 9th day of infection increase the parasitemia and survival. The medication diluted in water showed better results with significant reduction of parasitemia and an increase of survival. This result may be related to the frequency with which the medication diluted in water was ingested by each animal, and the lower stress that this form of administration provides the animals. Figure 1: Parasitemic curve of animals infected with Y strain of T. cruzi and treated with medication highly diluted 17DH T. cruzi. CONTROL: mice treated with alcohol 7%; GAVAGE: treated with medication highly diluted 17DH T. cruzi by gavage; WATER: treated with medication highly diluted 17dH T. cruzi in water. Conclusion: There is a difference in the effect of the medication highly diluted depending on the way of treatment used. For mice, the use of drug diluted in water offered frequently, results in better benefits. The clinical use of these results in humans, should consider the allometric system medication dosage which takes into account the metabolic rate of each organism.

47. Transitioning to Batch Dosing of High-Cost Antimicrobials in the Inpatient Setting

Background Antimicrobial stewardship (AMS) committees ensure appropriate antimicrobial utilization. One stewardship intervention is to evaluate the delivery model of high-cost antimicrobials to better utilize resources and mitigate expenses. We analyzed the total medication waste and costs of high-cost antimicrobials, specifically daptomycin, ertapenem, amphotericin, and micafungin, at our institution and propose innovative cost-savings changes at a systems level. Methods This retrospective study consisted of 263 patients. All patients were at least 18 years old who was admitted to our academic institution from January 2020 to April 2021 and received daptomycin, ertapenem, amphotericin, or micafungin. Demographics, daily medication dosage, total doses received, the date and time of the start of the medication, last administered dose, and discontinued order were recorded. Results The daptomycin cohort consisted of 143 patients with 46.2% females and average age of 56.3 years. In this group, 145.3 vials were wasted which equated to a loss of &22,630. The ertapenem group had 53 patients with 62.3% females and a mean age of 62.3 years. There were 24 vials wasted with a calculated loss of &1080. The amphotericin cohort had 32 patients with an average age of 52.2 years and 43.8% females. There were 189 vials wasted with a loss of &46,116. The micafungin group had 35 patients with 42.9% females and average age of 60.4 years. This group had 12 vials wasted with a loss of &2052. Conclusion Each antimicrobial has a specific formulation protocol. Daptomycin and ertapenem formulation occurs in the early morning. Amphotericin formulation occurs 2 hours prior to medication use. Micafungin formulation occurs at the time the order label prints. These medications were more often administered in the late morning to early afternoon timeframe. The order to discontinue the medications also occurred at the same interval. One reason could be due to decisions made on morning rounds from primary teams and specialty input. These orders would then be placed after rounds. A cost-saving method would be to batch and change the formulation time for all antimicrobials to later in the afternoon, which would not only prevent waste, but also allow the AMS team to effectively audit appropriate antimicrobial use. Disclosures All Authors: No reported disclosures

Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

Background Limited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a quality improvement project that utilized a randomized, controlled, crossover study design to compare two different educational techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 min, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and a repeated measures mixed linear regression model were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal (median 34 s [IQR, 22–54] vs 50 s; [IQR 38–61 s], P = 0.006) and fewer mid-infusion adjustments. Ease of use was reported to be significantly higher for the metronome group (median ranking 5, IQR 4–5) compared to the standard group (median ranking 2, IQR 2–3; P < 0.001). Conclusions Knowledge regarding a metronome technique may help EMS clinicians provide safe and effective IV infusions. Such a technique may be beneficial for learners and educators alike.

Audit of ADHD medication prescription and monitoring in intellectual disability services, Greater Glasgow & Clyde

AimsStudies have shown that people with intellectual disability (ID) show a greater severity of attention deficit hyperactivity disorder (ADHD) symptoms and atypical presentation, as well as having a greater risk of developing comorbidities, such as challenging behaviour, anxiety, tic disorders and sleep problems. It is estimated that 1.5% of patients with ID will have a clinical diagnosis of ADHD.The aim of this audit was to find whether individuals with ID and ADHD, who are prescribed medication for ADHD are adequately monitored and reviewed in accordance with the ADHD medication prescription guidance by NICE and the Royal College of Psychiatrists (RCPsych).MethodThis audit looked at ADHD medication prescription for the ID population within Greater Glasgow & Clyde NHS. This is the 6th audit cycle where electronic records (EMIS) were analysed between 28/9/19 to 09/10/20. (The 5th cycle data collection period ended on 28/9/19). We collected data on all patients aged over 18 years.An audit tool was developed to find whether the following were documented; patient demographics, physical health monitoring, symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review. 100% of patients should have all components on the ADHD audit tool documented, as per NICE/ RCPsych prescription guidance.Result32 patients were identified as being diagnosed with ADHD prescribed medication. One patient was impacted by the COVID-19 pandemic which meant that the required monitoring was not fully carried out. The age ranged from 18 to 56 years. 75% had mild intellectual disability, 19% had moderate and 6% had severe, with no cases of profound intellectual disability. Blood Pressure/pulse was recorded in 84% of patients. Height/weight/ BMI was recorded in 81% of patients. 97% of patients had ADHD symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review recorded.ConclusionThere is further scope for improvement in the monitoring and documentation of physical health observations, however there was a significant improvement compared to the previous cycle of the audit. Other aspects of monitoring and documentation appear to be recorded in almost 100% of patients. This finding emphasises the challenges of physical health monitoring and compliance in psychiatry as a whole. We need to continue to encourage awareness and education around the physical health risks to our patients, not only due to their comorbidities but also as a result of the psychotropic medications we prescribe them.

