WorldWideScience

Sample records for antiviral prescribing practices

  1. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  2. Prescribing Practices and Polypharmacy in Kitovu Hospital ...

    African Journals Online (AJOL)

    admin

    This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda. The average ... patient essential knowledge indicators were greatly improved but only modest reduction ..... management of childhood illness strategy.

  3. Impact of social prescribing on general practice workload and polypharmacy.

    Science.gov (United States)

    Loftus, A M; McCauley, F; McCarron, M O

    2017-07-01

    Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further

  4. Alliances of cooperation: negotiating New Hampshire nurse practitioners' prescribing practice.

    Science.gov (United States)

    Sampson, Deborah A

    2009-01-01

    Nurse practitioner legislation varies among states, particularly in relation to practice without physician oversight, altering the legal environment within which nurse practitioners can use knowledge and skills to meet patient needs. Using New Hampshire as a case study, this historical analysis of nurse practitioners' negotiations over time for independent practice, defined in state practice acts, illuminates the complex social and economic factors affecting nurses' struggle to gain legal rights over their own professional practice without supervision and intervention from another profession. In New Hampshire, not only did organized medicine oppose nurses rights to practice, but pharmacists demanded the right to control all aspects of medication management, including who could prescribe and under what circumstances prescribing could occur. Shifting social and political terrain as well as changes in legislative and state professional board leadership affected the environment and negotiations of a small group of nurses who were ultimately successful in obtaining the right to define their own professional practice.

  5. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts....

  6. A survey of prescribing practices for monoamine oxidase inhibitors.

    Science.gov (United States)

    Balon, R; Mufti, R; Arfken, C L

    1999-07-01

    A survey examined prescribing practices for monoamine oxidase inhibitors (MAOIs) and explored reasons for the widely noted decline in their use. A one-page questionnaire was sent in 1997 to 1,129 members of the Michigan Psychiatric Association. A total of 717 responses were received, for a response rate of 64 percent. Only data from the 573 psychiatrists who were currently practicing were used. Twelve percent of the respondents never prescribed MAOIs, 27 percent had not prescribed them for at least three years, and 17 percent had prescribed them from one to three years ago. Thirty percent of the respondents had prescribed an MAOI within the past three months, and 14 percent between three and 12 months ago. The most frequent reasons for not prescribing the drugs were side effects and interactions with other medications (46 percent), preference for other medications (30 percent), and dietary restrictions necessary for patients taking MAOIs (19 percent). Ninety-two percent of respondents believed that MAOIs were useful for atypical depression, 64 percent for major depression, 54 percent for melancholic depression, 56 percent for panic disorder, 44 percent for social phobia, 27 percent for dysthymia, 12 percent for obsessive-compulsive disorder, and 19 percent for posttraumatic stress disorder. However, only 2 percent said they would use MAOIs as their first-line treatment in atypical depression, and only 3 percent would use them a first-line treatment in social phobia. The results document the commonly held view that practicing psychiatrists believe MAOIs are efficacious but use them infrequently, primarily due to concerns about side effects and drug interactions.

  7. Advancing practice through prescribing: is there a better way?

    Science.gov (United States)

    Harding, Stephen; Gardner, Andrew

    2006-07-01

    The literature demonstrates a clear relationship between the rate of adverse effects and the number of prescribers that a service consumer may consult. This brings into question the benefits, for the service consumer, of nurses prescribing. Given the complexities of care for certain population groups, for example older people, it is suggested that there is greater benefit in professionals working collaboratively toward the best outcome for the person in care, with nurses offering more informed advice to their partners in service delivery. Nurses who advance their practice through the development of an expert knowledge base relevant to their area of expertise can contribute to the diagnosis and management of particular client groups by providing specialist advice to primary and direct care professionals. It is proposed that this could be achieved using an 'academic detailing' approach rather than becoming another prescriber of pharmacotherapy.

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

    Science.gov (United States)

    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.

  9. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Brown, Erwin; Charani, Esmita; Fenelon, Lynda; Gould, Ian M; Holmes, Alison; Ramsay, Craig R; Wiffen, Philip J; Wilcox, Mark

    2013-04-30

    The first publication of this review in Issue 3, 2005 included studies up to November 2003. This update adds studies to December 2006 and focuses on application of a new method for meta-analysis of interrupted time series studies and application of new Cochrane Effective Practice and Organisation of Care (EPOC) Risk of Bias criteria to all studies in the review, including those studies in the previously published version. The aim of the review is to evaluate the impact of interventions from the perspective of antibiotic stewardship. The two objectives of antibiotic stewardship are first to ensure effective treatment for patients with bacterial infection and second support professionals and patients to reduce unnecessary use and minimize collateral damage. To estimate the effectiveness of professional interventions that, alone or in combination, are effective in antibiotic stewardship for hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial-resistant pathogens or Clostridium difficile infection and their impact on clinical outcome. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE from 1980 to December 2006 and the EPOC specialized register in July 2007 and February 2009 and bibliographies of retrieved articles. The main comparison is between interventions that had a restrictive element and those that were purely persuasive. Restrictive interventions were implemented through restriction of the freedom of prescribers to select some antibiotics. Persuasive interventions used one or more of the following methods for changing professional behaviour: dissemination of educational resources, reminders, audit and feedback, or educational outreach. Restrictive interventions could contain persuasive elements. We included randomized clinical trials (RCTs), controlled clinical trials (CCT), controlled before-after (CBA) and interrupted time series studies (ITS). Interventions

  10. Methods of prescribing relative exercise intensity: physiological and practical considerations.

    Science.gov (United States)

    Mann, Theresa; Lamberts, Robert Patrick; Lambert, Michael Ian

    2013-07-01

    Exercise prescribed according to relative intensity is a routine feature in the exercise science literature and is intended to produce an approximately equivalent exercise stress in individuals with different absolute exercise capacities. The traditional approach has been to prescribe exercise intensity as a percentage of maximal oxygen uptake (VO2max) or maximum heart rate (HRmax) and these methods remain common in the literature. However, exercise intensity prescribed at a %VO2max or %HRmax does not necessarily place individuals at an equivalent intensity above resting levels. Furthermore, some individuals may be above and others below metabolic thresholds such as the aerobic threshold (AerT) or anaerobic threshold (AnT) at the same %VO2max or %HRmax. For these reasons, some authors have recommended that exercise intensity be prescribed relative to oxygen consumption reserve (VO2R), heart rate reserve (HRR), the AerT, or the AnT rather than relative to VO2max or HRmax. The aim of this review was to compare the physiological and practical implications of using each of these methods of relative exercise intensity prescription for research trials or training sessions. It is well established that an exercise bout at a fixed %VO2max or %HRmax may produce interindividual variation in blood lactate accumulation and a similar effect has been shown when relating exercise intensity to VO2R or HRR. Although individual variation in other markers of metabolic stress have seldom been reported, it is assumed that these responses would be similarly heterogeneous at a %VO2max, %HRmax, %VO2R, or %HRR of moderate-to-high intensity. In contrast, exercise prescribed relative to the AerT or AnT would be expected to produce less individual variation in metabolic responses and less individual variation in time to exhaustion at a constant exercise intensity. Furthermore, it would be expected that training prescribed relative to the AerT or AnT would provide a more homogenous training

  11. Perceptions and Attitudes of Medical Sales Representatives (MSRs) and Prescribers Regarding Pharmaceutical Sales Promotion and Prescribing Practices in Pakistan

    OpenAIRE

    Khan, Nabeel; Naqvi, Atta; Ahmad, Rizwan; Ahmed, Farrukh; McGarry, Kenneth; Fazlani, Raafia; Ahsan, Mahrukh

    2016-01-01

    Pakistan is the 6th most populous country in the world and has an enormous potential for an ever increasing drug market. The health care system is highly prone to unethical drug prescribing practices. In addition, there is a huge tendency of pharmaceutical firms to indulge in unethical drug promotional practices by means of inducements and other benefits through their medical sales representatives (MSRs). On the other hand, the prescribers are also reported to be demanding inducements from th...

  12. A survey of veterinary antimicrobial prescribing practices, Washington State 2015.

    Science.gov (United States)

    Fowler, H; Davis, M A; Perkins, A; Trufan, S; Joy, C; Buswell, M; McElwain, T F; Moore, D; Worhle, R; Rabinowitz, P M

    2016-12-24

    Antimicrobial resistance is a growing global health issue. It is also a recognised problem in veterinary medicine. Between September and December 2015 the authors administered a cross-sectional survey to licensed veterinarians in Washington State to assess factors affecting antimicrobial prescribing practices among veterinarians in Washington State. Two hundred and three veterinarians completed the survey. The majority of respondents (166, 82 per cent) were engaged in small animal or exotic animal practice. 24 per cent of respondents reported not ordering culture and sensitivity (C/S) testing in practice. Of the 76 per cent of veterinarians who reported ordering C/S tests, 36 per cent reported ordering such testing 'often' or 'always' when treating presumptive bacterial infections. Most respondents (65 per cent) mentioned cost as the most common barrier to ordering a C/S test. Only 16 (10 per cent) respondents reported having access to or utilising a clinic-specific antibiogram. This survey demonstrated that while antimicrobials are commonly used in veterinary practice, and veterinarians are concerned about antimicrobial resistance, cost is a barrier to obtaining C/S tests to guide antimicrobial therapy. Summaries of antimicrobial resistance patterns are rarely available to the practising veterinarian. Efforts to promote antimicrobial stewardship in a 'One Health' manner should address barriers to the judicious use of antimicrobials in the veterinary practice setting. British Veterinary Association.

  13. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

    Directory of Open Access Journals (Sweden)

    Wagner AC

    2010-09-01

    Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

  14. Acute oxygen therapy: a review of prescribing and delivery practices

    Directory of Open Access Journals (Sweden)

    Cousins JL

    2016-05-01

    Full Text Available Joyce L Cousins,1–3 Peter AB Wark,3–5 Vanessa M McDonald2–5 1Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Sydney, 2School of Nursing and Midwifery, 3Priority Research Centre for Healthy Lungs, 4School of Medicine and Public Health, The University of Newcastle, 5Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia Abstract: Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care. Keywords: chronic obstructive pulmonary disease, COPD, type II respiratory failure, oxygen therapy, prescribing, hypoxia, hypercapnia

  15. ETHICAL PRACTICES IN DRUG PRESCRIBING. A COMPARATIVE STUDY BETWEEN DOCTORS’ AND PHARMACISTS’ OPINION ABOUT DRUG PRESCRIBING IN ROMANIA

    Directory of Open Access Journals (Sweden)

    LASZLO-ZOLTAN SZTANKOVSZKY

    2015-11-01

    Full Text Available The prescription of drugs is influenced by a number of factors with a great impact upon the health of the main beneficiaries of health services. The purpose of the study is to identify the perception of doctors and pharmacists on drug prescription practices adopted by doctors. Material and Methods: a number of 349 subjects (149 pharmacists and 200 doctors answered a survey about the perception of drug dispensing in Romania. Variables like age, work environment (urban, rural, length of employment were taken into account. Results: When prescribing a treatment, 93% of doctors follow the standard treatment protocol for the given diagnosis and 93,5% of them are declaring that personal resources are the main source for training while the percent appreciated by pharmacists is evaluated to 65,78%. A total of 50% of doctors are considering other criteria than the treatment when prescribing a drug (financial contribution for the patient or National Health Insurance House. A total of 59% of doctors are recommending overthe-counter products while pharmacists consider that is happening in more than 70% of the cases. Conclusions: There are differences of opinion between doctors and pharmacists regarding doctor’s practices of prescribing drugs to their patients, like: kinds of sponsorship for the continuing education, the relationship with the pharmaceutical representative or the frequency of prescribing over-the-counter products or supplements when they are recommending a certain treatment.

  16. How to educate prescribers in antimicrobial stewardship practices

    NARCIS (Netherlands)

    Pulcini, C.; Gyssens, I.C.J.

    2013-01-01

    Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection

  17. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this

  18. Fluorine prescribing practice of paediatricians in Berlin, Germany

    OpenAIRE

    Mittelsdorf, Arlette

    2010-01-01

    The subject of this study was to find out about paediatricians' approach towards fluoride within the municipal area of Berlin, Germany. For this purpose, an anonymous questionnaire consisting of 14 questions had been mailed; it was answered by a total number of 33 paediatricians. Basically, the survey indicates that they all prescribe fluorine in tablet form, but they differ about initiation and duration. About 30% prescribe fluorine between the age of 30 days and 6 years. All of ...

  19. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    LENUS (Irish Health Repository)

    Kennelly, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later.

  20. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan

    2017-02-09

    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  1. Prescribing pattern and indicators for performance in a psychiatric practice.

    Science.gov (United States)

    Sharma, Sangeeta; Chadda, Rk; Rishi, Rk; Gulati, Raj K; Bapna, Js

    2003-01-01

    AIMS To assess the prescribing pattern and to measure some specific aspects of the behaviour of the prescribers (psychiatrists) before and after educational interventions using core drug use indicators. METHODS In the present randomized retrospective controlled pre-post intervention prescription survey of schizophrenia and depression, 100 prescriptions each for schizophrenia and depression were obtained before and after each intervention. The prescriptions were analyzed for the following prescriber-specific indicators: number of drugs prescribed, prescribing by generic names, prescriptions for essential drugs, antiparkinsonian and benzodiazepines, nature of drugs and number of combinations prescribed. Based on the results of pre-intervention data, two interactional workshops were conducted 1 and 6 months after pre-intervention data collection. The first workshop focused on the results of the prescription audit feedback and reasons thereof. The second workshop focused, in addition, on appropriate management of schizophrenia and depression using consensus treatment guidelines with the aim of evolving a consensus on the treatment in a given hospital setting. RESULTS Before intervention, the essential drugs accounted for 80.95 and 96.91% of the total number of drugs prescribed in depression and schizophrenia, respectively. Prescription for essential drugs improved further significantly in the post intervention period to 95.26% (Pprescriptions for essential drugs declined to 80.95%. The average number of drugs prescribed per encounter marginally declined in both schizophrenia (2.46±0.94 to 2.34±0.65) and depression (2.09±0.79 to 2.00±0.65) after the second intervention. The patients receiving two or more drugs from the same group together declined from 12 to 9% in schizophrenia, but increased from 5 to 10% in depression after intervention. Trihexyphenidyl, an antiparkinsonian drug, was co-prescribed (90%) with antipsychotic agents (98%) in schizophrenia; however

  2. Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2016-01-01

    Full Text Available 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

  3. Practices in prescribing protein substitutes for PKU in Europe

    DEFF Research Database (Denmark)

    Aguiar, A; Ahring, K; Almeida, M F;

    2015-01-01

    BACKGROUND: There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS: A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein...

  4. GPs motivations of prescribing antidepressants and their practical relevance.

    NARCIS (Netherlands)

    Volkers, A.; Jong, A. de; Braspenning, J.C.C.; Bakker, D. de; Dijk, L. van

    2004-01-01

    Background: Insight in the motivations of prescribing antidepressants may contribute to advance the efficiency of the current, large antidepressant prescription rate. Less is known about why general practitioners (GPs) treat patients with antidepressants or not and choose modern SSRIs instead of the

  5. New drugs in general practice: prescribing patterns and external influences

    NARCIS (Netherlands)

    Florentinus, S.R.

    2006-01-01

    In this thesis several studies are presented with the objective to detect and elucidate the patterns by which new drugs are prescribed by general practitioners (GPs). Furthermore, we studied the influences of medical specialists and community pharmacists as important factors on the GP's decision to

  6. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

  7. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

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

    Science.gov (United States)

    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.

  9. Practical considerations when prescribing icodextrin: a narrative review.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; Perl, Jeffrey

    2014-01-01

    Icodextrin is a peritoneal dialysis solution that is commonly used to increase ultrafiltration during the long dwell. The other major clinical benefit of icodextrin is that it is glucose-sparing, which may help preserve peritoneal membrane function. Since it has a different chemical composition than dextrose, and with its increasing use, there are several clinical considerations healthcare providers must familiarize themselves with prior to prescribing icodextrin. Failure to recognize these special properties of icodextrin can lead to adverse events reaching patients. This narrative review explores the hemodynamic, metabolic, and idiopathic effects of icodextrin to facilitate the safe use of icodextrin in peritoneal dialysis. Hemodynamic effects include hypotension from enhanced ultrafiltration contributing to loss of residual kidney function. Metabolic effects include the chemical structure of icodextrin interfering with biochemical assays, resulting in misleading glucose readings on non-specific glucometers. Idiopathic adverse effects include a diffuse rash and sterile peritonitis. It is also important to remember that not all antibiotic combinations have undergone stability testing in icodextrin. This narrative review will help healthcare providers to confidently prescribe icodextrin to maximize its benefit in peritoneal dialysis patients.

  10. A practical guide for prescribing birth control pills.

    Science.gov (United States)

    Abrams, J

    1994-06-01

    More than 50 million US women have used oral contraceptives (OCs) in the past 25 years, and the consensus is that the benefits and advantages of OC use outweigh most of the disadvantages. Side effects have been reduced or eliminated by reduced dosage preparations, and effectiveness has been virtually 100%. Despite this widespread use, most US women are misinformed about OCs, perhaps because pediatricians, family physicians, and nurse-practitioners are insufficiently informed. The economic power of the drug manufacturers has been brought to bear on the medical profession to prescribe OCs for virtually every woman of child-bearing age. The drug industry which has been touting the safety of OCs has recently introduced new progestins which are supposed to be "lipid-neutral" and have fewer androgenic effects. Therefore, the potentially harmful effects of the old progestins were deemphasized deliberately. A cautious but advisable approach for physicians to follow in prescribing OCs has 8 points. 1) All sexually active females should be advised that barrier contraception is the best protection (except abstinence) from sexually transmitted diseases, including AIDS. 2) OCs with more than 35 mcg estrogen should be withdrawn from the market. 3) All patients should be encouraged to lead a healthy lifestyle. 4) Barrier methods should be encouraged for patients with such medical conditions as migraine headaches, prominent varicose veins, diabetes, increasing weight gain, hypertension, thyroid dysfunction, and mitral valve prolapse. 5) Switching to a preparation with the new progestins should be considered for some patients who are smokers or have abnormal lipid profiles. 6) It might be advantageous under certain circumstances for a patient to discontinue OC use for a period of time. 7) Women who no longer desire a pregnancy should be encouraged to consider surgical sterilization. 8) Nulliparous women over 30 years old should discontinue OC use to diminish their risk of breast

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

    LENUS (Irish Health Repository)

    Cadogan, C

    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.

  12. Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice.

    Science.gov (United States)

    Dallas, Anthea; van Driel, Mieke; van de Mortel, Thea; Magin, Parker

    2014-09-01

    Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing. To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing. A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group. Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on prescribing. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis. Registrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor. Understanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future. © British Journal of General Practice 2014.

  13. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Science.gov (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  14. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students.

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    Kamala Thriemer

    Full Text Available OBJECTIVES: Antibiotic resistance (ABR particularly hits resource poor countries, and is fuelled by irrational antibiotic (AB prescribing. We surveyed knowledge, attitudes and practices of AB prescribing among medical students and doctors in Kisangani, DR Congo. METHODS: Self-administered questionnaires. RESULTS: A total of 184 questionnaires were completed (response rate 94.4%. Knowledge about AB was low (mean score 4.9/8 points, as was the estimation of local resistance rates of S. Typhi and Klebsiella spp.(correct by 42.5% and 6.9% of respondents respectively. ABR was recognized as a problem though less in their own practice (67.4% than nation- or worldwide (92.9% and 85.5%, p<.0001. Confidence in AB prescribing was high (88.6% and students consulted more frequently colleagues than medical doctors when prescribing (25.4% versus 11.6%, p= 0.19. Sources of AB prescribing included pharmaceutical companies (73.9%, antibiotic guidelines (66.3%, university courses (63.6%, internet-sites (45.7% and WHO guidelines (26.6%. Only 30.4% and 16.3% respondents perceived AB procured through the central procurement and local pharmacies as of good quality. Local AB guidelines and courses about AB prescribing are welcomed (73.4% and 98.8% respectively. CONCLUSIONS: This data shows the need for interventions that support rational AB prescribing.

  15. Taking stock: provider prescribing practices in the presence and absence of ACT stock

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    Jones Caroline

    2011-08-01

    Full Text Available Abstract Background Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought. Methods A systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock. Results Of the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia, reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children Conclusions Prescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.

  16. Defining inappropriate practices in prescribing for elderly people: a national consensus panel.

    Science.gov (United States)

    McLeod, P J; Huang, A R; Tamblyn, R M; Gayton, D C

    1997-02-01

    To develop a consensus-based list of inappropriate practices in prescribing for elderly people. Mail survey of a 32-member national panel. Academic medical centres across Canada. Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.

  17. Antibiotic prescribing in Danish general practice 2004-13

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert; Hansen, Malene Plejdrup;

    2016-01-01

    general practice relative to the entire primary care sector. METHODS: This was a registry-based study including all patients who redeemed an antibiotic prescription between July 2004 and June 2013 at a Danish community pharmacy. Antibiotic use was expressed as DDDs and treatments/1000 inhabitants...

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

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    Sekharan Gopalakrishnan

    2013-01-01

    Full Text Available 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.

  19. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis

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    van Dijk Liset

    2007-08-01

    Full Text Available Abstract Background Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general practitioners, distinguishing general GP-characteristics, characteristics of the practice setting, characteristics of the patient population and information sources used by GPs. Methods Secondary analysis was carried out on data from the Second Dutch Survey in General Practice. Data were available for 138 GPs working in 93 practices. ATC-coded prescription data from electronic medical records, census data and data from GP/practice questionnaires were analyzed with multilevel techniques. Results The average GP writes prescriptions for 233 different drugs, i.e. 30% of the available drugs on the market within one year. There is considerable variation between ATC main groups and subgroups and between GPs. GPs with larger patient lists, GPs with higher prescribing volumes and GPs who frequently receive representatives from the pharmaceutical industry have a broader range when controlled for other variables. Conclusion The range of drugs prescribed is a useful instrument for analysing GPs' prescribing behaviour. It shows both variation between GPs and between therapeutic groups. Statistically significant relationships found were in line with the hypotheses formulated, like the one concerning the influence of the industry. Further research should be done into the relationship between the range and quality of prescribing and the reasons why some GPs prescribe a greater number of different drugs than others.

  20. Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

    Science.gov (United States)

    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)

  1. Prescribing practices amid the OxyContin crisis: examining the effect of print media coverage on opioid prescribing among physicians.

    Science.gov (United States)

    Borwein, Alexandra; Kephart, George; Whelan, Emma; Asbridge, Mark

    2013-12-01

    The pain medication OxyContin (hereafter referred to as oxycodone extended release) has been the subject of sustained, and largely negative, media attention in recent years. We sought to determine whether media coverage of oxycodone extended release in North American newspapers has led to changes in prescribing of the drug in Nova Scotia, Canada. An interrupted time-series design examined the effect of media attention on physicians' monthly prescribing of opioids. The outcome measures were, for each physician, the monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone extended release. The exposure of interest was media attention defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in the prescribing of oxycodone extended release in Nova Scotia were observed, and they followed changes in media coverage. Oxycodone extended release prescribing rose steadily prior to receiving media attention. Following peak media attention in the United States, the prescribing of oxycodone extended release slowed. Likewise, following peak coverage in Canadian newspapers, the prescribing of oxycodone extended release declined. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied. This study demonstrates that print media reporting of oxycodone extended release in North American newspapers, and its continued portrayal as a social problem, coincided with reductions in the prescribing of oxycodone extended release by physicians in Nova Scotia. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m......, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. PARTICIPANTS: 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. INTERVENTIONS: The interventions included different mRDT training......RDT-negative patients; a more directive intervention approach and local preferences for ACTs. CONCLUSIONS: Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities...

  3. What are the perceived learning needs of Australian general practice registrars for quality prescribing?

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    Aslani Parisa

    2010-12-01

    Full Text Available Abstract Background Little is known about the perceived learning needs of Australian general practice (GP registrars in relation to the quality use of medicines (QUM or the difficulties experienced when learning to prescribe. This study aimed to address this gap. Methods GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. Results The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. Conclusions GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.

  4. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-11-03

    To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy

  5. Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink

    Science.gov (United States)

    Kontopantelis, Evangelos; Akbarov, Artur; Rodgers, Sarah; Avery, Anthony J; Ashcroft, Darren M

    2015-01-01

    Study question What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices? Methods A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin. Study answer and limitations 49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in

  6. Defining inappropriate practices in prescribing for elderly people: a national consensus panel

    OpenAIRE

    McLeod, P. J.; Huang, A R; Tamblyn, R M; Gayton, D. C.

    1997-01-01

    OBJECTIVE: To develop a consensus-based list of inappropriate practices in prescribing for elderly people. DESIGN: Mail survey of a 32-member national panel. SETTING: Academic medical centres across Canada. PARTICIPANTS: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. OUTCOME MEASURES: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse ef...

  7. Influence of Medical Representatives on Prescribing Practices in Mekelle, Northern Ethiopia.

    Science.gov (United States)

    Workneh, Birhanu Demeke; Gebrehiwot, Mehari Gebregergis; Bayo, Tigist Assefa; Gidey, Meles Tekie; Belay, Yared Belete; Tesfaye, Desalegn Mergiaw; Kassa, Terefe Teshome

    2016-01-01

    Drug promotion by medical representatives is one of the factors that influence physicians' prescribing decisions and choice of drugs. To assess the influence of medical representatives on prescribing practice of physicians in health facilities, Mekelle, Northern Ethiopia. Facility-based cross-sectional study was conducted enrolling all physicians working in public and private health facilities. All public and private health facilities were included and similarly, all physicians rendering services in these facilities were sampled in the study. The data were collected from February to March, 2015. Data were then entered into Epidata Version 3.1 and transferred to STATA version 12 for analysis. Both bivariable and multivariable logistic regressions were used to determine predictors. Of the ninety physicians approached in this study, 40 (48.2%) of the physicians believed that their prescribing decisions were influenced by visits of medical representatives (MRs). The odds of physicians who received gifts from MRs being influenced to prescribe their respective products was six times higher than those who reported not accepting any gifts [AOR = 6.56, 95% CI: 2.25, 19.13]. Stationery materials 23(35.4%) and drug samples 20(54.2%) were the commonest kinds of gifts given to physicians and face to face talking 45(54.2%) was the most frequent promotional methods. The finding of this study showed that around thirty-nine percent of MRs have had negative attitude toward competitors' product. Moreover, working in private health facility was also another predictor of influence of prescribing decision in the study area [AOR = 12.78, 95% CI: 1.31, 124.56]. Nearly half of the physicians working in Mekelle reported that their prescribing decisions were influenced by MRs in the last 12 months. Accepting gifts and working in private health facilities were predictors of influencing prescribing decisions. However, most MRs fails to provide adequate and accurate information regarding their

  8. Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand

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    Critchley Julia

    2005-06-01

    Full Text Available Abstract Background Over-prescribing of benzodiazepines appears common in many countries, a better understanding of prescribing practices and attitudes may help develop strategies to reduce prescribing. This study aimed to evaluate benzodiazepine prescribing behaviour and attitudes in general practitioners practising in Chiang Mai and Lampoon, Thailand. Methods Questionnaire survey of general practitioners in community hospitals, to estimate: i use of benzodiazepines for anxiety/insomnia, panic disorder, depression, essential hypertension, and uncomplicated low back pain and ii views on the optimal duration of benzodiazepine use. Results Fifty-five of 100 general practitioners returned the completed questionnaires. They reported use of benzodiazepines for anxiety/insomnia (n = 51, 93%, panic disorder (n = 43, 78%, depression (n = 26, 43%, essential hypertension (n = 15, 27 % and uncomplicated low back pain (n = 10, 18%. Twenty-eight general practitioners would prescribe benzodiazepines for non-psychiatric conditions, 17 for use as muscle relaxants. Seventy-five per cent, 62% and 29% of the general practitioners agreed or totally agreed with the use of benzodiazepines for insomnia, anxiety and depression, respectively. Practitioners agreed that prescribing should be less than one week (80%; or from 1 week to 1 month (47%; or 1 to 4 months (16%; or 4 to 6 months (5% or more than 6 months (2%. Twenty-five general practitioners (45% accepted that they used benzodiazepines excessively in the past year. Conclusion A considerable proportion of general practitioners in Chiang Mai and Lampoon, Thailand inappropriately use benzodiazepines for physical illnesses, especially essential hypertension and uncomplicated low back pain. However, almost half of them thought that they overused benzodiazepines. General practitioner's lack of time, knowledge and skills should be taken into account in improving prescribing behaviour and attitudes.

  9. Encouraging good antimicrobial prescribing practice: A review of antibiotic prescribing policies used in the South East Region of England

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    Mayon White Richard T

    2001-05-01

    Full Text Available Abstract Background Good prescribing practice has an important part to play in the fight against antimicrobial resistance. Whilst it was perceived that most hospitals and Health Authorities possessed an antibiotic policy, a review of antibiotic policies was conducted to gain an understanding of the extent, quality and usefulness of these policies. Methods Letters were sent to pharmacists in hospitals and health authorities in across the South East region of the National Health Service Executive (NHSE requesting antibiotic policies. data were extracted from the policies to assess four areas; antibiotic specific, condition specific, patient specific issues and underpinning evidence. Results Of a possible 41 hospital trusts and 14 health authorities, 33 trusts and 9 health authorities (HAs provided policies. Both trust and HA policies had a median publication date of 1998 (trust range 1993-99, HA 1994-99. Eleven policies were undated. The majority of policies had no supporting references for the statements made. All policies provided some details on specific antibiotics. Gentamicin and ciprofloxacin were the preferred aminoglycoside and quinolone respectively with cephalosporins being represented by cefuroxime or cefotaxime in trusts and cephradine or cephalexin in HAs. 26 trusts provided advice on surgical prophylaxis, 17 had meningococcal prophylaxis policies and 11 covered methicillin resistant Staphylococcus aureus (MRSA. There was little information for certain groups such as neonates or children, the pregnant or the elderly. Conclusion There was considerable variation in content and quality across policies, a clear lack of an evidence base and a need to revise policies in line with current recommendations.

  10. Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice

    Science.gov (United States)

    van Duijn, Huug J; Kuyvenhoven, Marijke M; Tiebosch, Hanneke M; Schellevis, François G; Verheij, Theo JM

    2007-01-01

    Background Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT) episodes to be labelled as infections) probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year. Methods Data were used from the Second Dutch National Survey of General Practice (DNSGP-2) with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients. Results The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67), a stronger inclination to label episodes as infections (beta 0.24), a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11) and being male (beta 0.11) were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes. Conclusion Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels. PMID:17883832

  11. Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice

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    Schellevis François G

    2007-09-01

    Full Text Available Abstract Background Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT episodes to be labelled as infections probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year. Methods Data were used from the Second Dutch National Survey of General Practice (DNSGP-2 with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients. Results The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67, a stronger inclination to label episodes as infections (beta 0.24, a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11 and being male (beta 0.11 were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes. Conclusion Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels.

  12. Sources of information and HRT prescribing practices among gynecologists in Puebla, Mexico.

    Science.gov (United States)

    Mueller, Kimberly A; Sanchez, Gabriela Jimenez Zeron; Sievert, Lynnette Leidy

    2003-06-30

    The purpose of this study was to determine the sources of information and hormone replacement therapy (HRT) prescribing practices of gynecologists in the capital city of Puebla, Mexico. Practicing gynecologists (n=44) in 29 colonias (neighborhoods) in the city of Puebla completed a self-administered standardized questionnaire. Survey topics included primary sources of information about HRT, discussion of patient health practices, awareness of alternative medicines, and HRT prescribing practices. Medical journals, hospital presentations, and textbook manuals were rated as the primary sources of information about HRT by 69-73% of physicians. Patients were rated as a primary source of information by 25% of physicians, and pharmaceutical representatives by 16% of physicians. Almost all physicians reported a willingness to discuss diet, smoking habits and other health issues with their patients. Natural and herbal medications were recommended by 25% of physicians. Contrary to studies in the US, more male than female physicians reported recommending hormones to 90-100% of their menopausal patients (60 vs. 33%, n.s.). This study revealed that physicians utilize a wide range of information about HRT, including patients and pharmaceutical representatives. Physicians' willingness to list patients as a source of information about HRT indicates the degree to which patients are involved in the medicalization of menopause. Reasons given for prescribing HRT (e.g. prevention of osteoporosis) were similar to those identified in studies in the US and Canada. Some variation in physician attitudes and practices related to HRT was apparent within the city of Puebla, Mexico.

  13. ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing-2016.

    Science.gov (United States)

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2017-09-01

    The results of the 2016 ASHP national survey of pharmacy practice in hospital settings are presented. A stratified random sample of pharmacy directors at 1,315 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method offering a choice of completing a paper survey or an online survey. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. The survey response rate was 29.8%. Drug policy development by pharmacy and therapeutics committees continues to be an important strategy for improving prescribing. Strict formulary systems are maintained in 63.0% of hospitals, and 89.7% of hospitals use clinical practice guidelines that include medications. Pharmacists have the authority to order laboratory tests in 89.9% of hospitals and order medications in 86.8% of hospitals. Therapeutic interchange policies are used in 89.2% of hospitals. Electronic health records (EHRs) have been implemented partially or completely in most hospitals (99.1%). Computerized prescriber-order-entry systems with clinical decision support are used in 95.6% of hospitals, and 92.6% of hospitals have barcode-assisted medication administration systems. Transitions-of-care programs are increasing in number, with 34.6% of hospitals now offering discharge prescription services. Pharmacists practice in 39.5% of hospital ambulatory or primary care clinics. The most common service offered by pharmacists to outpatients is anticoagulation management (26.0%). When pharmacists practice in ambulatory care clinics, 64.5% have prescribing authority through collaborative practice agreements. Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Effect of educational outreach on general practice prescribing of antibiotics and antidepressants: A two-year randomised controlled trial

    Science.gov (United States)

    Enriquez-puga, Andres; Baker, Richard; Paul, Sanjoy; Villoro-Valdes, Renata

    2009-01-01

    Objective Prescribing of broad spectrum antibiotics and antidepressants in general practice often does not accord with guidelines. The aim was to determine the effectiveness of educational outreach in improving the prescribing of selected antibiotics and antidepressants, and whether the effect is sustained for two years. Design Single blind randomized trial. Setting Twenty-eight general practices in Leicestershire, England. Intervention Educational outreach visits were undertaken, tailored to barriers to change, 14 practices receiving visits for reducing selected antibiotics and 14 for improving antidepressant prescribing. Main outcome measures Number of items prescribed per 1000 registered patients for amoxicillin with clavulanic acid (co-amoxiclav) and quinolone antibiotics, and average daily quantities per 1000 patients for lofepramine and fluoxetine antidepressants, measured at the practice level for six-month periods over two years. Results There was no effect on the prescribing of co-amoxiclav, quinolones, or fluoxetine, but prescribing of lofepramine increased in accordance with the guidelines. The increase persisted throughout two years of follow-up. Conclusion A simple, group-level educational outreach intervention, designed to take account of identified barriers to change, can have a modest but sustained effect on prescribing levels. However, outreach is not always effective. The context in which change in prescribing practice is being sought, the views of prescribers concerning the value of the drug, or other unrecognised barriers to change may influence the effectiveness of outreach. PMID:19958063

  15. Prescribing Data in General Practice Demonstration (PDGPD project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

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    Williamson Margaret

    2012-08-01

    Full Text Available Abstract Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1 hypertension (HT and 2 chronic heart failure (CHF. The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI intervention on prescribing practice among Australian general practitioners (GP in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion with each group undertaking the clinical topics (CHF and HT in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a

  16. What interventions should pharmacists employ to impact health practitioners' prescribing practices?

    Science.gov (United States)

    Grindrod, Kelly A; Patel, Payal; Martin, Janet E

    2006-09-01

    To determine which interventions are effective in influencing health practitioners' prescribing practices and explore differences in intervention complexity, setting, sustainability, cost effectiveness, and impact on patient outcomes. A systematic search for English-language systematic reviews was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature, EMBASE, and the Cochrane Library from the date of inception to July 2005 using search terms in accordance with Cochrane recommendations. Included reviews were required to clearly report a search strategy, inclusion/exclusion criteria, literature assessment criteria, and methods for synthesizing or summarizing information and references. Two reviewers independently identified studies for inclusion, assessed study quality, and extracted relevant information. Interventions were classified as consistently effective, inconsistently effective, and effectiveness uncertain. Thirty-four of 4585 titles reviewed met the inclusion criteria. Quality scores ranged from 70% to 100%. Consistently effective interventions included reminders (manual and computerized), audit and feedback, educational outreach visits, organizational strategies, and patient-mediated interventions. Inconsistently effective interventions included computer decision support systems and educational meetings. Multi-faceted interventions were consistently shown to be more efficacious than single interventions. Limited data precluded exploration of the effects of interventions in different settings, sustainability of effect, cost effectiveness, and patient clinical outcomes. Interventions that are most effective for impacting prescribing practice include audit and feedback, reminders, educational outreach visits, and patient-mediated interventions. To maximize impact, pharmacists' efforts to positively impact prescribing practices should focus on these intervention types rather than relying primarily on passive didactics or dissemination

  17. Opioid-prescribing practices in chronic cancer pain in a tertiary care pain clinic

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    Raghu S Thota

    2011-01-01

    Full Text Available Introduction: Under treatment of pain is a recognized global issue. Opioid analgesic medication is the mainstay of treatment in cancer patients as per the World Health Organization (WHO pain relief ladder, yet 50% of cancer patients worldwide do not receive adequate pain relief or are undertreated. Aim: The aim of this study was to audit the ongoing opioid-prescribing practices in our tertiary cancer pain clinic during January-June 2010. Materials& Methods: The prescribed type of opioid, dose, dosing interval, and laxatives details were analyzed. Results: Five hundred pain files were reviewed and 435 were found complete for audit. Three hundred forty-eight (80% patients were prescribed opioids. Two hundred fifty-nine (74.4% received weak opioids while 118 (33.9% received strong opioids. A total of 195 (45% patients had moderate and 184 (42% had severe pain. Ninety-three (26.7% patients received morphine; however, only 31.5% (58 of 184 in severe pain received morphine as per the WHO pain ladder. Only 73 of 93 (78.4% patients received an adequate dose of morphine with an adequate dosing interval and only 27 (29% were prescribed laxatives with morphine. Conclusion: This study shows that the under treatment of pain and under dosing of opioids coupled with improper side effect management are major issues.

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

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    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.

  19. Influence of Medical Representatives on Prescribing Practices in Mekelle, Northern Ethiopia.

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    Birhanu Demeke Workneh

    Full Text Available Drug promotion by medical representatives is one of the factors that influence physicians' prescribing decisions and choice of drugs.To assess the influence of medical representatives on prescribing practice of physicians in health facilities, Mekelle, Northern Ethiopia.Facility-based cross-sectional study was conducted enrolling all physicians working in public and private health facilities. All public and private health facilities were included and similarly, all physicians rendering services in these facilities were sampled in the study. The data were collected from February to March, 2015. Data were then entered into Epidata Version 3.1 and transferred to STATA version 12 for analysis. Both bivariable and multivariable logistic regressions were used to determine predictors.Of the ninety physicians approached in this study, 40 (48.2% of the physicians believed that their prescribing decisions were influenced by visits of medical representatives (MRs. The odds of physicians who received gifts from MRs being influenced to prescribe their respective products was six times higher than those who reported not accepting any gifts [AOR = 6.56, 95% CI: 2.25, 19.13]. Stationery materials 23(35.4% and drug samples 20(54.2% were the commonest kinds of gifts given to physicians and face to face talking 45(54.2% was the most frequent promotional methods. The finding of this study showed that around thirty-nine percent of MRs have had negative attitude toward competitors' product. Moreover, working in private health facility was also another predictor of influence of prescribing decision in the study area [AOR = 12.78, 95% CI: 1.31, 124.56].Nearly half of the physicians working in Mekelle reported that their prescribing decisions were influenced by MRs in the last 12 months. Accepting gifts and working in private health facilities were predictors of influencing prescribing decisions. However, most MRs fails to provide adequate and accurate information

  20. Gaining insight into benzodiazepine prescribing in General Practice in France: a data-based study

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    Marc Le Vaillant

    2011-05-01

    Full Text Available Abstract Background In recent decades, benzodiazepine (BZD prescriptions have been called into question in most European countries by physicians and health authorities alike, and guidelines on medical indications and treatment duration have been established to avoid long-term use and dependency. In France, many public policy measures have been implemented as BZDs are among the most prescribed medications. General practitioners (GPs were identified by the Caisse d'Assurance Maladie (the French public health insurance fund as high prescribers for these drugs. In this context, the aim of the study was to determine GPs' rates and to identify correlates of BZD and Z-drugs prescribing. Methods Data on patient characteristics, diagnoses and BZD prescriptions were drawn from French GPs' electronic medical records. These were accessed via the database which the Société Française de Médecine Générale, the French Society of General Practice, has been compiling since 1993 in a network of 90 GPs working mainly in solo practices. The participants in this network routinely register data in their daily practice. The present study examined 51,216 patients from 52 GP practices and we performed a multivariate logistic regression. The dependent variable was whether a patient was prescribed BZD at least once during 2006. Results In the present study, 12.5% of patients older than 18 were prescribed BZDs at least once during 2006 and the average (SD was 2.6 (2.4 BZD prescriptions/patient/year. The adjusted odds (confidence interval of having at least one BZD prescription were 1.20 (1.10 - 1.30 in patients older than 65; 1.05 (1.01 - 1.10 in women; 1.25 (1.17 - 1.33 in patients with associated comorbidities (cardiovascular diseases and 1.76 (1.62 - 1.92 in heavy consumers of health care (more than 4 consultations with a GP per year. Conclusions The present study showed the persistence of high rates of BZD prescription by GPs, particularly in women and older

  1. Atopic children and use of prescribed medication: A comprehensive study in general practice.

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    Pols, David H J; Nielen, Mark M J; Bohnen, Arthur M; Korevaar, Joke C; Bindels, Patrick J E

    2017-01-01

    A comprehensive and representative nationwide general practice database was explored to study associations between atopic disorders and prescribed medication in children. All children aged 0-18 years listed in the NIVEL Primary Care Database in 2014 were selected. Atopic children with atopic eczema, asthma and allergic rhinitis (AR) were matched with controls (not diagnosed with any of these disorders) within the same general practice on age and gender. Logistic regression analyses were performed to study the differences in prescribed medication between both groups by calculating odds ratios (OR); 93 different medication groups were studied. A total of 45,964 children with at least one atopic disorder were identified and matched with controls. Disorder-specific prescriptions seem to reflect evidence-based medicine guidelines for atopic eczema, asthma and AR. However, these disorder-specific prescriptions were also prescribed for children who were not registered as having that specific disorder. For eczema-related medication, about 3.7-8.4% of the children with non-eczematous atopic morbidity received these prescriptions, compared to 1.4-3.5% of the non-atopic children. The same pattern was observed for anti-asthmatics (having non-asthmatic atopic morbidity: 0.8-6.2% vs. controls: 0.3-2.1%) and AR-related medication (having non-AR atopic morbidity: 4.7-12.5% vs. controls: 2.8-3.1%). Also, non-atopic related medication, such as laxatives and antibiotics were more frequently prescribed for atopic children. The present study shows that atopic children received more prescriptions, compared to non-atopic children. Non-atopic controls frequently received specific prescriptions for atopic disorders. This indicates that children with atopic disorders need better monitoring by their GP.

  2. An evaluation of knowledge, attitude and practices about prescribing fixed dose combinations among resident doctors

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    Nimit Goswami

    2013-01-01

    Full Text Available Background: Fixed Dose Combinations (FDCs improve patient compliance and decrease pill burden. However, irrational prescribing of FDCs is a major health concern. As resident doctors are primarily involved in patient management at tertiary care hospitals, knowledge about prescribing FDCs is of paramount importance. Objective: To evaluate knowledge, attitude and practice, regarding use of FDCs by resident doctors at a tertiary care teaching hospital. Materials and Methods: The study was carried out among resident doctors working at Civil Hospital, Ahmedabad, a tertiary care teaching hospital. One hundred resident doctors from the departments of medicine, obstetrics and gynaecology, surgery, paediatrics, skin and psychiatry, who gave their informed consent, were enrolled. A prevalidated questionnaire regarding knowledge, attitude and prescribing practice of fixed dose combinations was filled up. Data was analyzed with suitable statistical tests. Results: Out of the 100 residents recruited for the study, 34, 33 and 33 residents were selected from the 1 st , 2 nd and 3 rd year respectively. The resident doctors were not aware about all of the advantages and disadvantages of FDCs. On an average, only 31% of the residents (lowest 16% among 1 st year residents had knowledge about the Essential Medicine List (EML. Knowledge about rationality of given FDCs was lacking in 81% of the residents. Only 47% could name a single banned FDC in India. Common sources of information about FDCs were medical representatives, colleagues/peers, the Monthly Index of Medical Specialities (MIMS and Continuous Medical Education (CMEs. A majority of residents (96% agreed that FDCs should be allowed to be marketed. The residents opined that most commonly prescribed FDCs were of antimicrobial drugs, amongst which amoxicillin + clavulanic acid was the most frequent. Conclusion: There is need to improve knowledge about rationality, EML, usage and banned FDCs in post graduate

  3. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    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...... 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....