Rhythmically Enhanced Music as Analgesic for Chronic Pain: A Pilot, Non-Controlled Observational Study

Chronic pain changes brain connectivity, brainwaves, and volume, often resulting in disability, anxiety, and depression. Opioid pain relievers impair function, with risk of addiction. Music analgesia research suggests that music for long-term analgesia includes slow tempo, pleasantness, and self-choice. Hypothesis: individuals listening to self-chosen music with embedded beats ½ h twice a day, could show brainwave entrainment (BWE) at healthy frequencies of healthy descending pain modulatory system. BWE may change brain activity, restoring organization in DPMS altered by chronic pain. Volunteers with chronic pain >1 year participated in a study of 4 weeks of listening to one half hour of music twice a day, and four weeks of non-listening, reporting pain and analgesic use bi-weekly using visual analog scale (VAS) and 0–10 numerical pain scores (NPS), medication types, and dosage. Volunteers selected from 27 half-hour pieces of music in several genres in a mobile app. Isochronic beats were embedded in the music with tempo, key, and isochronic theta frequencies proportional, to enhance the brain’s perception of rhythmic patterns and harmonics. Mean NPS showed a 26% reduction (p = 0.018). Significantly, mean medication dosage declined by over 60% (p = 0.008). Double-blind studies, larger populations are needed in future.

The Impact of Prescribed Dosage Assumptions on the Evaluation of Adherence and Persistence to Medication in Patients After Acute Myocardial Infarction

Medication adherence is a significant problem in public health. Prescription-level pharmacy databases have great potential for monitoring actual drug adherence patterns at the healthcare system level. Many research papers have reported adherence estimates in different settings and populations. However, comparison between studies is not always straightforward due to different approaches taken when computing adherence. A crucial component to accurately estimate adherence is the availability of days’ supply information for each dispensing event. Reasonable assumptions regarding medication dosage have to be made, when this information is not available. In this study, we evaluate adherence and persistence to medication in patients after myocardial infarction and show that corresponding estimates differ significantly, when using different dosage assumptions, namely, when using defined daily dose or tablet per day dosage regimens. Moreover, we demonstrate that observed differences between medications might be a result of inaccurate dosage assumptions. We propose a comparison of distribution of days between dispensing events to that of days’ supplied as a relatively simple visual inspection to validate dosage assumptions.

364 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation: Final Report

Introduction Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics. Methods The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up. Results Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2.06 nights/week compared to .051 times per week for the blinded taper group (p = .042). The average weekly diazepam equivalent dose of medication used by the open label tapering group was 11.29 mg whereas the weekly dose for the blinded tapering group was 3.22 (p = .069). Conclusion CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence. Support (if any) National Institute of Drug Abuse, Grant # R34 DA042329-01

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

BackgroundLimited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a pragmatic, randomized, controlled, crossover study comparing two different techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and multiple linear regression were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal, fewer mid-infusion adjustments, and greater ease of use. Conclusions Use of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery.

Biochemical differences between nano- and normal formulation of tamoxifen and other natural bioactive materials ameliorate breast cancer in experimental rats

Background Human breast cancer is the most prevalent malignancy in women all-over the world. The aim is to look further into the effectiveness of the nanoformulation of tamoxifen and even certain bioactive compounds (yeast, isoflavone, and silymarin) and their impacts on diminishing the breast cancer progression. A single medication dosage of 7,12-dimethylbenz[a]anthracene (DMBA) was administered intragastrically by fifty-four female Sprague–Dawley rats. After fourteen days of DMBA admission, the procedure protocol actually started out. At long last, all of the experimental findings assessed, tabulated, and statistically analyzed. Results In contrast to the normal groups, a substantial elevation in apoptosis and lipid peroxide was observed in all nanogroups. Conclusion The best biochemical outcome and beneficial factors which elevate the occurrence and activation of the apoptosis process have been demonstrated by nanotamoxifen.

Pharmaceutical Consultation in Hospitals at Northern Border Region, Saudi Arabia

Background: Pharmacists' traditional position as drug dispensers has recently developed into a more active role in risk evaluation and management. Dispensing is often handled by pharmacy technicians in Saudi Arabia because pharmacists are so preoccupied with their managerial and administrative responsibilities. Pharmacists' meetings with patients are limited to medication dosage and frequency, as well as rare adverse effects and drug interactions. Methods: We conducted a quantitative questionnaire study in Saudi Arabia to look into the role of hospital pharmacists in patient counseling, the assessment of pharmacists' patient counseling opinions, and the possible determinants of personal consultation. Results: The number of patient inquiries was found to be very low, ranging from 5 to 20 per month. The amount of private pharmaceutical consultations was also poor. This finding showed that people trust pharmacists. Conclusion: Reorganizing the pharmacist's operations will help to enhance pharmaceutical consultations. This will help patients make better decisions about their medications and improve their quality of life.