  4. Continued high rates of antibiotic prescribing to adults with respiratory tract infection : survey of 568 UK general practices

    NARCIS (Netherlands)

    Gulliford, Martin C; Dregan, Alex; Moore, Michael V; Ashworth, Mark; Staa, Tjeerd van; McCann, Gerard; Charlton, Judith; Yardley, Lucy; Little, Paul; McDermott, Lisa

    2014-01-01

    OBJECTIVES: Overutilisation of antibiotics may contribute to the emergence of antimicrobial drug resistance, a growing international concern. This study aimed to analyse the performance of UK general practices with respect to antibiotic prescribing for respiratory tract infections (RTIs) among young

  5. Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies

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    Ramdhanie Joseph

    2004-06-01

    Full Text Available Abstract Background Upper respiratory tract infections (URTIs are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs prescribing behaviour for antimicrobials in children (≤ 16 years with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC as a reference. Methods A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p 30 years were more likely to prescribe antibiotics for the common cold (p = 0.014. Severity (95.7% and duration of illness (82.5% influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75% and concern for secondary bacterial infections (70%. Physicians do not request laboratory investigations primarily because they are unnecessary (86% and the waiting time for results is too long (51%. Conclusions Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary

  6. Rethinking medication prescribing practices in an inner-city Hispanic mental health clinic.

    Science.gov (United States)

    Opler, Lewis A; Ramirez, Paul Michael; Dominguez, Lourdes M; Fox, Michelle S; Johnson, Patrick B

    2004-03-01

    Improved compliance with pharmacotherapy was achieved in treating Hispanic outpatients with psychotic disorders when recognition of culturally based differences between patients and psychiatrists led to modifications in prescribing practices. Unacculturated Hispanic outpatients experienced akathisia as an increase in "nerviosismo." Addressing this issue, as well as using anxiolytics and low doses of antipsychotics when beginning treatment, led to an improvement in compliance. Increased discussion of other antipsychotic side effects, which forced us to confront our false assumption that unacculturated Hispanics would be prone to suggestibility and, therefore, that discussions of side effects would lead to an increase in somatization, similarly improved medication compliance and therapeutic alliance. Practicing psychiatrists need to become aware of cultural factors to better treat patients with different backgrounds.

  7. Practice characteristics and prescribing of cardiovascular drugs in areas with higher risk of CHD in Scotland: cross-sectional study

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    McLean Gary

    2008-07-01

    Full Text Available Abstract Background We examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics. Methods Propensity score matching was used to identify two groups of practices in Scotland. The cases were in areas with 5% or more of the population in South Asian ethnic groups. The controls were in areas with less than 1% of the population in South Asian ethnic groups and were matched for other population characteristics. Results The 39 case practices have lower prescribing rates than the matched controls for all heart disease drugs Significant different are found for six drugs (statins, ace Inhibitors, clopidogrel, thiazides, warfarin and digoxin. The differences range from 12.8% less for amlodipine to 43.9% for clopidogrel. The case practices also have lower prescribing costs than the unmatched group with the exception of ace inhibitors and aspirin. The highest prescribing costs for all drugs are found in the matched control group. The case practices are smaller than the controls, and have fewer GPs per 1,000 patients. Case practices have fewer quality markers and receive less in total resources, but have higher sums reimbursed to cover their employed staff costs. Conclusion Patients with higher risk of CHD tend to live in areas served by practices with lower prescribing rates and poorer structural characteristics. The scale of the differences in prescribing suggests that health care system factors rather than individual treatment decisions cause inequity in care. Identifying whether South Asian individuals are less likely to receive heart disease drugs than non South Asians requires individual-level prescribing data, which is currently not available in the UK.

  8. Opioid therapy for chronic low back pain: prescribing considerations for advanced practice registered nurses.

    Science.gov (United States)

    Lall, Maureen Patricia

    2014-12-01

    Chronic low back pain is a common, disabling, and costly condition, and advanced practice registered nurses (APRNs) must carefully evaluate patients before considering long-term opioid therapy as a management strategy. APRNs should refer patients suspected of having a serious condition, or identifiable etiology, for specialist evaluation, as many patients improve with physical therapy, interventional pain management procedures, or surgical intervention. For patients unresponsive to nonopioid treatment, APRNs with an understanding of opioids, and the experience to assess and manage the risks of opioid misuse, abuse, and diversion, may consider long-term opioid therapy as part of a multimodal management plan. Such prescribing necessitates careful patient selection; informed consent; prudent opioid dosing and titration; and monitoring for response to treatment, adverse effects, and aberrant drug-taking behavior. Treatment and regulatory guidelines can assist APRNs in providing safe and effective care to patients with chronic low back pain.

  9. Comparison of antibiotic susceptibility in viridans group streptococci in low and high antibiotic-prescribing General Practices.

    Science.gov (United States)

    Goldsmith, C E; Hara, Y; Sato, T; Nakajima, T; Nakanishi, S; Mason, C; Moore, J E; Matsuda, M; Coulter, W A

    2015-04-01

    Antibiotic resistance has become a global public health issue. Most antibiotics are prescribed in the community, although there is less stewardship of such agents in the community compared to secondary and tertiary care. Few studies have attempted to examine the prescribing practices in General Practice and its impact on antibiotic resistance and, therefore, a study was performed in order to compare antibiotic susceptibilities of commensal viridans group streptococci (VGS) obtained from patient cohorts in General Practices (GP), who were high and low prescribers of oral antibiotics. Sixty-five patients (antibiotic susceptibility against (i) tetracyclines (doxycycline); (ii) macrolides (erythromycin); (iii) β-lactams (penicillin G); and (iv) fluoroquinolones (ofloxacin & levofloxacin). There were no significant differences in MICs between high and low GP prescribers with doxycycline (P = 0·094), erythromycin (P = 0·122), ofloxacin (P = 0·193) and levofloxacin (P = 0·058). However, there was a significant difference between high and low GP practices with regard to penicillin G (P = 0·031). This finding is important as the β-lactams are the most commonly prescribed oral antibiotic in the community. This study demonstrates that high prescribing practices may lead to an altered (higher) level of resistance to these agents in the commensal VGS population, which may be important as reservoirs of antibiotic resistance determinants in subsequent horizontal gene transfer events, particularly with newly colonizing pathogens, including pneumococci. Primary care physicians should be aware that increased prescribing of antibiotics may led to increased level of penicillin resistance. © 2015 John Wiley & Sons Ltd.

  10. Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study

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    Okebe Joseph

    2007-05-01

    Full Text Available Abstract Background Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs. Objective To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State. Method Audit of 665 patient records at six private and seven government health facilities in 2003. Results Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%, sulphadoxine-pyrimethamine (22.7% or artemisinin derivatives alone (15.8%. Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5% were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments. Conclusion Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.

  11. Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010

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    Daniel J. Pallin

    2014-05-01

    Full Text Available Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA. The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs and analyze potential quality measures. Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation. Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4% were for skin infection, and 2.7% (2.6-2.9% were first visits for skin infection, with no increase over time (p=0.80. However, anti-CA-MRSA antibiotic use increased, from 61% (56-66% to 74% (71-78% of antibiotic regimens (p<0.001. Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06. Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse. Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse. Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for

  12. Do herpes zoster patients receive antivirals?: a national survey in general practice.

    NARCIS (Netherlands)

    Opstelten, W.; Essen, G.A. van; Moons, K.G.M.; Wijck, A.J.M. van; Schellevis, F.G.; Kalkman, C.J.; Verheij, T.J.M.

    2005-01-01

    BACKGROUND: The main complications of herpes zoster (HZ) are postherpetic neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may modify the course of disease and reduce the risk of complications. OBJECTIVE: To assess which doctors' and patients' characteristics were relate

  13. An evaluation of knowledge, attitude, and practice of adverse drug reaction reporting among prescribers at a tertiary care hospital

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    Chetna K Desai

    2011-01-01

    Full Text Available Objectives: Spontaneous reporting is an important tool in pharmacovigilance. However, its success depends on cooperative and motivated prescribers. Under-reporting of adverse drug reactions (ADRs by prescribers is a common problem. The present study was undertaken to evaluate the knowledge, attitude, and practices (KAP regarding ADR reporting among prescribers at the Civil Hospital, Ahmedabad, to get an insight into the causes of under-reporting of ADRs. Materials and Methods: A pretested KAP questionnaire comprising of 15 questions (knowledge 6, attitude 5, and practice 4 was administered to 436 prescribers. The questionnaires were assessed for their completeness (maximum score 20 and the type of responses regarding ADR reporting. Microsoft Excel worksheet (Microsoft Office 2007 and Chi-Square test were used for statistical analysis. Results: A total of 260 (61% prescribers completed the questionnaire (mean score of completion 18.04. The response rate of resident doctors (70.7% was better than consultants (34.5% (P < 0.001. ADR reporting was considered important by 97.3% of the respondents; primarily for improving patient safety (28.8% and identifying new ADRs (24.6%. A majority of the respondents opined that they would like to report serious ADRs (56%. However, only 15% of the prescribers had reported ADRs previously. The reasons cited for this were lack of information on where (70% and how (68% to report and the lack of access to reporting forms (49.2%. Preferred methods for reporting were e-mail (56% and personal communication (42%. Conclusion: The prescribers are aware of the ADRs and the importance of their reporting. However, under reporting and lack of knowledge about the reporting system are clearly evident. Creating awareness about ADR reporting and devising means to make it easy and convenient may aid in improving spontaneous reporting.

  14. Off-label and unlicensed prescribing of psychotropics in children in Dutch general practice .

    NARCIS (Netherlands)

    Volkers, A.; Dijk, L. van

    2006-01-01

    Background: Unsafe drug use is a point of concern in children with psychotropics. Methylfenidate is licensed to prescribe above the age of 6 years, but most of the antidepressants and benzodiazepines are not approved in children. We studied the off-label and unlicensed prescribing of psychotropics i

  15. Clinical and haematological predictors of antibiotic prescribing for acute cough in adults in Swiss practices--an observational study.

    Science.gov (United States)

    Streit, Sven; Frey, Peter; Singer, Sarah; Bollag, Ueli; Meli, Damian N

    2015-02-06

    Acute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. Nonetheless, antibiotics are often prescribed in this situation, which may lead to unnecessary side effects and, even worse, the development of antibiotic resistant microorganisms worldwide. This study assessed the role of point-of-care C-reactive protein (CRP) testing and other predictors of antibiotic prescription in patients who present with acute cough in general practice. Patient characteristics, symptoms, signs, and laboratory and X-ray findings from 348 patients presenting to 39 general practitioners with acute cough, as well as the GPs themselves, were recorded by fourth-year medical students during their three-week clerkships in general practice. Patient and clinician characteristics of those prescribed and not-prescribed antibiotics were compared using a mixed-effects model. Of 315 patients included in the study, 22% were prescribed antibiotics. The two groups of patients, those prescribed antibiotics and those treated symptomatically, differed significantly in age, demand for antibiotics, days of cough, rhinitis, lung auscultation, haemoglobin level, white blood cell count, CRP level and the GP's license to self-dispense antibiotics. After regression analysis, only the CRP level, the white blood cell count and the duration of the symptoms were statistically significant predictors of antibiotic prescription. The antibiotic prescription rate of 22% in adult patients with acute cough in the Swiss primary care setting is low compared to other countries. GPs appear to use point-of-care CRP testing in addition to the duration of clinical symptoms to help them decide whether or not to prescribe antibiotics.

  16. Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study.

    Science.gov (United States)

    Asante, Kwaku Poku; Boamah, Ellen Abrafi; Abdulai, Martha Ali; Buabeng, Kwame Ohene; Mahama, Emmanuel; Dzabeng, Francis; Gavor, Edith; Annan, Edith Andrews; Owusu-Agyei, Seth; Gyansa-Lutterodt, Martha

    2017-06-20

    Antibiotic resistance (ABR) has become a major public health challenge in most parts of the world including Ghana and is a major threat to gain in bacterial disease control. The role of prescribers in the control of antibiotics is identified as crucial in developing interventions to control ABR. To guide policy recommendations on ABR, a study was carried out among prescribers to identify gaps in their knowledge of ABR and to document their prescription practices. A cross-sectional survey was conducted among prescribers from both public and private facilities in the Brong Ahafo Region of Ghana using both quantitative and qualitative methods in 2014. Three hundred and seventy nine prescribers participated in the quantitative study and a subset of 33 participated in in-depth interviews. Majority (50.0%) of the prescribers interviewed were nurses. Most (51.0%) of the prescribers were located in hospitals. Knowledge of ABR was high among all the prescribers. About 80.0% percent of all prescribers agreed that the antibiotics that are currently used could lose its efficacy in future. There is no singular formal source of information on antibiotic resistance. The prescribers held a strong perception that antibiotic resistance is imminent though their knowledge on various resistant bacterial strains was limited. Prescribers attributed ABR burden to factors such as poor prescription practices and limited ABR control measures. The prescription practices of the prescribers vary but were mostly inappropriate among the lower cadre. The knowledge of ABR is high among prescribers. There is however a gap in the knowledge and perception of optimal antibiotic prescription practices among prescribers. There is the need for a formal source of information on ABR to support prescriber's antibiotic prescription practices.

  17. Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010

    Directory of Open Access Journals (Sweden)

    Shae-Leigh C. Vella

    2012-04-01

    Full Text Available Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study. In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia.

  18. Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Sigurðardóttir, Nanna Rún; Nielsen, Anni Brit Sternhagen; Munck, Anders

    2015-01-01

    Objective: To compare the appropriateness of antibiotic prescribing for upper respiratory tract infections (URTIs) in two countries with different prevalence of antimicrobial resistance: Denmark and Iceland. Design: A cross-sectional study. Settings and subjects. General practitioners (GPs) in De...

  19. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract episodes in Dutch general practice.

    Science.gov (United States)

    van Duijn, Huug J; Kuyvenhoven, Marijke M; Schellevis, François G; Verheij, Theo J M

    2005-08-01

    The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regression was carried out to assess associations between possible determinants and volume of second-choice antibiotic prescriptions. In approximately 39% of acute RT episodes antibiotics were prescribed, with one-quarter being second-choice antibiotics, relatively more frequently in lower than in upper RT episodes: 30 versus 19%. GPs who were more frequently consulted by patients with RT episodes (beta = 0.29; 95% CI 0.13-0.41), who labelled RT episodes more as diagnoses than as symptoms (beta = 0.27; 95% CI 0.15-0.42), who less frequently used national GP guidelines (beta = -0.17; 95% CI -0.31 to -0.03) and who were more inclined to prescribe new drugs (beta = 0.26; 95% CI 0.13-0.40), prescribed more second-choice antibiotics. Given the growing number of prescriptions of second-choice antibiotics, it is important to implement professional guidelines in daily practice, while training in being reluctant to prescribe new drugs and being alert to the marketing activities of pharmaceutical companies should be started in the medical curriculum.

  20. Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

    DEFF Research Database (Denmark)

    Llor, Carl; Bjerrum, Lars; Munck, Anders;

    2013-01-01

    BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test....... METHODS: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model...... was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume...

  1. Study of prescribing practices of injections in outpatients of a rural tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Suvarna S. Rathod

    2013-12-01

    Results: The total number of injections prescribed in 744 prescriptions was 205. Most (71.70% of the patients receiving them were above 35 years of age. The most common complaint for which the injections were prescribed was musculoskeletal pain (45.36% followed by fever. About 155 (75.60% prescriptions contained injection diclofenac which was the most commonly used drug followed by injection paracetamol (11.21%. There was a high tendency of using brand names in prescriptions (89.30%. Conclusion: The study revealed high proportion of use of injectable drugs. There was overuse of analgesic injections like diclofenac, most of which were unnecessary and irrational. This leads to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. There is a need to develop local guidelines for injection usage along with educational sessions for prescribing doctors. [Int J Basic Clin Pharmacol 2013; 2(6.000: 747-750

  2. Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

    Directory of Open Access Journals (Sweden)

    Marić Nađa P.

    2012-01-01

    Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

  3. Exploring the equity of GP practice prescribing rates for selected coronary heart disease drugs: a multiple regression analysis with proxies of healthcare need

    Directory of Open Access Journals (Sweden)

    St Leger Antony S

    2005-02-01

    Full Text Available Abstract Background There is a small, but growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The aim of this paper is to further explore the equity of prescribing for five major CHD drug groups and to explain the amount of variation in GP practice prescribing rates that can be explained by a range of healthcare needs indicators (HCNIs. Methods The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1–4 in the North West of England, including 132 GP practices. Prescribing rates (average daily quantities per registered patient aged over 35 years and HCNIs were developed for all GP practices. Analysis was undertaken using multiple linear regression. Results Between 22–25% of the variation in prescribing rates for statins, beta-blockers and bendrofluazide was explained in the multiple regression models. Slightly more variation was explained for ACE inhibitors (31.6% and considerably more for aspirin (51.2%. Prescribing rates were positively associated with CHD hospital diagnoses and procedures for all drug groups other than ACE inhibitors. The proportion of patients aged 55–74 years was positively related to all prescribing rates other than aspirin, where they were positively related to the proportion of patients aged >75 years. However, prescribing rates for statins and ACE inhibitors were negatively associated with the proportion of patients aged >75 years in addition to the proportion of patients from minority ethnic groups. Prescribing rates for aspirin, bendrofluazide and all CHD drugs combined were negatively associated with deprivation. Conclusion Although around 25–50% of the variation in prescribing rates was explained by HCNIs, this varied markedly between PCTs and drug groups. Prescribing rates were generally characterised by both positive and negative associations with HCNIs, suggesting possible inequities in prescribing rates on the basis

  4. Does a computerized price comparison module reduce prescribing costs in general practice?

    DEFF Research Database (Denmark)

    Vedsted, Peter; Nielsen, Jørgen Nørskov; Olesen, Frede

    1997-01-01

    OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were...

  5. out-patient prescribing practices at mbagathi district hospital-nairobi ...

    African Journals Online (AJOL)

    2013-12-01

    Dec 1, 2013 ... Request for reprints to: G. Muyu, Mbagathi District Hospital, Nairobi, Kenya ... society at large. ... public health problems. ... medicine use in outpatient health facilities and has .... Analysis of percentage constitution of selected prescribing variables with respect to total number of ..... United Arab Emirates. LJM ...

  6. Using qualitative insights to change practice: exploring the culture of antibiotic prescribing and consumption for urinary tract infections

    Science.gov (United States)

    Duane, Sinead; Domegan, Christine; Callan, Aoife; Galvin, Sandra; Cormican, Martin; Bennett, Kathleen; Murphy, Andrew W

    2016-01-01

    Objectives The aim of this paper is to explore the culture of antibiotic prescribing and consumption in the community for urinary tract infections (UTI) from the perspective of the general practitioners (GPs) and community member. Design Indepth interviews were conducted with GPs, and focus groups were held with community members. Setting General practice and community setting. Participants 15 GPs practising in rural and urban locations in Ireland participated in the indepth interviews. 6 focus groups (n=42) with participants who had direct or indirect experiences with UTI were also undertaken. Results The decision to prescribe or consume an antibiotic for a UTI is a set of complex processes including need recognition, information search and evaluation processes governed by the relationship and interactions between the GP and the patient. Different GP and patient decision-making profiles emerged emphasising the diversity and variety of general practice in real-life settings. The GP findings showed a requirement for more microbiological information on antibiotic resistance patterns to inform prescribing decisions. Focus group participants wanted a conversation with the GP about their illness and the treatment options available. Conclusions Collectively, this research identified the consultation as a priority intervention environment for stimulating change in relation to antibiotics. This paper demonstrates how qualitative research can identify the interacting processes which are instrumental to the decision to prescribe or consume an antibiotic for a suspected UTI. Qualitative research empowers researchers to investigate the what, how and why of interventions in real-life setting. Qualitative research can play a critical and instrumental role in designing behavioural change strategies with high impact on practice. The results of this research were used to design a complex intervention informed by social marketing. Trial registration number NCT01913860; Pre

  7. UK prescribing practices as proxy markers of unmet need in allergic rhinitis: a retrospective observational study

    Science.gov (United States)

    Price, David B; Scadding, Glenis; Bachert, Claus; Saleh, Hesham; Nasser, Shuaib; Carter, Victoria; von Ziegenweidt, Julie; Durieux, Alice M S; Ryan, Dermot

    2016-01-01

    Little data on UK prescribing patterns and treatment effectiveness for allergic rhinitis (AR) are available. We quantified unmet pharmacologic needs in AR by assessing AR treatment effectiveness based on the prescribing behaviour of UK general practitioners (GP) during two consecutive pollen seasons (2009 and 2010). We conducted a retrospective observational study with the data from the Optimum Patient Care Research Database. We assessed diagnoses and prescription data for patients with a recorded diagnosis of rhinitis who took rhinitis medication during the study period. We assessed the data from 25,069 patients in 2009 and 22,381 patients in 2010. Monotherapy was the initial prescription of the season for 67% of patients with seasonal AR (SAR) and 77% of patients with nonseasonal upper airways disease (NSUAD), for both years. Initial oral antihistamine (OAH) or intranasal corticosteroid (INS) monotherapy proved insufficient for >20% of SAR and >37% of NSUAD patients. Multiple therapy was the initial prescription for 33% of SAR and 23% of NSUAD in both years, rising to 45% and >50% by season end, respectively. For NSUAD, dual-therapy prescriptions doubled and triple-therapy prescriptions almost tripled during both seasons. Many patients revisited their GP regardless of initial prescription. Initial OAH or INS monotherapy provides insufficient symptom control for many AR patients. GPs often prescribe multiple therapies at the start of the season, with co-prescription becoming more common as the season progresses. However, patients prescribed multiple therapies frequently revisit their GP, presumably to adjust treatment. These data suggest the need for more effective AR treatment and management strategies. PMID:27334893

  8. Developing Baselines for Prescribed Burning Smoke Management Plans and Best Management Practices

    Science.gov (United States)

    2015-09-01

    interim policy, EPA recognized the many benefits of using fire for land management and presented a control strate- gy based on states/tribes developing...Smoke Manage - ment Forecast (s): C. Notifications: ERDC/CERL TR-15-30 58 Element 10: Briefing A. Briefing Checklist; including, but not...ER D C/ CE RL T R- 15 -3 0 OACSIM Environmental Quality Program Studies Developing Baselines for Prescribed Burning Smoke Management

  9. PHYSICIAN PRESCRIBING PRACTICES AND ADVERSE DRUG REACTIONS: A Proposal for Further FDA Regulation of Prescription Drugs

    OpenAIRE

    Corrigan, Kerry A.

    1995-01-01

    In 1938 the Food and Drug Administration (FDA) adopted regulations which created a category of prescription drugs to be distributed only by order of a physician or other licensed medical personnel. This categorization, along with the extensive regulation of the approval, labelling and marketing of human drugs, has substantially reduced the risks which accompanied self-medication. However, the current regulatory regime does not place any limits on physician prescribing. This shortfall in regul...

  10. [Prescribed and dispensed in the third trimester of pregnancy drugs: What practices and risks?].

    Science.gov (United States)

    Parent, G; Mottet, N; Mairot, P; Baudier, F; Carel, D; Goguey, M; Riethmuller, D; Limat, S

    2016-09-01

    The aim of the study was to describe the prescribing of drugs to pregnant women during the third trimester of pregnancy. The retrospective analysis is interested by pregnant women from August 2009 to April 2011, living in Franche-Comté. The used data are recorded in the database of the French Health Insurance Service. Drugs prescribing were analyzed and classified according to three categories: drugs that are contraindicated, not recommended drugs and drugs that are used. This classification is based on two databases: the Summaries of Product Characteristics of Vidal 2010 and data from the National Security Agency of Medicines. The potential exposure of patients was pointed out. On 15,027 patients, 80% had a prescription. Six percent of prescriptions containing drugs not recommended and 1% drugs that contraindicated. Therapeutic classes identified are analgesics, anti-infective drugs and medicines supplementing with vitamins and minerals. Contraindicated drugs (10%) are NSAIDs, rubella vaccine, cyclins and ACE inhibitors and ARBs. Approximately 2.7% of women were potentially exposed to these drugs. Despite the recommendations of the ANSM, some drugs that are contraindicated are prescribed for pregnant women in their third trimester of pregnancy. In the absence of studies, the decision must be made on a case by case basis by assessing the risk-benefit ratio. Particular care is to bring about the drugs taken in self-medication. Information and advice are key steps to avoid incidents. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. District nurses prescribing as nurse independent prescribers.

    Science.gov (United States)

    Downer, Frances; Shepherd, Chew Kim

    2010-07-01

    Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi's seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.

  12. Risks and responsibilities in prescribing opioids for chronic noncancer pain, part 2: best practices.

    Science.gov (United States)

    Cone, Edward J; DePriest, Anne Z; Gordon, Allan; Passik, Steven D

    2014-11-01

    Opioids are increasingly prescribed to provide effective therapy for chronic noncancer pain, but increased use also means an increased risk of abuse. Primary care physicians treating patients with chronic noncancer pain are concerned about adverse events and risk of abuse and dependence associated with opioids, yet many prescribers do not follow established guidelines for the use of these agents, either through unawareness or in the mistaken belief that urine toxicology testing is all that is needed to monitor compliance and thwart abuse. Although there is no foolproof way to identify an abuser and prevent abuse, the best way to minimize the risk of abuse is to follow established guidelines for the use of opioids. These guidelines entail a careful assessment of the patient, the painful condition to be treated, and the estimated level of risk of abuse based on several factors: history of abuse and current or past psychiatric disorders; design of a therapeutic regimen that includes both pharmacotherapeutic and nonpharmacologic modalities; a formal written agreement with the patient that defines treatment expectations and responsibilities; selection of an appropriate agent, including consideration of formulations designed to deter tampering and abuse; initiation of treatment at a low dosage with titration in gradual increments as needed to achieve effective analgesia; regular reassessment to watch for signs of abuse, to perform drug monitoring, and to adjust medication as needed; and established protocols for actions to be taken in case of suspected abuse. By following these guidelines, physicians can prescribe opioids to provide effective analgesia while reducing the likelihood of abuse.

  13. Bortezomib Inpatient Prescribing Practices in Free-Standing Children's Hospitals in the United States.

    Directory of Open Access Journals (Sweden)

    Amanda M DiNofia

    Full Text Available This study is a pharmacoepidemiologic description of pediatric bortezomib use. Exposure was identified through billing codes in patients admitted to US children's hospitals that participated with the Pediatric Health Information System between 2004 and 2013. Associated information on underlying diseases, demographics, institutional use, mortality, and physician type was collected. Exposure to bortezomib was identified in 314 patients. Hematologist/Oncologists prescribed half of the bortezomib used. Use increased during the study period. Inpatient volume was positively correlated with bortezomib utilization. Bortezomib use in pediatrics is increasing for a variety of diseases. Variation in use exists across institutions. Further studies are needed to characterize bortezomib's efficacy in pediatric diseases.

  14. Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

    OpenAIRE

    Drivenes, Elin; Østrem, Anders; Melbye, Hasse

    2014-01-01

    Background A combination of inhaled corticosteroid and long-acting beta2 agonist (ICS/LABA) is used frequently to treat chronic obstructive pulmonary disease (COPD) patients. The aim of the study was to determine whether prescribing ICS/LABA to COPD patients in primary care in 2009/10 was within the GOLD guidelines and whether and to what degree patient characteristics were associated with prescription of these drugs by GPs. Methods This was a cross-sectional study in seven Norwegian GP pract...

  15. Improving Knowledge of General Dental Practitioners on Antibiotic Prescribing by Raising Awareness of the Faculty of General Dental Practice (UK Guidelines

    Directory of Open Access Journals (Sweden)

    Sana Zahabiyoun

    2015-10-01

    Full Text Available Objectives: Cases of antimicrobial resistance are increasing, partly due to inappropriate prescribing practices by dentists. The purpose of this study was to investigate the prescrib- ing practices and knowledge of dentists with regards to antibiotics. Moreover, this study aimed to determine whether the prescriptions comply with the recommended guidelines and whether clinical audit can alter the prescribing practices of dentists leading to better use of antibiotics in the dental service.Materials and Methods: A clinical audit (before/after non-controlled trial was carried out in two dental clinics in the northeast of England. Retrospective data were collected from 30 antibiotic prescriptions, analysed and compared with the recommended guide- lines. Data collected included age and gender of patients, type of prescribed antibiotics and their dosage, frequency and duration, clinical condition and reason for prescribing. The principles of appropriate prescribing based on guidance by the Faculty of General Dental Practice in the United Kingdom (UK, FGDP, were discussed with the dental clini- cians. Following this, prospective data were collected and similarly managed. Pre and post audit data were then compared. Changes were tested for significance using McNemar's test and P value<0.05 was considered statistically significant.Results: After intervention, data revealed that antibiotic prescribing practices of dentists improved, as there was an increase in the percentage of prescriptions that were in accor- dance with the FGDP (UK guidelines.Conclusion: In view of the limited data collected, this study concludes that there are inap- propriate antibiotic prescribing practices amongst general dental practitioners and that clinical audit can address this situation, leading to a more rational use of antibiotics in dental practice.

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

    Science.gov (United States)

    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.

  17. A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis

    Directory of Open Access Journals (Sweden)

    Blanchon Thierry

    2011-05-01

    Full Text Available Abstract Background The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. Methods We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. Results By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2% prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4% prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%. General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p Conclusions The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.

  18. Change in ranking order of prescribing patterns by age and sex standardization of the practice population--audit may be misleading

    DEFF Research Database (Denmark)

    Olesen, Frede; Vedsted, Peter; Nielsen, Jørgen Nørskov

    1996-01-01

    OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information...

  19. Educating nonmedical prescribers.

    Science.gov (United States)

    Stewart, Derek; MacLure, Katie; George, Johnson

    2012-10-01

    The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20,000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. © 2012 The Authors. British Journal of

  20. Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy.

    Directory of Open Access Journals (Sweden)

    Oriol Yuguero Torres

    Full Text Available To investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain.This descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients. Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach's alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural. Sick leave data were obtained from the Catalan Health Institute.High empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription.Sick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

  1. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

    Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.

    1999-01-01

    The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collabora......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...

  2. An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice: The RAPiD Cluster Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Paula Elouafkaoui

    2016-08-01

    Full Text Available Dentists prescribe approximately 10% of antibiotics dispensed in UK community pharmacies. Despite clear clinical guidance, dentists often prescribe antibiotics inappropriately. This cluster-randomised controlled trial used routinely collected National Health Service (NHS dental prescribing and treatment claim data to compare the impact of individualised audit and feedback (A&F interventions on dentists' antibiotic prescribing rates.All 795 antibiotic prescribing NHS general dental practices in Scotland were included. Practices were randomised to the control (practices = 163; dentists = 567 or A&F intervention group (practices = 632; dentists = 1,999. A&F intervention practices were allocated to one of two A&F groups: (1 individualised graphical A&F comprising a line graph plotting an individual dentist's monthly antibiotic prescribing rate (practices = 316; dentists = 1,001; or (2 individualised graphical A&F plus a written behaviour change message synthesising and reiterating national guidance recommendations for dental antibiotic prescribing (practices = 316; dentists = 998. Intervention practices were also simultaneously randomised to receive A&F: (i with or without a health board comparator comprising the addition of a line to the graphical A&F plotting the monthly antibiotic prescribing rate of all dentists in the health board; and (ii delivered at 0 and 6 mo or at 0, 6, and 9 mo, giving a total of eight intervention groups. The primary outcome, measured by the trial statistician who was blinded to allocation, was the total number of antibiotic items dispensed per 100 NHS treatment claims over the 12 mo post-delivery of the baseline A&F. Primary outcome data was available for 152 control practices (dentists = 438 and 609 intervention practices (dentists = 1,550. At baseline, the number of antibiotic items prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. At follow-up, antibiotic

  3. Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital

    Directory of Open Access Journals (Sweden)

    Zhu XP

    2013-02-01

    Full Text Available Xiu-Ping Zhu,1 Ling-Ling Zhu,2 Quan Zhou11Department of Pharmacy, 2Cadre Department, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaBackground: A retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teaching hospital.Methods: Enteral nutrition was divided into three types according to the nitrogen source, ie, total protein type [Nutrison Fibre®, Fresubin Energy Fibre®, Fresubin®, Supportan® (a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids, Fresubin Diabetes® (a diabetes-specific formula, Ensure®]; short peptide type (Peptison®; and amino acid type (Vivonex®. A pharmacoeconomic analysis was done based on defined daily dose methodology.Results: Among hospitalized patients taking enteral nutrition, 34.8% received enteral nutrition alone, 30% concomitantly received parenteral nutrition, and 35.2% received enteral nutrition after parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving enteral nutrition. In total, 61.5% of patients received triple therapy with Nutrison Fibre, Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs of formulas in descending order were as follows: Nutrison Fibre, Fresubin Energy Fibre, Fresubin Diabetes > Supportan > Peptison, Ensure > Vivonex, Fresubin. The ratio of the cumulative DDDs for the three types of enteral nutrition was 35:2.8:1 (total protein type to short peptide type to amino acid type. Off-label use of Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress hyperglycemia. Only 2.1% of cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike enteral

  4. Simplifying the Use of Pharmacogenomics in Clinical Practice: Building the Genomic Prescribing System.

    Science.gov (United States)

    Danahey, Keith; Borden, Brittany A; Furner, Brian; Yukman, Patrick; Hussain, Sheena; Saner, Donald; Volchenboum, Samuel L; Ratain, Mark J; O'Donnell, Peter H

    2017-09-26

    A barrier to the use of genomic information during prescribing is the limited number of software solutions that combine a user-friendly interface with complex medical data. We built and designed an online, secure, electronic custom interface termed the Genomic Prescribing System (GPS). Actionable pharmacogenomic (PGx) information was reviewed, collected, and stored in the back-end of GPS to enable creation of customized drug- and variant-specific clinical decision support (CDS) summaries. The database architecture utilized the star schema to store information. Patient raw genomic data underwent transformation via custom-designed algorithms to enable gene and phenotype-level associations. Multiple external data sets (PubMed, The Systematized Nomenclature of Medicine (SNOMED), National Drug File - Reference Terminology (ND-FRT), and a publically-available PGx knowledgebase) were integrated to facilitate the delivery of patient, drug, disease, and genomic information. Institutional security infrastructure was leveraged to securely store patient genomic and clinical data on a HIPAA-compliant server farm. As of May 17, 2016, the GPS back-end housed 257 CDS encompassing 112 genetic variants, 42 genes, and 46 PGx-actionable drugs. The GPS user interface presented patient-specific CDS alongside a recognizable traffic light symbol (green/yellow/red), denoting PGx risk for each genomic result. The number of traffic lights per visit increased with the corresponding increase in the number of available PGx-annotated drugs over time. An integrated drug and disease search functionality, links to primary literature sources, and potential alternative PGx drugs were indicated. The system, which was initially used as stand-alone CDS software within our clinical environment, was then integrated with the institutional electronic medical record for enhanced usability. There have been nearly 2000 logins in 43 months since inception, with usage exceeding 56 logins per month and system up

  5. Suboptimal Use of Oral Anticoagulants in Atrial Fibrillation: Has the Introduction of Direct Oral Anticoagulants Improved Prescribing Practices?

    Science.gov (United States)

    Alamneh, Endalkachew A; Chalmers, Leanne; Bereznicki, Luke R

    2016-06-01

    Atrial fibrillation (AF) and the associated risk of stroke are emerging epidemics throughout the world. Suboptimal use of oral anticoagulants for stroke prevention has been widely reported from observational studies. In recent years, direct oral anticoagulants (DOACs) have been introduced for thromboprophylaxis. We conducted a systematic literature review to evaluate current practices of anticoagulation in AF, pharmacologic features and adoption patterns of DOACs, their impacts on proportion of eligible patients with AF who receive oral anticoagulants, persisting challenges and future prospects for optimal anticoagulation. In conducting this review, we considered the results of relevant prospective and retrospective observational studies from real-world practice settings. PubMed (MEDLINE), Scopus (RIS), Google Scholar, EMBASE and Web of Science were used to source relevant literature. There were no date limitations, while language was limited to English. Selection was limited to articles from peer reviewed journals and related to our topic. Most studies identified in this review indicated suboptimal use of anticoagulants is a persisting challenge despite the availability of DOACs. Underuse of oral anticoagulants is apparent particularly in patients with a high risk of stroke. DOAC adoption trends are quite variable, with slow integration into clinical practice reported in most countries; there has been limited impact to date on prescribing practice. Available data from clinical practice suggest that suboptimal oral anticoagulant use in patients with AF and poor compliance with guidelines still remain commonplace despite transition to a new era of anticoagulation featuring DOACs.

  6. Prescribing practices of topical corticosteroids in the outpatient dermatology department of a rural tertiary care teaching hospital.

    Science.gov (United States)

    Rathod, Suvarna S; Motghare, Vijay M; Deshmukh, Vinod S; Deshpande, Rushikesh P; Bhamare, Chetanraj G; Patil, Jyoti R

    2013-09-01

    Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra. A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.

  7. PRACTICE OF PRESCRIBING BETA-BLOCKERS AND ITS COMPLIANCE WITH CLINICAL GUIDELINES ACCORDING TO TWO REGISTERS OF CARDIOVASCULAR DISEASES

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    S. Yu. Martsevich

    2016-01-01

    Full Text Available  Aim. To assess real clinical practice of prescribing beta-blockers (BB and its compliance with updated guidelines, using data from outpatient registers that are carried out in medical institutions of different levels. Material and methods. We analyzed data from two outpatient registries - RECVASA and PROFILE. RECVASA register included patients aged ≥18 years with arterial hypertension (HT, ischemic heart disease (IHD, chronic heart failure (CHF and atrial fibrillation (AF that consulted in 3 outpatient clinics of Ryazan city in 2012-2013 (n=3690. PROFILE register included patients aged ≥18 years with HT, IHD, CHF, AF that consulted in specialized cardiac unit of the State Research Center for Preventive Medicine in 2011-2015 (n=1531. Results. There were differences in the basic characteristics of the registers: in the RECVASA register average age of patients was higher, HT, IHD and CHF were more frequent; PROFILE register included more patients with the history of myocardial infarction. In the RECVASA register 41.5% (n=1533 of patients received BB, and in the PROFILE register – 47.7% (n=731. The most frequently prescribed BB was bisoprolol in all cardiovascular diseases. Conclusion. In a specialized medical institution BB used more often under the conditions where they are necessary. The choice of a specific BB inside the pharmacological group, even in a specialized medical institution does not always correspond to clinical guidelines and evidence-based medicine.

  8. Influence of generics in prescribing dynamics of proton pump inhibitors in general practice

    Directory of Open Access Journals (Sweden)

    Simona Cammarota

    2009-01-01

    Full Text Available Use of antisecretory drugs has greatly increased in recent years in Italy. After the launching of generic lansoprazole (early 2006, several Italian Regional Health Authorities have introduced measures to favour the prescription of less expensive PPI. The aim of this study is to evaluate general practitioners’ prescription (GPs of different Proton Pump Inhibitors (PPIs in the period between 2005 to 2008. Analysis has been performed on a database of 99 medical practitioners that have managed an average of 150,000 inhabitants. We evaluate the PPIs prescriptions from Jan 2005 to Dec 2008. Evaluations performed are the following: 1 PPI prescription (total and separately for lansoprazole, esomeprazole, pantoprazole, rabeprazole, and omeprazole; 2 prevalence of the reimbursement purpose (Gastroprotection – G; Acid-Related Disease – ARD; 3 PPI prescriptions separately for ARD diagnostic codes. Data were expressed as Compound Annual Growth Rate (CAGR. PPI consumption were quantified using Defined Daily Dose system (DDD. The total volume of PPI’s prescribing increased progressively over the 4 years (CAGR +15%. The proportion of defined daily doses accounted for by lansoprazole increased from 12.0% in 2005 to 30.9% in 2008. The prescription of omeprazole decreased from 42.2% to 26.7%, while that of esomeprazole remained costant. The reimbursement purpose was higher for G (CAGR +43% than for ARD (CAGR +7%. We found an increase of lansoprazole prescriptions especially for heartburn (CAGR +52.4%, gastroesophageal reflux (CAGR 34,5% and upper abdominal pain (CAGR 37,2%. Generic PPIs has unexpectedly increased the prescription of whole drug class during the period 2005-2008. Our data suggest that the appropriateness of PPI prescription after generic PPI introduction should be carefully monitored to distinguish between cost-effective from cost-ineffective PPI treatment.

  9. Best practice: E-Model--prescribing physical activity and exercise for individuals with fibromyalgia.

    Science.gov (United States)

    Busch, Angela J; Thille, Patty; Barber, Karen A R; Schachter, Candice L; Bidonde, Julia; Collacott, Brenda K

    2008-01-01

    Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the model's five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.

  10. Electronic Prescribing

    Science.gov (United States)

    ... Do you prescribe electronically?” For more information about electronic prescribing, call 1-800-MEDICARE (1-800-633- ... TTY users should call 1-877-486-2048 . Electronic eRx Prescribing I went to the pharmacy, and ...

  11. Stemming the Tide of Antibiotic Resistance (STAR: A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

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    Hare Monika

    2009-03-01

    Full Text Available Abstract Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include

  12. Frequency of ill-founded off-label prescribing in Dutch general practice.

    NARCIS (Netherlands)

    Gijsen, R.; Jochemsen, H.; Dijk, L. van; Caspers, P.

    2009-01-01

    Purpose: The aim of this study is to quantify the extent of ill-founded off-label drug prescriptions in Dutch general practice. The study is based upon information on both the prescription itself and the patient’s medical history. Methods: In total, 48 combinations of drugs and off-label indications

  13. PRESCRIBING PRACTICES OF NON TEACHING GENERAL PRACTITIONERS OF PRIVATE CLINICS AND PHYSICIANS OF A TERTIARY CARE TEACHING HOSPITAL: A COMPARATIVE CROSS SECTIONAL STUDY

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    Sudar Codi R, Samiya Khan, Manimekalai K

    2015-01-01

    Full Text Available Background: Doctor’s prescription provides vivid information and instruction to the patient. In spite of the WHO programs, irrational prescribing is still a common practice. Aim: To evaluate and compare the prescribing pattern of private practitioners and physicians of a tertiary care teaching hospital in a semi urban area and detect their rationality. Materials & methods: 150 prescriptions, each prescribed by private practitioners and physicians of a tertiary care hospital were collected over a period of two months and evaluated. Information regarding the drugs used, drugs from the essential drug list, the use of injections, fixed dose combinations, drug prescribed by generic names were observed. Results: The average number of drugs per prescription prescribed by the private practitioners was 2.47 compared to 1.58 by the physicians of a tertiary care hospital. 82% of prescriptions of private practitioners had one injection prescribed in the prescription compared to 12% by physicians of a tertiary care hospital. 30 unnecessary drugs, 46 unnecessary injections and 8 irrational fixed dose combinations were prescribed by the private practitioners, whereas only 6 unnecessary drugs and 2 unnecessary injections were prescribed by the physicians of a tertiary care hospital respectively. There was no irrational fixed dose combination prescribed by them. The private practitioners prescribed 12 (3.2% drugs by generic names, whereas the physicians of a tertiary care hospital prescribed 72 (30.3% drugs by generic names. (P<0.000. 36 (9.7% drugs prescribed by the private practitioners were not included in the essential drug list and only 2 (0.8% drugs prescribed by the physicians of a tertiary care hospital were not included in the essential drug list. Conclusion: Private practitioners prescribe more irrational prescriptions on comparison with the physicians of a tertiary care teaching hospital. This may be due to the promotional pharmaceutical incentives

  14. Changing physician prescribing behaviour.

    Science.gov (United States)

    Gray, J

    2006-01-01

    Didactic approaches to educating physicians and/or other health professionals do not produce changes in learner behaviour. Similarly, printed materials and practice guidelines have not been shown to change prescribing behaviour. Evidence-based educational approaches that do have an impact on provider behaviour include: teaching aimed at identified learning needs; interactive educational activities; sequenced and multifaceted interventions; enabling tools such as patient education programs, flow charts, and reminders; educational outreach or academic detailing; and audit and feedback to prescribers. Dr. Jean Gray reflects over the past 25 years on how there has been a transformation in the types of activities employed to improve prescribing practices in Nova Scotia. The evolution of Continuing Medical Education (CME) has resulted in the creation of the Drug Evaluation Alliance of Nova Scotia (DEANS) program, which is one exemplar of an evidence-based educational approach to improving physician prescribing in that province. Key words: Evidence-based, education, prescribing.

  15. Knowledge of Health Professionals on Folic Acid Use and Their Prescribing Practice in Bahir Dar City Administration, Northwest Ethiopia: Cross-Sectional Study

    Science.gov (United States)

    Demilew, Yeshalem Mulugeta; Asres Nigussie, Azezu

    2017-01-01

    Background Taking folic acid supplement during periconception period is effective to prevent neural tube defects. Unfortunately, a minority of Ethiopian women took folic acid supplement during this period. Low consumption of folic acid might be correlated with knowledge and prescribing practice of health professionals. Therefore, this study was conducted to assess knowledge and prescribing practice of health professionals. Methods Institution based cross-sectional quantitative study supplemented by qualitative approach using thematic content analysis of in-depth interview was conducted. A total of 424 health professionals were selected by simple random sampling technique. A convenience sampling technique was used to generate the qualitative data. Bivariable and multivariable logistic regression analysis were used to identify factors associated with knowledge of health professionals. Result About 47.7% of health professionals had sufficient knowledge and 9.7% of them had prescribed folic acid to women during periconception period. Age, having work experience in ANC clinic, and being a general practitioner were independent predictors for knowledge of health professionals. Lack of guideline to use as a reference, refreshment training and clear direction from health bureau, time constraint, differing patient priorities, and competing topics were some of the reasons for insufficient knowledge and poor practice. Conclusion The majority of the health professionals had insufficient knowledge and poor prescribing practice on folic acid during periconception period. Lack of guideline to be used as a reference, refreshment training and clear direction from health bureau, time constraint, differing patient priorities, and competing topics were some of the reasons for low level of knowledge and poor prescribing practice. Thus, guideline to use as a reference, refreshment training, incorporate the topic in the curriculum of health professionals and supportive supervision should

  16. Knowledge of Health Professionals on Folic Acid Use and Their Prescribing Practice in Bahir Dar City Administration, Northwest Ethiopia: Cross-Sectional Study.

    Science.gov (United States)

    Demilew, Yeshalem Mulugeta; Asres Nigussie, Azezu

    2017-01-01

    Taking folic acid supplement during periconception period is effective to prevent neural tube defects. Unfortunately, a minority of Ethiopian women took folic acid supplement during this period. Low consumption of folic acid might be correlated with knowledge and prescribing practice of health professionals. Therefore, this study was conducted to assess knowledge and prescribing practice of health professionals. Institution based cross-sectional quantitative study supplemented by qualitative approach using thematic content analysis of in-depth interview was conducted. A total of 424 health professionals were selected by simple random sampling technique. A convenience sampling technique was used to generate the qualitative data. Bivariable and multivariable logistic regression analysis were used to identify factors associated with knowledge of health professionals. About 47.7% of health professionals had sufficient knowledge and 9.7% of them had prescribed folic acid to women during periconception period. Age, having work experience in ANC clinic, and being a general practitioner were independent predictors for knowledge of health professionals. Lack of guideline to use as a reference, refreshment training and clear direction from health bureau, time constraint, differing patient priorities, and competing topics were some of the reasons for insufficient knowledge and poor practice. The majority of the health professionals had insufficient knowledge and poor prescribing practice on folic acid during periconception period. Lack of guideline to be used as a reference, refreshment training and clear direction from health bureau, time constraint, differing patient priorities, and competing topics were some of the reasons for low level of knowledge and poor prescribing practice. Thus, guideline to use as a reference, refreshment training, incorporate the topic in the curriculum of health professionals and supportive supervision should be given to increase the knowledge

  17. Change in ranking order of prescribing patterns by age and sex standardization of the practice population--audit may be misleading

    DEFF Research Database (Denmark)

    Olesen, Frede; Vedsted, Peter; Nielsen, Jørgen Nørskov

    1996-01-01

    OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information...... recommend prior age and sex standardization. Our results are of value in creating a more reliable basis for a debate on variation in prescribing patterns between peers......OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information...... on the age, sex, and numbers of patients per practice was also obtained. The direct standardization method was used to adjust practice populations for age and sex. SETTING: The town of Randers, Aarhus County, Denmark. SUBJECTS: 35 practices, 41 GPs. MAIN OUTCOME MEASURES: Ranking of the 35 practices...

  18. Prescribing practices of topical corticosteroids in the outpatient dermatology department of a rural tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Suvarna S Rathod

    2013-01-01

    Full Text Available Background: Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. Aim: The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra. Materials and Methods: A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. Results: About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Conclusion: Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.

  19. The curriculum for the teaching of history: between training, the prescribed and the practiced

    Directory of Open Access Journals (Sweden)

    Olavo Pereira Soares

    2012-03-01

    Full Text Available This article analyzes the relations between the curriculum of the initial formation for history teaching and the school curriculum for the teaching of this discipline. It has been assumed that the initial formation have decisive influence in the analyses that the undergraduates and entrants in the mastership makes about the school curriculum, and that such analyses no it restricts unto prescript. Initially, we present our considerations about the trajectory of current curriculum requirements for the teaching of history. After that, we raise data about as the initial formation curriculum is incorporated by undergraduates who act in public schools, and in that measure such formation interferes in the analysis and intervention that they makes in school curriculum. The data presented are tied to pedagogic and didactic interventions executed for undergraduates of the PIBID – Purse Institucional Program of the Introduction to teaching. Its possible verify that the undergraduates in action in the schools get identify how their theoretical formation enables the analyse and the intervention in the curriculum practice of the schools. The analysis of the school curriculum enables a distanced and qualitative reading of the initial formation, it allows the proposition of changes in both curriculum structures.

  20. Rational prescribing in primary care (RaPP: economic evaluation of an intervention to improve professional practice.

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    Atle Fretheim

    2006-06-01

    761,998 US dollars, or 540 US dollars per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted, and the cost-effectiveness was estimated to be 183 US dollars. CONCLUSIONS: We found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial. A major reason to promote the use of thiazides is their lower price compared to other drugs. The cost of the intervention was more than twice the savings within the time frame of our study. However, we predict modest savings over a 2-y period.

  1. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study.

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    Jianhua Wu

    Full Text Available BACKGROUND: Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions. METHODS: A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008 patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing. RESULTS: Of 365,718 patients with complete data, 13.8% (50,558 were prescribed lipid lowering drugs: 28.5% (21,101/74,137 of those eligible and 10.1% (29,457/291,581 of those ineligible. Only 41.7% (21,101/50,558 of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39; diabetes (OR 4.49; 95% CI 4.35-4.64; total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29; and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42. The predictors were similar in eligible and ineligible patients. CONCLUSIONS: Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

  2. Primary non-adherence to prescribed medication in general practice: lack of influence of moderate increases in patient copayment.

    Science.gov (United States)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún; Einarsson, Ólafur B; Jónsson, Kristinn; Almarsdóttir, Anna B

    2013-02-01

    Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known. To determine the prevalence of primary non-adherence, test whether it is influenced by a moderate increase in patient copayment implemented in 2010 and examine the difference between copayment groups (general versus concession patients). A population-based data linkage study, wherein prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200 000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. The rate of primary non-adherence was 6.2%. It was lower after the increased copayment, reaching statistical significance for hypertensive agents, non-steroidal anti-inflammatory drugs (NSAIDs) and antipsychotics. Generally, primary non-adherence, except for antibacterials and NSAIDs, was highest in old-age pensioners. Primary non-adherence in Icelandic general practice was within the range of prior studies undertaken in other countries and was not adversely affected by the moderate increase in patient copayment. Older patients showed a different pattern of primary non-adherence. This may possibly be explained by higher prevalence of medicine use.

  3. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia

    OpenAIRE

    Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini

    2016-01-01

    Background Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. Methods We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS...

  4. Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa

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    Conway David J

    2010-06-01

    Full Text Available Abstract Background The decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country. Methods Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined. Results Slide requests were made for 33.2% (173 of those enrolled, being more frequent in children (0-15 yrs than adults during the wet season (p = 0.003. In the same period, requests were commoner in under-fives compared to older children (p = 0.022; however, a positive test result was 4.4 times more likely in the latter group (p = 0.010. Parasitaemia was confirmed for only 4.7% (10/215 and 12.5% (37/297 of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons. Conclusions The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older

  5. Comparison of prescriber evaluations and patient-directed self-reports in office-based practice for buprenorphine treatment of opiate-dependent individuals in France, 2002

    Directory of Open Access Journals (Sweden)

    Estelle Lavie

    2008-11-01

    Full Text Available Estelle Lavie1, Mélina Fatséas1, Jean-Pierre Daulouède1,2, Cécile Denis1, Jacques Dubernet1, Laurent Cattan3, Marc Auriacombe11Laboratoire de psychiatrie/EA4139, INSERM IFR-99 and Faculté de médecine Victor Pachon, University Victor Segalen Bordeaux 2, Bordeaux, France; 2Bizia, Centre de soins d’addictologie, Centre Hospitalier de la Côte Basque, Bayonne, France; 3Centre médical, Noisy-le-sec, FranceAbstract: The objective of this cross-sectional evaluation study was to compare data generated through prescriber assessments, and data generated from independent direct contact with opiate-dependent patients in office-based practice to evaluate buprenorphine treatment for modality of buprenorphine absorption, benzodiazepine use, and depressive symptoms. A group of buprenorphine office-based practice prescribers was selected to participate in this study. They were asked to screen for inclusion all their patients coming for a visit from February to August 2002. Once included by their prescribing physician, patients were given a series of self-administered questionnaires to be returned directly to the research staff, independently of their prescriber. Each prescriber was given a questionnaire to complete based on their knowledge and interview of the patient. Items assessed were history of current treatment, current substance use, buprenorphine treatment related behavior (daily frequency of intake, route of administration, benzodiazepine use and existence of a major depressive episode. Prescribers and patients’ questionnaires were compared. Concordance of both assessments was assessed by kappa statistics. The sensitivity and specificity as well as the positive and negative predictive values of prescriber collected information were compared to that of their patients’. There was an overall good correlation between both data sources on the procedures for buprenorphine use especially for intravenous use of buprenorphine. There were important

  6. Cost comparison analysis: pentaerythrithyl tetranitrate (PETN) and isosorbide dinitrate (ISDN) prescribed to diabetic patients in primary care practices in Germany.

    Science.gov (United States)

    Icks, A; Haastert, B; Rathmann, W; Schröder-Bernhardi, D; Giani, G

    2007-09-01

    Both pentaerythrithyltetranitrate (Pentalong, PETN) and isosorbide dinitrate (ISDN) are commonly used in the therapy of ischemic heart disease (IHD). However, little is known about the therapeutic patterns in diabetic patients and no comparative data are available regarding the prescription costs of these two substances. Thus, the aim of this investigation was to compare the costs for PETN and ISDN therapy in diabetic patients in primary care. All continuously treated patients aged > or = 40 years with diabetes (anti-diabetic agents) and IHD or angina pectoris (ICD codes) and newly started on PETN or ISDN therapy (index date) in the period 2000-2005 were selected from a database containing data from 400 practices throughout Germany (Disease Analyzer, IMS Health). Prescriptions costs for PETN and ISDN, as well as costs for cardiovascular comedication, were determined for the period 183 days before and after the index date, and that changes in costs after the index date were calculated. Differences in costs between the two groups were evaluated using multivariate regression, adjusting for age, sex and comorbidity. Patients in Eastern (n = 137, age 71 +/- 10 years, 55% male) and Western Germany (n = 212, age 73 +/- 9 years, 50% male) were analyzed separately since there is a longer history of PETN use in Eastern Germany. Significantly more patients were treated with PETN in Eastern Germany (61 vs. 11%, p PETN and ISDN differed with respect to sex and comorbidity. PETN therapy was more expensive than ISDN therapy in both German regions (adjusted cost differences were 10 and 17 Euro). However, when comedication was taken into account, a smaller cost increase after the index date was observed in the PETN group than in the ISDN group (non-significant cost savings of 43 and 52 Euro after adjustment for Western and Eastern Germany, respectively). PETN therapy tends to produce a saving in costs compared to ISDN therapy in diabetic patients when costs for comedication are

  7. Recommendations on the use of prescribed burning practices in grassland conservation - An evidence-based study from Hungary

    Science.gov (United States)

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

    2015-04-01

    Fire as a natural disturbance has been present in most European grasslands. In parallel controlled use of burning was an important part of the traditional landscape management for millennia. It was used to reduce litter and suppress woody vegetation as well as to maintain open landscapes suitable for farming. Recently, human activities have a considerable impact on natural fire regimes through habitat fragmentation, cessation of traditional grassland management and climate change. Nowadays the majority of human-ignited fires are uncontrolled burnings and arson, which have serious negative impacts on human life, property and can be detrimental also from the nature conservation point of view. Despite fire was widely applied in the past and the considerable extension and frequency of current grassland fires, the impact of fire on the grassland biodiversity is still scarcely documented in Europe. The aim of our study was to gather practical knowledge and experiences from Hungary concerning the effects of fire on grasslands. To fulfil this aim we sent questionnaires to experts from Hungarian national park directorates to gather unpublished data and field observations concerning the effects of burning on grasslands. Based on the answers for the questionnaires fire regularly occur in almost every grassland types in Hungary. We found that effects of fire are habitat-specific. One hand uncontrolled burning and arson have serious detrimental impacts on many endangered species (ground-dwelling birds, such as Asio flammeus, Tringa totanus and Vanellus vanellus; or lizards, such as Ablepharus kitaibelii). On the other hand in several cases fire has a positive effect on the habitat structure and favours species of high nature conservation interest (plant species, such as Adonis volgensis, Chamaecytisus supinus and Pulsatilla grandis; butterflies, such as Euphydryas aurinia; bird species such as Circus aeruginosus and Larus cachinnans). Our results suggest that even uncontrolled

  8. Ten years of antibiotic consumption in ambulatory care: Trends in prescribing practice and antibiotic resistance in Austria

    Directory of Open Access Journals (Sweden)

    Apfalter Petra

    2009-05-01

    stable over this time period at around 5%. For macrolides, the rate of resistant isolates increased from 5% to 12.8%, with a peak in 2005 at 14.7%. Conclusion The Austrian resistance data can not explain the fundamental change in prescribing practice. The more frequent use of ciprofloxacin has most likely contributed to rising resistance rates in E. coli in Austria. Penicillin G is still a highly effective substance for the treatment of invasive infections caused by pneumococci.

  9. A questionnaire based survey on knowledge, attitude and practices of medical practitioners regarding the prescribing of medications during pregnancy

    Directory of Open Access Journals (Sweden)

    Gausia Banu

    2016-04-01

    Conclusions: Most respondents exhibited a healthy attitude and a fairly sound knowledge, except for their perception of risk associated with individual drugs which was much higher than what is mentioned in the literature. Educational interventions may help to increase the awareness leading to better and confident prescribing. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 984-988

  10. Prescribing practices and clinical predictors of glucose-lowering therapy within the first year in people with newly diagnosed Type 2 diabetes

    DEFF Research Database (Denmark)

    Mor, Anil; Berencsi, K; Svensson, E

    2015-01-01

    AIM: To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. METHODS: We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from...... outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). RESULTS: Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62...

  11. Cultivating change door to door: Educational outreach to improve prescribing practices in rural veterans with posttraumatic stress disorder.

    Science.gov (United States)

    Montaño, Macgregor; Bernardy, Nancy C; Sherrieb, Kathleen

    2017-01-01

    Clinical guidelines for the management of posttraumatic stress disorder (PTSD) recommend against the use of benzodiazepines. Benzodiazepines and PTSD are both associated with addiction-related risks. The Department of Veterans Affairs (VA) prescribing trends show continued use of benzodiazepines and polysedative use in veterans with PTSD, particularly in rural areas. The authors examine the use of an educational intervention to improve pharmacologic management of veterans with PTSD in rural clinics. The VA Academic Detailing Service Informatics Toolset provides prescribing, demographic and risk factor data for veterans with PTSD treated at the White River Junction VA Medical Center (WRJ VA) and affiliated rural clinics in Vermont and New Hampshire. Individualized academic detailing visits were provided to clinicians identified by the informatics tool with the aim of increasing guideline-concordant care. Other educational efforts included traditional, didactic group education on evidence-based PTSD care and the development and dissemination of educational materials for clinicians and patients. Prescribing trends of benzodiazepines, off-label atypical antipsychotics, and prazosin were collected quarterly for 3 years (October 1, 2013, to September 30, 2016). Prescribing rates of benzodiazepines during the educational intervention decreased from 13% to 9.3%. Use of off-label atypical antipsychotics, a class of medications not recommended for PTSD, stayed relatively flat at about 10%. Prescribing of prazosin, a medication recommended for treatment of trauma nightmares, increased from 9.8% to 14.3%. Academic detailing and other educational programming appear to be effective for addressing gaps and lag in quality PTSD care and are associated with a positive trend of decreased benzodiazepine use. Efforts will continue, now with added focus on concurrent use of benzodiazepines and opioids and the use of off-label atypical antipsychotics in rural veterans with PTSD.

  12. The effect of ethnicity on prescribing practice and treatment outcome in inpatients suffering from schizophrenia in Greece

    Directory of Open Access Journals (Sweden)

    Christodoulou Christos

    2011-04-01

    Full Text Available Abstract Background No studies have been conducted in Greece with the aim of investigating the influence of ethnicity on the prescribing and treatment outcome of voluntarily admitted inpatients. Most studies conducted in the UK and the US, both on inpatients and outpatients, focus on the dosage of antipsychotics for schizophrenic patients and many suffer from significant methodological limitations. Using a simple design, we aimed to assess negative ethnic bias in psychotropic medication prescribing by comparing discrepancies in use between native and non-native psychiatric inpatients. We also aimed to compare differences in treatment outcome between the two groups. Methods In this retrospective study, the prescribing of medication was compared between 90 Greek and 63 non-Greek inpatients which were consecutively admitted into the emergency department of a hospital covering Athens, the capital of Greece. Participants suferred from schizophrenia and other psychotic disorders. Overall, groups were compared with regard to 12 outcomes, six related to prescribing and six related to treatment outcome as assesed by standardised psychometric tools. Results No difference between the two ethnic groups was found in terms of improvement in treatment as measured by GAF and BPRS-E. Polypharmacy, use of first generation antipsychotics, second generation antipsychotics and use of mood stabilizers were not found to be associated with ethnicity. However, non-Greeks were less likely to receive SSRIs-SNRIs and more likely to receive benzodiazepines. Conclusions Our study found limited evidence for ethnic bias. The stronger indication for racial bias was found in benzodiazepine prescribing. We discuss alternative explanations and give arguments calling for future research that will focus on disorders other than schizophrenia and studying non-inpatient populations.

  13. Calcium and Vitamin D Supplement Prescribing Practices among Providers Caring for Children with Autism Spectrum Disorders: Are We Addressing Bone Health?

    Directory of Open Access Journals (Sweden)

    Shylaja Srinivasan

    2016-01-01

    Full Text Available Children with autism spectrum disorders (ASD have several risk factors for low bone mineral density. The gluten-free, casein-free (GFCF diet is a complementary therapy sometimes used in ASD that raises concerns for the adequacy of calcium and vitamin D intake. This study evaluated the prescribing practices of calcium and vitamin D supplements and the practice of checking 25-hydroxy vitamin D (25(OHD levels by providers in 100 children with ASD, 50 of whom were on the GFCF diet. Fifty-two percent and 46% of children on the GFCF diet were on some form of vitamin D and calcium supplements, respectively, compared to 18% and 14% of those not on this diet. Twenty-four percent of children in the GFCF group had a documented 25(OHD level compared to none in the non-GFCF group. The data highlight a gap in calcium and vitamin D supplement prescribing practices among providers caring for children with ASD as well as a gap in the practice of checking 25(OHD levels.

  14. Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

    Science.gov (United States)

    Herber, Oliver Rudolf; Gies, Verena; Schwappach, David; Thürmann, Petra; Wilm, Stefan

    2014-10-02

    The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

  15. Safe and judicious paediatric psychotropic prescribing

    National Research Council Canada - National Science Library

    McNicholas, F; Orakwue, N

    2014-01-01

    ... of professional groups. Clinicians' perceived levels of competence and standardised monitoring lag behind prescribing practice and should be addressed by regular continuous professional development...

  16. Use of a multiple choice questionnaire to assess UK prescribing channels' knowledge of helminthology and best practice surrounding anthelmintic use in livestock and horses.

    Science.gov (United States)

    Easton, Stephanie; Bartley, David J; Hotchkiss, Emily; Hodgkinson, Jane E; Pinchbeck, Gina L; Matthews, Jacqueline B

    2016-06-01

    Grazing livestock and equines are at risk of infection from a variety of helminths, for which the primary method of control has long been the use of anthelmintics. Anthelmintic resistance is now widespread in a number of helminth species across the globe so it is imperative that best practice control principles be adopted to delay the further spread of resistance. It is the responsibility of all who prescribe anthelmintics (in the UK, this being veterinarians, suitably qualified persons (SQPs) and pharmacists) to provide adequate information on best practice approaches to parasite control at the point of purchase. Poor uptake of best practice guidelines at farm level has been documented; this could be due to a lack of, or inappropriate, advice at the point of anthelmintics purchase. Therefore, the aim here was to evaluate levels of basic knowledge of helminthology, best practice guidelines and dispensing legislation among veterinarians and SQPs in the UK, through a Multiple Choice Question (MCQ) test, that was distributed online via targeted emails and social media sites. For each respondent, the percentage correct was determined (for the MCQ test overall and for subsections) and the results analysed initially using parametric and non-parametric statistics to compare differences between prescribing channels. The results showed that channels generally performed well; veterinarians achieved a mean total percentage correct of 79.7% (range 34.0-100%) and SQPs, a mean total percentage correct of 75.8% (range 38.5-100%) (p=0.051). The analysis indicated that veterinarians performed better in terms of knowledge of basic helminthology (p=0.001), whilst the SQP group performed better on legislation type questions (p=0.032). There was no significant difference in knowledge levels of best practice between the two channels. Multivariable linear regression analysis showed that veterinarians and those answering equine questions only performed significantly better than those

  17. Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence

    Science.gov (United States)

    Leurent, Baptiste; Baiden, Frank; Baltzell, Kimberly; Björkman, Anders; Bruxvoort, Katia; Clarke, Siân; DiLiberto, Deborah; Elfving, Kristina; Goodman, Catherine; Hopkins, Heidi; Lal, Sham; Liverani, Marco; Magnussen, Pascal; Mårtensson, Andreas; Mbacham, Wilfred; Mbonye, Anthony; Onwujekwe, Obinna; Roth Allen, Denise; Shakely, Delér; Staedke, Sarah; Vestergaard, Lasse S; Whitty, Christopher J M; Wiseman, Virginia; Chandler, Clare I R

    2017-01-01

    Objectives The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts. Design A comparative case study approach, analysing variation in outcomes across different settings. Setting Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. Participants 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. Interventions The interventions included different mRDT training packages, supervision, supplies and community sensitisation. Outcome measures Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial). Results Outcomes varied widely across cases: 12–100% mRDT uptake; 44–98% adherence to positive mRDTs; 27–100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs. Conclusions Basic training and resources are essential but insufficient to maximise

  18. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract in Dutch general practice.

    OpenAIRE

    Duijn, H.J. van; Kuyvenhoven, M M; Schellevis, F.; Verheij, T.J.M.

    2005-01-01

    Objectives: The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Methods: Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regr...

  19. The discomfort caused by patient pressure on the prescribing decisions of hospital prescribers.

    Science.gov (United States)

    Lewis, Penny J; Tully, Mary P

    2011-03-01

    The influence of patient expectations and demands on the decisions of prescribers in general practice has been associated with irrational prescribing and lack of evidence-based practice. However, to our knowledge, no one has investigated patient pressure to prescribe in secondary care. To investigate the influences on hospital prescribers' decisions by exploring what they found uncomfortable when prescribing. Qualitative interviews with 48 prescribers of varying seniority from 4 hospitals were conducted. Interviews were based on the critical incident technique, and prescribers were asked, before an interview, to remember any uncomfortable prescribing decisions that they had made; these were then discussed in detail during an interview. This approach allowed the interviewer to explore the more general influences on the decision to prescribe. Interviews were tape recorded and transcribed verbatim. A grounded theory approach to data analysis was taken. Prescribers discussed various factors that could provoke feelings of discomfort when prescribing. Pressure on the prescribing decision from patients, relatives, or carers was a major theme, and more than half of interviewees discussed discomfort caused by such perceived pressure on the prescribing decision. How prescribers dealt with this pressure varied with seniority and the type of relationship that they had fostered with the patient. Nearly half of all incidents of patient pressure resulted in the patient being prescribed the medication they requested. Yet, many of these requests were deemed inappropriate by the prescriber. Their reasons for capitulation varied but included maintaining a good prescriber-patient relationship and avoiding conflict in the wider health care team. Pressure from patients, relatives, or carers was an uncomfortable influence on these hospital prescribers' prescribing decisions. Increasingly consumer-driven health care will intensify these issues in the future. We advocate further research

  20. The Prescribed Velocity Method

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    The- velocity level in a room ventilated by jet ventilation is strongly influenced by the supply conditions. The momentum flow in the supply jets controls the air movement in the room and, therefore, it is very important that the inlet conditions and the numerical method can generate a satisfactory...... description of this momentum flow. The Prescribed Velocity Method is a practical method for the description of an Air Terminal Device which will save grid points close to the opening and ensure the right level of the momentum flow....

  1. Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India: e0142317

    National Research Council Canada - National Science Library

    Megha Sharma; Anna Damlin; Ashish Pathak; Cecilia Stålsby Lundborg

    2015-01-01

    .... Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices...

  2. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  3. [Renal toxicity of antiviral drugs].

    Science.gov (United States)

    Frasca', Giovanni M; Balestra, Emilio; Tavio, Marcello; Morroni, Manrico; Manarini, Gloria; Brigante, Fabiana

    2012-01-01

    Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and the high susceptibility of the kidney are all factors contributing to renal injury. Many pathogenetic mechanisms are involved in the nephrotoxicity of antiviral drugs, including drug interaction with transport proteins in the tubular cell; direct cytotoxicity due to a high intracellular drug concentration; mitochondrial injury; and intrarenal obstruction or stone formation due to the low solubility of drugs at a normal urinary pH. As a result, various clinical pictures may be observed in patients treated with antiviral drugs, ranging from tubular dysfunction (Fanconi syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) to acute renal failure (induced by tubular necrosis or crystal nephropathy) and kidney stones. Careful attention should be paid to prevent renal toxicity by evaluating the glomerular filtration rate before therapy and adjusting the drug dosage accordingly, avoiding the combination with other nephrotoxic drugs, and monitoring renal parameters on a regular basis while treating patients.

  4. Ophthalmic antiviral chemotherapy : An overview

    Directory of Open Access Journals (Sweden)

    Athmanathan Sreedharan

    1997-01-01

    Full Text Available Antiviral drug development has been slow due to many factors. One such factor is the difficulty to block the viral replication in the cell without adversely affecting the host cell metabolic activity. Most of the antiviral compounds are analogs of purines and pyramidines. Currently available antiviral drugs mainly inhibit viral nucleic acid synthesis, hence act only on actively replicating viruses. This article presents an overview of some of the commonly used antiviral agents in clinical ophthalmology.

  5. Antiviral Drugs: Seasonal Flu

    Centers for Disease Control (CDC) Podcasts

    2010-09-29

    In this podcast, Dr. Joe Bresee explains the nature of antiviral drugs and how they are used for seasonal flu.  Created: 9/29/2010 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 9/29/2010.

  6. Prescribing Practice in Inpatients Versus Outpatients With Schizophrenia Initiating Treatment With Second-Generation Antipsychotics: A Naturalistic Follow-Up Study.

    Science.gov (United States)

    Edlinger, Monika; Rettenbacher, Maria A; Kemmler, Georg; Biedermann, Falko; Widschwendter, Christian G; Fleischhacker, W Wolfgang; Hofer, Alex

    2016-12-01

    The primary objective of this study was to investigate whether the choice and dosage of antipsychotic medication differ between patients with schizophrenia starting treatment in an inpatient or outpatient unit. In addition, we investigated whether the reason for the introduction of new antipsychotic medication had an impact on the treatment setting and whether the use of benzodiazepines differed between inpatients and outpatients. From October 1997 to September 2010, patients with a schizophrenia spectrum disorder according to the International Classification of Diseases, Tenth Revision aged between 18 and 65 years were allocated to a naturalistic drug-monitoring program when starting treatment with a second-generation antipsychotic drug. Psychopathological symptoms were rated at baseline and after 1, 2, 4, and 8 weeks of treatment using the Positive and Negative Syndrome Scale. Inpatients and outpatients were compared with regard to the use of antipsychotics and benzodiazepines. To compare different drugs, chlorpromazine and diazepam equivalents were calculated. Lack of efficacy and side effects were the main reasons for initiating new antipsychotic medication. Combined evaluation of all antipsychotic compounds by meta-analysis resulted in a significant effect of the treatment setting, with inpatients receiving higher doses than outpatients. In addition, inpatients were prescribed benzodiazepines more often and in higher doses than outpatients. Both antipsychotics and benzodiazepines were prescribed at higher doses in an inpatient setting. Moreover, benzodiazepines were prescribed more frequently to inpatients. Accordingly, the treatment setting needs to be taken into consideration in treatment recommendations for schizophrenia spectrum disorders.

  7. Antiviral Polymer Therapeutics

    DEFF Research Database (Denmark)

    Smith, Anton Allen Abbotsford

    2014-01-01

    The field of drug delivery is in essence an exercise in engineered pharmacokinetics. Methods of doing so have been developed through the introduction of a vehicle carrying the drug, either by encapsulation or covalent attachment. The emergence of polymer therapeutics in anticancer therapy has...... the examples of polymer therapeutics being applied as an antiviral treatment are few and far in-between. This work aims to explore antiviral therapeutics, specifically in context of hepatitis virus C (HCV) and HIV. The current treatment of hepatitis C consists of a combination of drugs, of which ribavirin....... Curiously, the therapeutic window of ribavirin was vastly improved in several of these polymers suggesting altered pharmacodynamics. The applicability of liver-targeting sugar moieties is likewise tested in a similarly methodical approach. The same technique of synthesis was applied with zidovudine to make...

  8. Psychiatric Prescribers' Experiences With Doctor Shoppers.

    Science.gov (United States)

    Worley, Julie; Johnson, Mary; Karnik, Niranjan

    2015-01-01

    Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.

  9. [Appropriate medication prescribing in older people].

    Science.gov (United States)

    Blain, H; Rambourg, P; Le Quellec, A; Ayach, L; Biboulet, P; Bismuth, M; Blain, A; Boulenger, J-P; Celton, B; Combe, B; Dauvilliers, Y; Davy, J-M; Geny, C; Hemmi, P; Hillaire-Buys, D; Jalabert, A; Jung, B; Leclercq, F; Léglise, M-S; Morel, J; Mourad, G; Ponrouch, M-P; Puisieux, F; Quantin, X; Quéré, I; Renard, E; Ribstein, J; Roch-Torreilles, I; Rolland, Y; Rosant, D; Terminet, A; Thuret, R; Villiet, M; Deshormières, N; Bourret, R; Bousquet, J; Jonquet, O; Millat, B

    2015-10-01

    Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.

  10. Learning to prescribe – pharmacists' experiences of supplementary prescribing training in England

    Directory of Open Access Journals (Sweden)

    Hutchinson Allen

    2008-12-01

    Full Text Available Abstract 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

  11. Nurse prescribing ethics and medical marketing.

    Science.gov (United States)

    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.

  12. When Medication Is Prescribed

    Science.gov (United States)

    ... page please turn Javascript on. Feature: Depression When Medication Is Prescribed Past Issues / Fall 2009 Table of ... you have about the medicine. —NIMH Types of Medications There are several types of medications used to ...

  13. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

    Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

  14. Broad-spectrum antiviral agents

    Directory of Open Access Journals (Sweden)

    Jun-Da eZhu

    2015-05-01

    Full Text Available Development of highly effective, broad-spectrum antiviral agents is the major objective shared by the fields of virology and pharmaceutics. Antiviral drug development has focused on targeting viral entry and replication, as well as modulating cellular defense system. High throughput screening of molecules, genetic engineering of peptides, and functional screening of agents have identified promising candidates for development of optimal broad-spectrum antiviral agents to intervene in viral infection and control viral epidemics. This review discusses current knowledge, prospective applications, opportunities, and challenges in the development of broad-spectrum antiviral agents.

  15. Prescribing patterns in premenstrual syndrome

    Directory of Open Access Journals (Sweden)

    Jones Paul W

    2002-06-01

    Full Text Available Abstract Background Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998 within a computerised general practitioner database. Methods Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients Results Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. Conclusions This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy.

  16. La respuesta inmune antiviral

    Directory of Open Access Journals (Sweden)

    Rainel Sánchez de la Rosa

    1998-02-01

    Full Text Available Se expone que los virus son parásitos intracelulares obligados, puesto que no tienen metabolismo propio; esto obliga al sistema inmune a poner en marcha sus mecanismos más especializados para reconocer y eliminar, tanto a los virus libres, como a las células infectadas. Se señala que las células presentadoras de antígenos, los linfocitos B y los T unidos al complejo mayor de histocompatibilidad, forman parte de la organización de la respuesta inmune antiviral; la inducción de esta respuesta con proteínas, péptidos y ADN desnudo, son alternativas actuales tanto en la prevención como en el tratamiento de las infecciones viralesIt is explained that viruses are compulsory intracellular parasites, since they don't have their own metabolism, which makes the immune system to start its mest specialized mechanisms to recognize and eliminate the free viruses and the infected cells. It is stated that the cells presenting antigens, and the B and T lymphocytes together with the major histocompatibility complex, are part of the organization of the immune antiviral response. The induction of this response with proteins, peptides and naked DNA are the present alternatives for the prevention and treatment of viral infections

  17. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

    Science.gov (United States)

    Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

    2017-08-01

    Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

  18. Antidepressant prescribing in community cancer care.

    Science.gov (United States)

    Ashbury, Fredrick D; Madlensky, Lisa; Raich, Peter; Thompson, Mark; Whitney, Geoff; Hotz, Ken; Kralj, Boris; Edell, William S

    2003-05-01

    To describe patterns of antidepressant (ADs) prescribing in community oncology practice. Data were collected using an electronic medical record on all staged breast, colon, and lung cancer patients in three community-based oncology practices. The data were analyzed retrospectively, using descriptive and bivariate analyses and multivariate logistic regression modeling. There were 850 breast, 299 colon, and 473 lung cancer patients identified in this analysis. Overall, 19.2% of breast, 11% of colon, and 13.7% of lung cancer patients had been prescribed ADs during the 2-year period. The clinic in which cancer treatment was received predicted AD prescribing. The relationship between AD administration and age proved to be nonlinear; the pattern exhibited an "inverted U" shape. Patients with comorbidities and on pain medications were more likely to be administered ADs. Colon cancer patients on pain medications were five times more likely to be administered ADs than those not on pain medications. While some predictors of AD prescribing appear to be consistent with other studies, such as being on pain medication, there is still a great amount of variability in prescribing patterns across community practices, age groups, and cancer diagnoses. This study demonstrates that prescriptions of ADs seem to be influenced by parameters other than psychopathology. Given the importance of major depression in oncology care, diagnosis of psychiatric disorders and prescription patterns of psychotropics should be part of the routine monitoring and quality management in oncology patient care.

  19. Putting Pediatric Off Label Prescribing on the Map: A Study to Understand which Children, Medications and Physicians are Involved in Prescribing Drugs for Unapproved Uses

    OpenAIRE

    Bazzano, Alicia Theresa Francesca

    2012-01-01

    Background: Prescribing medications for an indication or age outside of the terms of U.S. Food and Drug Administration (FDA) approval is called off label prescribing. In children, off label prescribing has resulted in drug disasters and increased adverse events and has been the subject of recent legislation promoting medication study. Off label prescribing appears to be a very common pediatric practice; nonetheless, the pharmacoepidemiology of off label prescribing has not been systematically...

  20. New users of antipsychotic medication: A population-based cohort study of occupational outcome measures in relation to antipsychotic on-label and off-label prescribing practices.

    Science.gov (United States)

    Baandrup, L; Kruse, M

    2016-01-01

    Treatment with antipsychotic medication is thoroughly investigated in schizophrenia and bipolar disorder but is also widely applied for a diversity of off-label conditions, despite an uncertain risk-benefit ratio. This study examined the relationship between antipsychotic prescribing patterns and labor market affiliation, considering both authority approved and off-label prescriptions and the relation to polypharmacy. Register-based cohort study using a dataset of 71,254 new antipsychotic users with a psychiatric diagnosis. Labor market affiliation and duration of welfare payments were analyzed using linear regression models and duration analysis. The analyses were adjusted for the following confounding variables: age, gender, diagnosis, marital status, length of education, and utilization of mental health care services. The majority of new antipsychotic users received welfare payments for prolonged periods of time during the observation period, even more so for individuals treated with antipsychotic polypharmacy or other antipsychotic combination regimens. The risk of permanently leaving the labor market was also associated with antipsychotic combination regimen. Antipsychotic treatment, especially in combination with other antipsychotics or other psychotropic drugs, could serve as a marker of subjects with increased need for support to maintain the labor market affiliation. However, causality cannot be inferred from an observational study because of residual confounding that could not be adjusted for in this study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Matrix with Prescribed Eigenvectors

    Science.gov (United States)

    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…

  2. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2017-07-06

    This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

  3. Antiviral immunity in amphibians.

    Science.gov (United States)

    Chen, Guangchun; Robert, Jacques

    2011-11-01

    Although a variety of virus species can infect amphibians, diseases caused by ranaviruses ([RVs]; Iridoviridae) have become prominent, and are a major concern for biodiversity, agriculture and international trade. The relatively recent and rapid increase in prevalence of RV infections, the wide range of host species infected by RVs, the variability in host resistance among population of the same species and among different developmental stages, all suggest an important involvement of the amphibian immune system. Nevertheless, the roles of the immune system in the etiology of viral diseases in amphibians are still poorly investigated. We review here the current knowledge of antiviral immunity in amphibians, focusing on model species such as the frog Xenopus and the salamander (Ambystoma tigrinum), and on recent progress in generating tools to better understand how host immune defenses control RV infections, pathogenicity, and transmission.

  4. In vitro evaluation of marine-microorganism extracts for anti-viral activity

    OpenAIRE

    Yasuhara-Bell Jarred; Yang Yongbo; Barlow Russell; Trapido-Rosenthal Hank; Lu Yuanan

    2010-01-01

    Abstract Viral-induced infectious diseases represent a major health threat and their control remains an unachieved goal, due in part to the limited availability of effective anti-viral drugs and measures. The use of natural products in drug manufacturing is an ancient and well-established practice. Marine organisms are known producers of pharmacological and anti-viral agents. In this study, a total of 20 extracts from marine microorganisms were evaluated for their antiviral activity. These ex...

  5. Should we prescribe heroin? A current Scottish debate.

    Science.gov (United States)

    Gallagher, J; McKeganey, N

    2007-11-01

    There have been recent calls from within both Scotland and England for the wider prescription of heroin to heroin addicts as a way of coping with our burgeoning drug problem and as a route to reducing drug related criminality. But how feasible is heroin prescribing in this context? This paper considers some of the existing research evidence relating to heroin prescribing and looks also at the ethics and practicalities of prescribing heroin to heroin addicts in Scotland. We conclude that whilst the evidence on the benefits of heroin prescribing is far from clear cut there is a case for mounting a Scottish trial of heroin prescribing. Such a trial would need to be tightly controlled and rigorously evaluated. It would need to show that heroin prescribing was associated not only with a comparable level of harm reduction, as methadone prescribing, but that it was also an effective route towards drug users' eventual recovery and drug cessation.

  6. Cycluridine: A novel antiviral effective against flaviviruses.

    Science.gov (United States)

    Galabov, Angel S; Mukova, Lucia; Abashev, Yuriy P; Wassilewa, Lilia; Tzvetkov, Petko; Minkov, Vassil; Barinskiy, Igor F; Rice, Charles M; Ouzounov, Sergey; Sidzhakova, Dorotea

    2017-08-01

    This review describes the contemporary state of research for antivirals effective against flaviviruses, especially focusing on inhibitors of the pestivirus causative agent of bovine viral diarrhoea virus. We highlight cycluridine, an originally synthesized Mannich's base [a tetrahydro-2(1H)-pyrimidinones derivative], as a highly effective antiviral possessing a strong inhibitory effect on bovine viral diarrhoea virus replication. Cycluridine was active against replication of a wide variety of bovine viral diarrhoea virus strains in cell cultures. The drug-sensitive period in the bovine viral diarrhoea virus replication cycle included the latent period and the exponential phase; a 90-min delay in the peak of viral RNA synthesis was observed. Cycluridine administered orally manifested a pronounced protective effect in calves with natural mucosal disease/viral diarrhoea and calves experimentally infected with bovine viral diarrhoea virus. Its magnitude of activity and selectivity places cycluridine in the lead among all known substances with anti- bovine viral diarrhoea virus activity. Additionally, cycluridine applied subcutaneously showed anti-tick-born encephalitis virus activity, manifesting a marked protective effect in mice infected with tick-born encephalitis virus. Cycluridine could be a prospective antiviral in veterinary and medical practice for the treatment of bovine viral diarrhoea virus and other flavivirus infections.

  7. Prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients in general practice: a cross-sectional study based on French and Italian prescribing data

    NARCIS (Netherlands)

    Darmon, D.; Laforest, L.; Ganse, E. Van; Petrazzuoli, F.; Weel, C. van; Letrilliart, L.

    2015-01-01

    BACKGROUND: Asthma is often poorly controlled and guidelines are often inadequately followed in medical practice. In particular, the prescription of non-asthma-specific drugs can affect the quality of care. The goal of this study was to measure the frequency of the prescription of antibiotics and an

  8. Antibiotic prescribing in primary care: first choice and restrictive prescribing are two different traits.

    NARCIS (Netherlands)

    Roosmalen, M.S van; Braspenning, J.C.C.; Smet, P.A.G.M. de; Grol, R.P.T.M.

    2007-01-01

    OBJECTIVE: To investigate the quality of antibiotic prescribing in primary care using quality indicators and the relatedness of these indicators. To determine the influence of general practice and practice population characteristics on the indicator scores. METHODS: Data on performance were collecte

  9. Diagnosis and antiviral intervention strategies for mitigating an influenza epidemic.

    Directory of Open Access Journals (Sweden)

    Robert Moss

    Full Text Available BACKGROUND: Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Here we identify optimal delivery strategies for antiviral interventions accounting for logistical constraints, and so determine how to improve a strategy's impact. METHODS AND FINDINGS: We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis. CONCLUSIONS: We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for

  10. Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study.

    Science.gov (United States)

    Scheid, Volker; Tuffrey, Veronica; Bovey, Mark

    2017-06-01

    The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to inform the development of best practice guidelines for a future pragmatic randomised controlled trial, with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London were analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, the patterns of combined herb use were analysed by means of factor analysis, and the correlations between these patterns and the presenting symptoms were analysed using the chi square test. Treating the emergent use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks and guidelines, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Antiviral Drug Research Proposal Activity

    Directory of Open Access Journals (Sweden)

    Lisa Injaian

    2011-03-01

    Full Text Available The development of antiviral drugs provides an excellent example of how basic and clinical research must be used together in order to achieve the final goal of treating disease. A Research Oriented Learning Activity was designed to help students to better understand how basic and clinical research can be combined toward a common goal. Through this project students gained a better understanding of the process of scientific research and increased their information literacy in the field of virology. The students worked as teams to research the many aspects involved in the antiviral drug design process, with each student becoming an "expert" in one aspect of the project. The Antiviral Drug Research Proposal (ADRP culminated with students presenting their proposals to their peers and local virologists in a poster session. Assessment data showed increased student awareness and knowledge of the research process and the steps involved in the development of antiviral drugs as a result of this activity.

  12. Emerging antiviral drugs.

    Science.gov (United States)

    De Clercq, Erik

    2008-09-01

    Foremost among the newly described antiviral agents that may be developed into drugs are, for the treatment of human papilloma virus (HPV) infections, cPrPMEDAP; for the treatment of herpes simplex virus (HSV) infections, BAY 57-1293; for the treatment of varicella-zoster virus (VZV) infections, FV-100 (prodrug of Cf 1743); for the treatment of cytomegalovirus (CMV) infections, maribavir; for the treatment of poxvirus infections, ST-246; for the treatment of hepatitis B virus (HBV) infections, tenofovir disoproxil fumarate (TDF) (which in the meantime has already been approved in the EU); for the treatment of various DNA virus infections, the hexadecyloxypropyl (HDP) and octadecyloxyethyl (ODE) prodrugs of cidofovir; for the treatment of orthomyxovirus infections (i.e., influenza), peramivir; for the treatment of hepacivirus infections (i.e., hepatitis C), the protease inhibitors telaprevir and boceprevir, the nucleoside RNA replicase inhibitors (NRRIs) PSI-6130 and R1479, and various non-nucleoside RNA replicase inhibitors (NNRRIs); for the treatment of human immunodeficiency virus (HIV) infections, integrase inhibitors (INIs) such as elvitegravir, nucleoside reverse transcriptase inhibitors (NRTIs) such as apricitabine, non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as rilpivirine and dapivirine; and for the treatment of both HCV and HIV infections, cyclosporin A derivatives such as the non-immunosuppressive Debio-025.

  13. Trends of contact lens prescribing in Jordan.

    Science.gov (United States)

    Haddad, Mera F; Bakkar, May; Gammoh, Yazan; Morgan, Philip

    2016-10-01

    To evaluate contact lens prescribing trends among optometrists in Jordan. Optometrists from 173 practices in Jordan were surveyed about prescribing contact lenses in their practice. Practitioners were required to record information for the last 10 patients that visited their practice. Demographic data such as age and gender was obtained for each patient. In addition, data relating to lens type, lens design, replacement methods and the care regime advised to each patient were recorded. Practitioners were required to provide information relating to their education and years of experience. The influence of education and experience with respect to lens prescribing trends was explored using linear regression models for the proportions of lens types fitted for patients. A total of 1730 contact lens fits were analyzed. The mean (±SD) age of lens wearers was 26.6 (±7.9) years, of whom 65% were female. Conventional hydrogel lenses were the most prescribed lenses, accounting for 60.3% of the fits, followed by silicone hydrogel lenses (31.3%), and rigid lenses (8.4%). In terms of lens design, spherical lenses appeared to be most commonly prescribed on monthly basis. Daily disposable lenses were second most prescribed lens modality, accounting for 20.4% of the study sample. Multi-purpose solution (MPS) was the preferred care regimen, with a prevalence of 88.1% reported in the study sample, compared to hydrogen peroxide (1-step and 2-step), which represented only 2.8% of the patients in this study. A relationship was established between the two educational groups for rigid lens prescribing (F=17.4, ptrends among optometrists in Jordan. Contact lens prescribing in terms of lens type, lens design, modality of wear and care regimen agree with global market trends with small variations. This report will help practitioners and the industry to detect any deficiencies in the contact lens market in Jordan, which will ease implementing current and future plans in developing contact

  14. Prescribing Optimal Nutrition and Physical Activity as “First-Line” Interventions for Best Practice Management of Chronic Low-Grade Inflammation Associated with Osteoarthritis: Evidence Synthesis

    Directory of Open Access Journals (Sweden)

    Elizabeth Dean

    2012-01-01

    Full Text Available Low-grade inflammation and oxidative stress underlie chronic osteoarthritis. Although best-practice guidelines for osteoarthritis emphasize self-management including weight control and exercise, the role of lifestyle behavior change to address chronic low-grade inflammation has not been a focus of first-line management. This paper synthesizes the literature that supports the idea in which the Western diet and inactivity are proinflammatory, whereas a plant-based diet and activity are anti-inflammatory, and that low-grade inflammation and oxidative stress underlying osteoarthritis often coexist with lifestyle-related risk factors and conditions. We provide evidence-informed recommendations on how lifestyle behavior change can be integrated into “first-line” osteoarthritis management through teamwork and targeted evidence-based interventions. Healthy living can be exploited to reduce inflammation, oxidative stress, and related pain and disability and improve patients’ overall health. This approach aligns with evidence-based best practice and holds the promise of eliminating or reducing chronic low-grade inflammation, attenuating disease progression, reducing weight, maximizing health by minimizing a patient’s risk or manifestations of other lifestyle-related conditions hallmarked by chronic low-grade inflammation, and reducing the need for medications and surgery. This approach provides an informed cost effective basis for prevention, potential reversal, and management of signs and symptoms of chronic osteoarthritis and has implications for research paradigms in osteoarthritis.

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

    Science.gov (United States)

    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.

  16. Growth of nurse prescribing competence: facilitators and barriers during education.

    Science.gov (United States)

    Hopia, Hanna; Karhunen, Anne; Heikkilä, Johanna

    2017-10-01

    To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme. The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme. The descriptive, qualitative study used the text of student online learning diaries as data during a 14-month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method. The growth of nurses' prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors' positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses' prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised. The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces. The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training. © 2016 John Wiley & Sons Ltd.

  17. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions

    DEFF Research Database (Denmark)

    Haastrup, Peter; Paulsen, Maja Skov; Zwisler, Jon Eik;

    2014-01-01

    Background: Guideline and reimbursement modifications have been introduced to optimize prescribing of antisecretory medication in Danish general practice. Impacts of the interventions have not been evaluated. Objectives: To analyse developments in prescribing of antisecretory medication in Denmar...

  18. Randomised controlled trials for evaluating the prescribing impact of information meetings led by pharmacists and of new information formats, in General Practice in Italy

    Directory of Open Access Journals (Sweden)

    Magnano Lucia

    2007-09-01

    Full Text Available Abstract Background Suboptimal translation of valid and relevant information in clinical practice is a problem for all health systems. Lack of information independent from commercial influences, limited efforts to actively implement evidence-based information and its limited comprehensibility are important determinants of this gap and may influence an excessive variability in physicians' prescriptions. This is quite noticeable in Italy, where the philosophy and methods of Evidence-Based Medicine still enjoy limited diffusion among practitioners. Academic detailing and pharmacist outreach visits are interventions of proven efficacy to make independent and evidence-based information available to physicians; this approach and its feasibility have not yet been tested on a large scale and, moreover, they have never been formally tested in Italy. Methods/Design Two RCTs are planned: 1 a two-arm cluster RCT, carried out in Emilia-Romagna and Friuli Venezia Giulia, will evaluate the effectiveness of small group meetings, randomising about 150 Primary Care Groups (corresponding to about 2000 GPs to pharmacist outreach visits on two different topics. Physicians' prescriptions (expressed as DDD per 1000 inhabitants/day, knowledge and attitudes (evaluated through the answers to a specific questionnaire will be compared for target drugs in the two groups (receiving/not receiving each topic. 2 A three-arm RCT, carried out in Sardinia, will evaluate both the effectiveness of one-to-one meetings (one pharmacist visiting one physician per time and of a 'new' information format (compared to information already available on changing physicians' prescription of specific drugs. About 900 single GPs will be randomised into three groups: physicians receiving a visit supported by "traditional" information material, those receiving a visit with "new" information material on the same topic and those not receiving any visit/material. Discussion The two proposed RCTs aim

  19. Prescribers and pharmaceutical representatives: why are we still meeting?

    Science.gov (United States)

    Fischer, Melissa A; Keough, Mary Ellen; Baril, Joann L; Saccoccio, Laura; Mazor, Kathleen M; Ladd, Elissa; Von Worley, Ann; Gurwitz, Jerry H

    2009-07-01

    Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring

  20. Viral Ancestors of Antiviral Systems

    Directory of Open Access Journals (Sweden)

    Luis P. Villarreal

    2011-10-01

    Full Text Available All life must survive their corresponding viruses. Thus antiviral systems are essential in all living organisms. Remnants of virus derived information are also found in all life forms but have historically been considered mostly as junk DNA. However, such virus derived information can strongly affect host susceptibility to viruses. In this review, I evaluate the role viruses have had in the origin and evolution of host antiviral systems. From Archaea through bacteria and from simple to complex eukaryotes I trace the viral components that became essential elements of antiviral immunity. I conclude with a reexamination of the ‘Big Bang’ theory for the emergence of the adaptive immune system in vertebrates by horizontal transfer and note how viruses could have and did provide crucial and coordinated features.

  1. Viral ancestors of antiviral systems.

    Science.gov (United States)

    Villarreal, Luis P

    2011-10-01

    All life must survive their corresponding viruses. Thus antiviral systems are essential in all living organisms. Remnants of virus derived information are also found in all life forms but have historically been considered mostly as junk DNA. However, such virus derived information can strongly affect host susceptibility to viruses. In this review, I evaluate the role viruses have had in the origin and evolution of host antiviral systems. From Archaea through bacteria and from simple to complex eukaryotes I trace the viral components that became essential elements of antiviral immunity. I conclude with a reexamination of the 'Big Bang' theory for the emergence of the adaptive immune system in vertebrates by horizontal transfer and note how viruses could have and did provide crucial and coordinated features.

  2. Viral Ancestors of Antiviral Systems

    Science.gov (United States)

    Villarreal, Luis P.

    2011-01-01

    All life must survive their corresponding viruses. Thus antiviral systems are essential in all living organisms. Remnants of virus derived information are also found in all life forms but have historically been considered mostly as junk DNA. However, such virus derived information can strongly affect host susceptibility to viruses. In this review, I evaluate the role viruses have had in the origin and evolution of host antiviral systems. From Archaea through bacteria and from simple to complex eukaryotes I trace the viral components that became essential elements of antiviral immunity. I conclude with a reexamination of the ‘Big Bang’ theory for the emergence of the adaptive immune system in vertebrates by horizontal transfer and note how viruses could have and did provide crucial and coordinated features. PMID:22069523

  3. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan

    National Research Council Canada - National Science Library

    Atif, Muhammad; Azeem, Muhammad; Sarwar, Muhammad Rehan; Shahid, Samia; Javaid, Sidra; Ikram, Huria; Baig, Uzma; Scahill, Shane

    2016-01-01

    A descriptive, retrospective and cross sectional study was conducted to assess the prescribing practices and antibiotic use patterns in the Accident and Emergency department of the Bahawal Victoria...

  4. Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

    Directory of Open Access Journals (Sweden)

    Murphy Marion

    2012-05-01

    Full Text Available Abstract Background Information about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care. Methods Participating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients’ consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary. Results 171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.16% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15–64 years (62.23%. There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP. Conclusion The study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad-spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection.

  5. An exploration of the continuing professional development needs of nurse independent prescribers and nurse supplementary prescribers who prescribe medicines for patients with diabetes.

    Science.gov (United States)

    Carey, Nicola; Courtenay, Molly

    2010-01-01

    Nurse Independent and Nurse Supplementary Prescribing has extended the role that nurses in the UK have in the management of care for patients with diabetes. Concerns surround nurses' pharmacological knowledge and provision of continuing professional development to meet the needs of nurse prescribers. To examine the continuing professional development needs of nurses who prescribe medicines to patients with diabetes. A questionnaire survey. The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. One thousand and four hundred questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 80% reported continuing professional development was available and that they had accessed it to support their prescribing role. Over 40% of nurses had continuing professional development needs in the areas of prescribing policy, pharmacology for diabetes and the management and treatment of diabetes related conditions. Senior nurses reported fewer continuing professional development needs. Access and provision of continuing professional development for nurse prescribers has improved since the initial implementation of nurse prescribing. However, nurse's pharmacological knowledge and the provision of continuing professional development continue to be an area of concern which warrant further investigation. Previous concerns have been identified about the provision of continuing professional development to meet the needs of nurse prescribers. Pharmacological knowledge is still the greatest continuing professional development requirement of nurses who prescribe for patients with diabetes. Education providers may wish to consider developing the content of continuing professional development programmes to meet these needs.

  6. Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance.

    Science.gov (United States)

    Smith, Alesha; Latter, Sue; Blenkinsopp, Alison

    2014-11-01

    To determine the adequacy of initial nurse independent prescribing education and identify continuing professional development and clinical governance strategies in place for non-medical prescribing. In 2006, new legislation in England enabled nurses with an independent prescribing qualification to prescribe, within their competence. In 2006, non-medical prescribing policies released by the Department of Health outlined the recommendations for education, continuing professional development and governance of non-medical prescribing; however, there was no evidence on a national scale about the extent of implementation and effectiveness of these strategies. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England. Questionnaire surveys (August 2008-February 2009) covering educational preparation, prescribing practice (nurse independent prescribers) and structures/processes for support and governance (non-medical prescribing leaders). Response rates were 65% (976 prescribers) and 52% (87 leaders). Most nurses felt their prescribing course met their learning needs and stated course outcomes and that they had adequate development and support for prescribing to maintain patient safety. Some types of community nurse prescribers had less access to support and development. The prescribing leaders reported lacking systems to ensure continuity of non-medical prescribing and monitoring patient experience. Educational programmes of preparation for nurse prescribing were reported to be operating satisfactorily and providing fit-for-purpose preparation for the expansion to the scope of nurse independent prescribing. Most clinical governance and risk management strategies for prescribing were in place in primary and secondary care. © 2014 John Wiley & Sons Ltd.

  7. Automated quality checks on repeat prescribing.

    OpenAIRE

    Rogers, Jeremy E; Wroe, Christopher J; Roberts, Angus; Swallow, Angela; Stables, David; Cantrill, Judith A; Rector, Alan L.

    2003-01-01

    BACKGROUND: Good clinical practice in primary care includes periodic review of repeat prescriptions. Markers of prescriptions that may need review have been described, but manually checking all repeat prescriptions against the markers would be impractical. AIM: To investigate the feasibility of computerising the application of repeat prescribing quality checks to electronic patient records in United Kingdom (UK) primary care. DESIGN OF STUDY: Software performance test against benchmark manual...

  8. Influenza Round Table: Antiviral Drugs

    Centers for Disease Control (CDC) Podcasts

    2009-11-04

    In this podcast, Dr. Joe Bresee explains the nature of antiviral drugs and how they are used.  Created: 11/4/2009 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 11/4/2009.

  9. Interchromosomal huddle kickstarts antiviral defense.

    Science.gov (United States)

    Schoenfelder, Stefan; Fraser, Peter

    2008-07-11

    Long-distance chromosomal interactions are emerging as a potential mechanism of gene expression control. In this issue, Apostolou and Thanos (2008) describe how viral infection elicits interchromosomal associations between the interferon-beta (IFN-beta) gene enhancer and DNA binding sites of the transcription factor NF-kappaB, resulting in the initiation of transcription and an antiviral response.

  10. The future of antiviral immunotoxins

    DEFF Research Database (Denmark)

    Spiess, K.; Høy Jakobsen, Mette; Kledal, Thomas N;

    2016-01-01

    There is a constant need for new therapeutic interventions in a wide range of infectious diseases. Over the past few years, the immunotoxins have entered the stage as promising antiviral treatments. Immunotoxins have been extensively explored in cancer treatment and have achieved FDA approval...

  11. NSAID prescribing precautions.

    Science.gov (United States)

    Risser, Amanda; Donovan, Deirdre; Heintzman, John; Page, Tanya

    2009-12-15

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding associated with NSAIDs are at especially high risk. Although aspirin is cardioprotective, other NSAIDs can worsen congestive heart failure, can increase blood pressure, and are related to adverse cardiovascular events, such as myocardial infarction and ischemia. Cyclooxygenase-2 inhibitors have been associated with increased risk of myocardial infarction; however, the only cyclooxygenase-2 inhibitor still available in the United States, celecoxib, seems to be safer in this regard. Hepatic damage from NSAIDs is rare, but these medications should not be used in persons with cirrhotic liver diseases because bleeding problems and renal failure are more likely. Care should be used when prescribing NSAIDs in persons taking anticoagulants and in those with platelet dysfunction, as well as immediately before surgery. Potential central nervous system effects include aseptic meningitis, psychosis, and tinnitus. Asthma may be induced or exacerbated by NSAIDs. Although most NSAIDs are likely safe in pregnancy, they should be avoided in the last six to eight weeks of pregnancy to prevent prolonged gestation from inhibition of prostaglandin synthesis, premature closure of the ductus arteriosus, and maternal and fetal complications from antiplatelet activity. Ibuprofen, indomethacin, and naproxen are safe in breastfeeding women. Care should be taken to prevent accidental NSAID overdose in children by educating parents about correct dosing and storage in childproof containers.

  12. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.

    Science.gov (United States)

    Hicks, Lauri A; Bartoces, Monina G; Roberts, Rebecca M; Suda, Katie J; Hunkler, Robert J; Taylor, Thomas H; Schrag, Stephanie J

    2015-05-01

    Appropriate antibiotic prescribing is an essential strategy to reduce the spread of antibiotic resistance. US prescribing practices have not been thoroughly characterized. We analyzed outpatient antibiotic prescribing data to identify where appropriate antibiotic prescribing interventions could have the most impact. Oral antibiotic prescriptions dispensed during 2011 were extracted from the IMS Health Xponent database. The number of prescriptions and census denominators were used to calculate prescribing rates. Prescription totals were calculated for each provider specialty. Regression modeling was used to examine the association between socioeconomic and population health factors and prescribing rates. Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons). Penicillins and macrolides were the most common antibiotic categories prescribed. The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P 1.0). Efforts to characterize antibiotic prescribing practices should focus on the South census region and family practitioners. Further understanding of the factors leading to high prescribing among key target populations will inform appropriate prescribing interventions. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  13. Appropriate prescribing for older people

    NARCIS (Netherlands)

    Drenth - van Maanen, A.C.

    2013-01-01

    Appropriate prescribing is the result of pharmacotherapeutic decision-making to maximise the net health benefit of treatment, given the resources available. Several risk factors for inappropriate prescribing in older people have been identified, such as polypharmacy, impaired renal function, and

  14. Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal

    2015-10-01

    Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices. [Int J Basic Clin Pharmacol 2015; 4(5.000: 919-923

  15. The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

    Science.gov (United States)

    Tann, Jennifer; Blenkinsopp, Alison; Grime, Janet; Evans, Amanda

    2010-01-01

    Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of…

  16. Optimizing antiviral agents for hepatitis B management in malignant lymphomas

    Science.gov (United States)

    Ozoya, Oluwatobi O.; Chavez, Julio; Sokol, Lubomir

    2017-01-01

    The global scale of hepatitis B infection is well known but its impact is still being understood. Missed hepatitis B infection impacts lymphoma therapy especially increased risk of hepatitis B virus (HBV) reactivation and poor treatment outcomes. The presence of undiagnosed chronic hepatitis also undermines chronic HBV screening methods that are based on a positive HBsAg alone. The goal of this review is to evaluate the literature for optimizing antiviral therapy for lymphoma patients with HBV infection or at risk of HBV reactivation. Relevant articles for this review were identified by searching PubMed, Embase, Ovid Medline, and Scopus using the following terms, alone and in combination: “chronic hepatitis B”, “occult hepatitis B”, ”special groups”, “malignant lymphoma”, “non-Hodgkin’s lymphoma”, “Hodgkin’s lymphoma”, “immunocompromised host”, “immunosuppressive agents”, “antiviral”, “HBV reactivation”. The period of the search was restricted to a 15-year period to limit the search to optimizing antiviral agents for HBV infection in malignant lymphomas [2001–2016]. Several clinical practice guidelines recommend nucleos(t)ide analogues-entecavir, tenofovir and lamivudine among others. These agents are best initiated along with or prior to immunosuppressive therapy. Additional methods recommended for optimizing antiviral therapy include laboratory modalities such as HBV genotyping, timed measurements of HBsAg and HBV DNA levels to measure and predict antiviral treatment response. In conclusion, optimizing antiviral agents for these patients require consideration of geographic prevalence of HBV, cost of antiviral therapy or testing, screening modality, hepatitis experts, type of immunosuppressive therapy and planned duration of therapy.

  17. Factor analysis improves the selection of prescribing indicators

    DEFF Research Database (Denmark)

    Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta

    2006-01-01

    OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was used...... indicators directly quantifying choice of coxibs, indicators measuring expenditure per Defined Daily Dose, and indicators taking risk aspects into account, (2) "Frequent NSAID prescribing", comprising indicators quantifying prevalence or amount of NSAID prescribing, and (3) "Diverse NSAID choice", comprising...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

  18. The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

    Science.gov (United States)

    Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen

    2007-01-01

    Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be

  19. The Ontario printed educational message (OPEM trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Grimshaw Jeremy

    2007-11-01

    Full Text Available Abstract Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM; however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1 angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2 retinal screening for diabetes; and 3 diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi

  20. A population approach to disease management: hepatitis C direct-acting antiviral use in a large health care system.

    Science.gov (United States)

    Belperio, Pamela S; Backus, Lisa I; Ross, David; Neuhauser, Melinda M; Mole, Larry A

    2014-06-01

    The introduction of the first direct-acting antiviral agents (DAAs) for the treatment of hepatitis C virus (HCV), telaprevir and boceprevir, marked a unique event in which 2 disease-changing therapies received FDA approval at the same time. Comparative safety and effectiveness data in real-world populations upon which to make formulary decisions did not exist. To describe the implementation, measurement, and outcomes of an enduring population-based approach of surveillance of medication management for HCV. The foundation of the population approach to HCV medication management used by the Department of Veterans Affairs (VA) relied upon a basic framework of (a) providing data for effective regional and local management, (b) education and training, (c) real-time oversight and feedback from a higher organization level, and (d) prompt outcome sharing. These population-based processes spanned across the continuum of the direct-acting antiviral oversight process. We used the VA's HCV Clinical Case Registry-which includes pharmacy, laboratory, and diagnosis information for all HCV-infected veterans from all VA facilities-to assess DAA treatment eligibility, DAA uptake and timing, appropriate use of DAAs including HCV RNA monitoring and medication possession ratios (MPR), nonconcordance with guidance for adjunct erythropoiesis-stimulating agent (ESA) and granulocyte colony-stimulating factor (GCSF) use, hematologic adverse effects, discontinuation rates, and early and sustained virologic responses. Training impact was assessed via survey and change in pharmacist scope of practice. One year after FDA approval, DAAs had been prescribed at 120 of 130 VA facilities. Over 680 VA providers participated in live educational training programs including 380 pharmacists, and pharmacists with a scope of practice for HCV increased from 59 to 110 pharmacists (86%). HCV RNA futility testing improved such that only 1%-3% of veterans did not have appropriate testing compared with 15%-17% 6

  1. Recent advances in antiviral therapy.

    OpenAIRE

    Kinchington, D

    1999-01-01

    In the early 1980s many institutions in Britain were seriously considering whether there was a need for specialist departments of virology. The arrival of HIV changed that perception and since then virology and antiviral chemotherapy have become two very active areas of bio-medical research. Cloning and sequencing have provided tools to identify viral enzymes and have brought the day of the "designer drug" nearer to reality. At the other end of the spectrum of drug discovery, huge numbers of ...

  2. New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectives.

    Science.gov (United States)

    Welsch, Christoph; Jesudian, Arun; Zeuzem, Stefan; Jacobson, Ira

    2012-05-01

    Until recently, the standard of care (SOC) for patients with chronic hepatitis C virus (HCV) infection has consisted of a combination of pegylated interferon-α [corrected] plus ribavirin, administered for 24- to 48-weeks depending on the HCV genotype. The sustained virologic response rate for this SOC has been only about 50% in patients infected with genotype 1 HCV, the most prevalent genotype in Europe and North America. HCV therapy has been revolutionised recently by the approval of two direct-acting antiviral agents (DAA) against the NS3/4A serine protease for use in genotype 1 HCV, the ketoamide inhibitors boceprevir and telaprevir. The novel SOC marks the beginning of an extraordinary new era in HCV therapy. We review this new SOC with an emphasis on practical issues related to protease inhibitors, e.g. prescribing guidelines, futility rules and management of adverse events. We also give a perspective on what to expect in the coming years. Newer DAA with simplified dosing regimens and/or minimal toxicity which, when used in combination, will lead to viral eradication in most if not all CHC patients who undergo treatment. The novel agents in clinical development are paving the way for future interferon-sparing regimens.

  3. Pharmacist independent prescribing in secondary care: opportunities and challenges.

    Science.gov (United States)

    Bourne, Richard S; Baqir, Wasim; Onatade, Raliat

    2016-02-01

    In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies.

  4. Evaluation of prescribing indicators and pattern among dermatological outpatients in a teaching hospital of central Nepal

    Directory of Open Access Journals (Sweden)

    Manohar Pradhan

    2016-08-01

    Full Text Available Background: Evaluation of prescribing indicators by proper analysis of prescriptions under the guidelines of World Health Organization enables us to detect some of the common problems of prescribing.Methodology: This study was conducted on randomly selected 325 prescriptions of dermatological outpatients of teaching hospital of College of Medical Sciences Bharatpur (Nepal with an objective to detect the problems of prescribing as well as to delineate the pattern of medicines prescribing.Results: Total number of medicines prescribed on these prescriptions was 743. The average number of medicines per encounter was 2.28. Antihistamines, antifungals, corticosteroids and antibiotics were four most frequently prescribed therapeutic classes. One systemic as well as one topical medicine belonging to same therapeutic class was prescribed on about one-third of totally analyzed prescriptions. Cetrizine was the most common individually prescribed medicine and fluconazole was the most commonly prescribed antifungal. Medicines prescribed by their generic name were 15.07% and those prescribed from national essential medicines list were 23.42%.Conclusion: This study reveals polypharmacy, inclination of prescribers for branded medicines and prescribing out of national formulary as problems. Educational and managerial interventions are required to rationalize the prescribing practice.JCMS Nepal. 2016;12(2:44-9.

  5. John F. Enders lecture 2006: antivirals for influenza.

    Science.gov (United States)

    Ong, Adrian K; Hayden, Frederick G

    2007-07-15

    The long history of influenza drug development has both contributed practical advances in antiviral chemotherapy and improved the understanding of influenza pathogenesis and epidemiology. The role played by these antivirals continues to grow with the dual threats of seasonal and pandemic influenza. The neuraminidase inhibitors are proven effective for the chemoprophylaxis and treatment of influenza A and B, although early therapy is essential for disease mitigation. Studies of topically applied zanamivir have demonstrated the importance of viral replication in the lower respiratory tract, even in uncomplicated influenza. Antiviral resistance, especially to the M2 ion channel inhibitors, sometimes limits clinical utility. Oseltamivir-resistant variants may emerge during treatment but have not yet circulated widely and are usually less fit than wild-type virus; most retain susceptibility to zanamivir. The transmission fitness cost of these resistant variants is drug-, neuraminidase subtype-, and mutation-specific. Continued vigilance in drug resistance surveillance is imperative, as is research into the development of new agents that will provide the potential for alternative and combination antiviral therapy.

  6. Phosprenyl: a novel drug with antiviral and immunomodulatory activity.

    Science.gov (United States)

    Danilov, L L; Maltsev, S D; Deyeva, A V; Narovlyansky, A N; Sanin, A V; Ozherelkov, S V; Pronin, A V

    1996-01-01

    A novel antiviral drug with immunomodulatory activity (Phosprenyl) is presented. The main active ingredient of the preparation is polyprenyl phosphates. This medicine is highly efficient against a number of viruses, including HIV in vitro, and tick-borne encephalitis and rabies viruses in the experimental models in vivo. In veterinary practice Phosprenyl is now regarded as an effective therapeutic means for treatment of canine distemper, hepatitis, enteritis, etc.

  7. Nurse prescribing in primary care: a metasynthesis of the literature.

    Science.gov (United States)

    Nuttall, Dilyse

    2017-08-08

    Aim The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting. Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber's experience. An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service

  8. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  9. Antifungal and antiviral products of marine organisms.

    Science.gov (United States)

    Cheung, Randy Chi Fai; Wong, Jack Ho; Pan, Wen Liang; Chan, Yau Sang; Yin, Cui Ming; Dan, Xiu Li; Wang, He Xiang; Fang, Evandro Fei; Lam, Sze Kwan; Ngai, Patrick Hung Kui; Xia, Li Xin; Liu, Fang; Ye, Xiu Yun; Zhang, Guo Qing; Liu, Qing Hong; Sha, Ou; Lin, Peng; Ki, Chan; Bekhit, Adnan A; Bekhit, Alaa El-Din; Wan, David Chi Cheong; Ye, Xiu Juan; Xia, Jiang; Ng, Tzi Bun

    2014-04-01

    Marine organisms including bacteria, fungi, algae, sponges, echinoderms, mollusks, and cephalochordates produce a variety of products with antifungal activity including bacterial chitinases, lipopeptides, and lactones; fungal (-)-sclerotiorin and peptaibols, purpurides B and C, berkedrimane B and purpuride; algal gambieric acids A and B, phlorotannins; 3,5-dibromo-2-(3,5-dibromo-2-methoxyphenoxy)phenol, spongistatin 1, eurysterols A and B, nortetillapyrone, bromotyrosine alkaloids, bis-indole alkaloid, ageloxime B and (-)-ageloxime D, haliscosamine, hamigeran G, hippolachnin A from sponges; echinoderm triterpene glycosides and alkene sulfates; molluscan kahalalide F and a 1485-Da peptide with a sequence SRSELIVHQR; and cepalochordate chitotriosidase and a 5026.9-Da antifungal peptide. The antiviral compounds from marine organisms include bacterial polysaccharide and furan-2-yl acetate; fungal macrolide, purpurester A, purpurquinone B, isoindolone derivatives, alterporriol Q, tetrahydroaltersolanol C and asperterrestide A, algal diterpenes, xylogalactofucan, alginic acid, glycolipid sulfoquinovosyldiacylglycerol, sulfated polysaccharide p-KG03, meroditerpenoids, methyl ester derivative of vatomaric acid, lectins, polysaccharides, tannins, cnidarian zoanthoxanthin alkaloids, norditerpenoid and capilloquinol; crustacean antilipopolysaccharide factors, molluscan hemocyanin; echinoderm triterpenoid glycosides; tunicate didemnin B, tamandarins A and B and; tilapia hepcidin 1-5 (TH 1-5), seabream SauMx1, SauMx2, and SauMx3, and orange-spotted grouper β-defensin. Although the mechanisms of antifungal and antiviral activities of only some of the aforementioned compounds have been elucidated, the possibility to use those known to have distinctly different mechanisms, good bioavailability, and minimal toxicity in combination therapy remains to be investigated. It is also worthwhile to test the marine antimicrobials for possible synergism with existing drugs. The prospects of

  10. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2012-09-19

    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  11. The pharmacist as prescriber: a discourse analysis of newspaper media in Canada.

    Science.gov (United States)

    Schindel, Theresa J; Given, Lisa M

    2013-01-01

    Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Teaching safe prescribing to medical students: perspectives in the UK

    Directory of Open Access Journals (Sweden)

    Nazar H

    2015-04-01

    Full Text Available Hamde Nazar,1 Mahdi Nazar,2 Charlotte Rothwell,1 Jane Portlock,3 Andrew Chaytor,1 Andrew Husband1 1School of Medicine, Pharmacy and Health, Durham University, UK; 2Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, UK; 3School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK Abstract: Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge underpinning the therapeutics and developed their personal skills and behaviors in order to write a safe and effective prescription (The Four Ps. However, there are reports of errors in medical prescribing and dissatisfied feedback from recent graduates, which evidence potential flaws in the current training in the practice of prescribing. We examine the Four Ps from a systems approach and offer scope for educators and curriculum designers to review and reflect on their current undergraduate teaching, learning, and assessment strategies in a similar manner. We also adopt a national framework of common competencies required of all prescribers to remain effective and safe in their area of practice as a more objective layer to the broader learning outcomes of the General Medical Council Tomorrow's Doctors 2009. This exercise demonstrates where standard, recognized competencies for safe prescribing can be accommodated pedagogically within existing medical curricula.Keywords: prescribing, medical curriculum, clinical pharmacology teaching, therapeutics, education

  13. ELECTORAL PRESCRIBERS. WHO ARE THEY?

    Directory of Open Access Journals (Sweden)

    Constantin SASU

    2016-12-01

    Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?

  14. Broad-spectrum antiviral therapeutics.

    Directory of Open Access Journals (Sweden)

    Todd H Rider

    Full Text Available Currently there are relatively few antiviral therapeutics, and most which do exist are highly pathogen-specific or have other disadvantages. We have developed a new broad-spectrum antiviral approach, dubbed Double-stranded RNA (dsRNA Activated Caspase Oligomerizer (DRACO that selectively induces apoptosis in cells containing viral dsRNA, rapidly killing infected cells without harming uninfected cells. We have created DRACOs and shown that they are nontoxic in 11 mammalian cell types and effective against 15 different viruses, including dengue flavivirus, Amapari and Tacaribe arenaviruses, Guama bunyavirus, and H1N1 influenza. We have also demonstrated that DRACOs can rescue mice challenged with H1N1 influenza. DRACOs have the potential to be effective therapeutics or prophylactics for numerous clinical and priority viruses, due to the broad-spectrum sensitivity of the dsRNA detection domain, the potent activity of the apoptosis induction domain, and the novel direct linkage between the two which viruses have never encountered.

  15. New opioid prescribing guidelines favor non-opioid alternatives.

    Science.gov (United States)

    2016-05-01

    Determined to make a dent in the growing problem of opioid addiction, the CDC has unveiled new guidelines for opioid prescribing for chronic pain. The recommendations urge providers to be more judicious in their prescribing, opting for opioids only after carefully weighing substantial risks and benefits. Public health authorities note the rampant use and misuse of opioids have "blurred the lines" between prescription opioids and illicit opioids. The new guidelines are designed to help frontline providers balance the need to manage their patients' chronic pain with the duty to curb dangerous prescribing practices. The recommendations are built around three principles: favor non-opioid alternatives for most cases of chronic pain, use the lowest effective dose when prescribing opioids, and exercise caution/monitor patients who are treated with opioids.

  16. What You Should Know about Flu Antiviral Drugs

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Newsletters What You Should Know About Flu Antiviral Drugs Language: ... that can be used to treat flu illness. What are antiviral drugs? Antiviral drugs are prescription medicines ( ...

  17. Naphthyridines with Antiviral Activity - A Review.

    Science.gov (United States)

    Singh, Inder P; Kumar, Sanjay; Gupta, Shiv

    2017-01-01

    Naphthyridine scaffold is an important pharmacophore in compounds which have shown various biological activities like antiviral, antimicrobial, anticancer, antiinflammatory and analgesic. This scaffold is also reported to exhibit activity against HIV, HCMV, HSV, HPV and HCV. Antiviral activity displayed by many naphthyridine analogs is in nM range. Only few review articles are available in literature which describe about various biological activities of naphthyridines, but there is no comprehensive compilation particularly for antiviral activities. The objective of this review is to compile the literature on anti-viral activities of naphthyridine analogs. SciFinder, Google Scholar and PubMed database were searched with keyword "naphthyridine" and the references obtained were further sorted using keywords "antihiv", "antiviral" and "virus", separately. References obtained were considered to review the antiviral literature of naphthyridines. Literature search using SciFinder database with different keywords gave several references. Only references of antiviral activities of naphthyridine compounds were reviewed. References to in-silico studies alone or on formulation development or on patents were excluded. This review will be helpful for future researches to design and synthesize naphthyridine analogs with improved antiviral activities. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

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

    Science.gov (United States)

    ... and Flu Vaccines Vaccine Effectiveness Types of Flu Vaccine Flu Shot Quadrivalent Influenza Vaccine Intradermal Influenza (Flu) Vaccination ... Cell-Based Flu Vaccines Flublok Seasonal Influenza (Flu) Vaccine Flu Vaccination by Jet Injector Adjuvant Vaccine Vaccine Virus ...

  19. Antiviral activity of ovotransferrin derived peptides.

    Science.gov (United States)

    Giansanti, Francesco; Massucci, M Teresa; Giardi, M Federica; Nozza, Fabrizio; Pulsinelli, Emy; Nicolini, Claudio; Botti, Dario; Antonini, Giovanni

    2005-05-27

    Ovotransferrin and lactoferrin are iron-binding proteins with antiviral and antibacterial activities related to natural immunity, showing marked sequence and structural homologies. The antiviral activity of two hen ovotransferrin fragments DQKDEYELL (hOtrf(219-227)) and KDLLFK (hOtrf(269-301) and hOtrf(633-638)) towards Marek's disease virus infection of chicken embryo fibroblasts is reported here. These fragments have sequence homology with two bovine lactoferrin fragments with antiviral activity towards herpes simplex virus, suggesting that these fragments could have a role for the exploitation of the antiviral activity of the intact proteins towards herpes viruses. NMR analysis showed that these peptides, chemically synthetized, did not possess any favourite conformation in solution, indicating that both the aminoacid sequence and the conformation they display in the intact protein are essential for the antiviral activity.

  20. Hepatitis C Virus and Antiviral Drug Resistance

    Science.gov (United States)

    Kim, Seungtaek; Han, Kwang-Hyub; Ahn, Sang Hoon

    2016-01-01

    Since its discovery in 1989, hepatitis C virus (HCV) has been intensively investigated to understand its biology and develop effective antiviral therapies. The efforts of the previous 25 years have resulted in a better understanding of the virus, and this was facilitated by the development of in vitro cell culture systems for HCV replication. Antiviral treatments and sustained virological responses have also improved from the early interferon monotherapy to the current all-oral regimens using direct-acting antivirals. However, antiviral resistance has become a critical issue in the treatment of chronic hepatitis C, similar to other chronic viral infections, and retreatment options following treatment failure have become important questions. Despite the clinical challenges in the management of chronic hepatitis C, substantial progress has been made in understanding HCV, which may facilitate the investigation of other closely related flaviviruses and lead to the development of antiviral agents against these human pathogens. PMID:27784846

  1. Nurse prescribing: radicalism or tokenism?

    Science.gov (United States)

    McCartney, W; Tyrer, S; Brazier, M; Prayle, D

    1999-02-01

    The creation of The Medical Products (Prescription by Nurses, etc.) Act 1992 has been generally welcomed by the nursing profession. This article seeks to introduce a note of scepticism about the assumed motivations for its introduction through an analysis of various legal, ethical, economic and political dimensions. In reviewing the position of nursing vis-à-vis medicine it is argued that one of the ways that nursing has sought to improve its professional position is to take on work previously done by doctors, and nurse prescribing can be seen in the context of the concurrent de-regulation of medicines, allowing greater access to medicines and therefore greater consumer choice. This de-regulation stems from the liberation ideology of the previous Conservative government. Viewed in this way nurse prescribing, particularly with reference to the limited nature of the nursing formulary, can be seen to be anomalous. In the light of this analysis, the reasons generally put forward (notably in the Crown Report 1989) for the introduction of nurse prescribing could be seen to be peripheral to its real purpose. It is argued that the most convincing reasons for its introduction relate to the medical profession as a social institution. It is proposed that the three primary aims behind the introduction of nurse prescribing are: the saving of money; the transfer of routine medical work to nursing; and a challenge to the professional monolith of medicine.

  2. Analgesic prescribing in palliative care.

    Science.gov (United States)

    Lowe, Emma; Hanchanale, Sarika; Hurlow, Adam

    2014-12-01

    Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.

  3. 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses.

    Science.gov (United States)

    Johnson, Chris F; Williams, Brian; MacGillivray, Stephen A; Dougall, Nadine J; Maxwell, Margaret

    2017-06-17

    Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs' use of antidepressants and their doses to treat depression. Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model. Depression treatment involved ethical and professional imperatives of 'doing the right thing' for individuals by striving to achieve the 'right care fit'. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate. Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks, preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain

  4. Is new drug prescribing in primary care specialist induced?

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2009-01-01

    Full Text Available Abstract Background Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. Methods This study estimates the influence of medical specialists on new drug prescribing in primary care shortly after market introduction. The influence of medical specialists on prescribing of five new drugs was measured in a cohort of 103 GPs, working in 59 practices, over the period 1999 until 2003. The influence of medical specialists on new drug prescribing in primary care was assessed using three outcome measures. Firstly, the proportion of patients receiving their first prescription for a new or reference drug from a specialist. Secondly, the proportion of GPs prescribing new drugs before any specialist prescribes to their patients. Thirdly, we compared the time until the GP's first own prescribing between GPs who waited for prescriptions from specialists and those who did not. Results The influence of specialists showed considerable differences among the new drugs studied. The proportion of patients receiving their first prescription from a specialist was greatest for the combination salmeterol/fluticasone (60.2%, and lowest for rofecoxib (23.0%. The proportion of GPs prescribing new drugs before waiting for prescriptions from medical specialists ranged from 21.1% in the case of esomeprazole to 32.9% for rofecoxib. Prescribing new drugs by specialists did not shorten the GP's own time to prescribing. Conclusion This study shows that the influence of medical specialists is clearly visible for all new drugs and often greater than for the existing older drugs, but the rapid uptake of new drugs in primary care does not seem specialist induced in all cases. GPs are responsible for a substantial amount of all early prescriptions for new drugs and for a subpopulation specialist endorsement is not a requisite to initiate in new drug prescribing

  5. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing.

    Science.gov (United States)

    Broom, Alex; Broom, Jennifer; Kirby, Emma

    2014-06-01

    The prospect of an 'antimicrobial perfect storm' in the coming decades through the emergence and proliferation of multi-resistant organisms has become an urgent public health concern. With limited drug discovery solutions foreseeable in the immediate future, and with evidence that resistance can be ameliorated by optimisation of prescribing, focus currently centres on antibiotic use. In hospitals, this is manifest in the development of stewardship programs that aim to alter doctors' prescribing behaviour. Yet, in many clinical contexts, doctors' antibiotic prescribing continues to elude best practice. In this paper, drawing on qualitative interviews with 30 Australian hospital-based doctors in mid-2013, we draw on Bourdieu's theory of practice to illustrate that 'sub-optimal' antibiotic prescribing is a logical choice within the habitus of the social world of the hospital. That is, the rules of the game within the field are heavily weighted in favour of the management of immediate clinical risks, reputation and concordance with peer practice vis-à-vis longer-term population consequences. Antimicrobial resistance is thus a principal of limited significance in the hospital. We conclude that understanding the habitus of the hospital and the logics underpinning practice is a critical step toward developing governance practices that can respond to clinically 'sub-optimal' antibiotic use.

  6. Antiviral active peptide from oyster

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    An active peptide against herpes virus was isolated from the enzymic hydrolysate of oyster (Crassostrea gigas) and purified with the definite direction hydrolysis technique in the order of alcalase and bromelin. The hydrolysate was fractioned into four ranges of molecular weight (>10 kDa, 10-5 kDa, 5-1 kDa and <1 kDa) using ultrafiltration membranes and dialysis. The fraction of 10?5 kDa was purified using consecutive chromatographic methods including DEAE Sephadex A-25 column, Sephadex G-25 column, and high performance liquid chromatogram (HPLC) by activity-guided isolation. The antiviral effect of the obtained peptide on herpetic virus was investigated in Vero cells by observing cytopathic effect (CPE). The result shows that the peptide has high inhibitory activity on herpetic virus.

  7. Antiviral Perspectives for Chikungunya Virus

    Directory of Open Access Journals (Sweden)

    Deepti Parashar

    2014-01-01

    Full Text Available Chikungunya virus (CHIKV is a mosquito-borne pathogen that has a major health impact in humans and causes acute febrile illness in humans accompanied by joint pains and, in many cases, persistent arthralgia lasting for weeks to years. CHIKV reemerged in 2005-2006 in several parts of the Indian Ocean islands and India after a gap of 32 years, causing millions of cases. The re-emergence of CHIKV has also resulted in numerous outbreaks in several countries in the eastern hemisphere, with a threat to further expand in the near future. However, there is no vaccine against CHIKV infection licensed for human use, and therapy for CHIKV infection is still mainly limited to supportive care as antiviral agents are yet in different stages of testing or development. In this review we explore the different perspectives for chikungunya treatment and the effectiveness of these treatment regimens and discuss the scope for future directions.

  8. An audit of generic prescribing in a general surgical department.

    LENUS (Irish Health Repository)

    Gleeson, M

    2013-01-17

    BACKGROUND: The Health Service Executive introduced a generic prescription policy to reduce costs. Despite this, generic prescription rates remain low. AIM: To audit in-patient prescription practice in a single surgical department and identify potential savings which could be realised by adherence to the generic prescribing policy. METHODS: Surgical in-patient charts were obtained at the point of discharge and their drug prescription information was recorded. RESULTS: 51 % of prescriptions involved a trade-name prescription where an appropriate generic equivalent existed. The cost implications for hospital and community patients were found to be greatly affected by substitution policies that exist at hospital pharmacy level. CONCLUSION: There is a need to promote greater adherence to generic prescribing amongst hospital doctors in line with international best practice. It can have a positive impact in terms of safe prescribing and can have cost implications at both hospital and community level.

  9. The primary care prescribing psychologist model: medical provider ratings of the safety, impact and utility of prescribing psychology in a primary care setting.

    Science.gov (United States)

    Shearer, David S; Harmon, S Cory; Seavey, Brian M; Tiu, Alvin Y

    2012-12-01

    Family medicine providers at a large family medicine clinic were surveyed regarding their impression of the impact, utility and safety of the Primary Care Prescribing Psychologist (PCPP) model in which a prescribing psychologist is embedded in a primary care clinic. This article describes the model and provides indications of its strengths and weaknesses as reported by medical providers who have utilized the model for the past 2 years. A brief history of prescribing psychology and the challenges surrounding granting psychologists the authority to prescribe psychotropic medication is summarized. Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care. Potential benefits of integrating prescribing psychology into primary care are considered and directions for future research are discussed.

  10. Soil heating and impact of prescribed burning

    Science.gov (United States)

    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.

  11. Assessment of antibiotic prescribing in Latvian general practitioners

    Directory of Open Access Journals (Sweden)

    Dumpis Uga

    2013-01-01

    Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

  12. Opioid Prescribing Education in Surgical Residencies: A Program Director Survey.

    Science.gov (United States)

    Yorkgitis, Brian K; Bryant, Elizabeth; Raygor, Desiree; Brat, Gabriel; Smink, Douglas S; Crandall, Marie

    2017-09-04

    Opioid abuse and misuse is a public health crisis. A national effort to reduce this phenomenon is ongoing. Residents represent a large pool of opioid prescribers but, are often not the target for opioid prescribing education (OPE). We developed a survey to assess current opioid prescribing practices and education among surgical residents. An Institutional Review Board and Association of Program Directors in Surgery approved survey was electronically mailed to surgical program directors (PDs). The survey included questions regarding residency type, location, number of graduates per year, perceived value of OPE, residency policy on prescribing outpatients controlled substances, presence of OPE, and preferred method of OPE. A total of 248 PDs were e-mailed the survey with 110 complete responses (44.4%). Of all 104 (94.5%) allow residents to prescribe outpatient opioids with 24 (23.1%) limiting the opioid class prescribed. A total of 29 (27.9%) programs require residents to obtain their own Drug Enforcement Administration registration. Only 22 (20.0%) programs had in place mandatory OPE, 7 (6.4%) PDs were unsure if OPE was a mandatory educational requirement. Furthermore, 70 (79.5%) of programs currently without OPE are considering adding it. Didactic lecture (18, 81.8%) is the most common modality for OPE. The mode time dedicated to OPE was 1 hour. When PDs were asked about which method would be best to deliver OPE, the most common response was case-based scenarios (39, 35.5%). Bivariate statistics were performed and no association was found between OPE and program characteristics'. Most surgical residency programs allow residents to prescribe outpatient opioids, very few require OPE. The most common method of OPE was didactic lectures. To enhance a resident's knowledge in prescribing opioids, programs should incorporate OPE into their curriculum. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Courtenay Molly

    2012-06-01

    Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

  14. New drug prescribing by hospital doctors: the nature and meaning of knowledge.

    Science.gov (United States)

    Prosser, Helen; Walley, Tom

    2006-04-01

    In the UK the high cost of new drugs is partly accountable for the growth in spending on prescription drugs. Most prescribing takes place in general practice and the influence of secondary care prescribing on primary care prescribing is well recognized; yet the factors that influence hospital prescribing have been little researched. Drawing on accounts of actual prescribing events from hospital doctors from a range of specialties, we investigated the processes by which new drugs come into practice, from hospital doctors' awareness of new drugs to the assimilation and interpretation of evidential sources. The determinants of new drug prescribing were interconnected within four forms of knowledge: scientific knowledge, social knowledge, patient knowledge and experiential knowledge. Furthermore, the nature of knowledge could only be understood within its situated context. The revelation of multiple and contingent forms of knowledge highlights the problematic nature of knowledge construction within the approaches of evidence-based medicine.

  15. Prescribing style and variation in antibiotic prescriptions for sore throat

    DEFF Research Database (Denmark)

    Cordoba Currea, Gloria Cristina; Siersma, Volkert Dirk; Lopez-Valcarcel, Beatriz Gonzalez

    2015-01-01

    Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we...

  16. In vitro evaluation of marine-microorganism extracts for anti-viral activity

    Directory of Open Access Journals (Sweden)

    Yasuhara-Bell Jarred

    2010-08-01

    Full Text Available Abstract Viral-induced infectious diseases represent a major health threat and their control remains an unachieved goal, due in part to the limited availability of effective anti-viral drugs and measures. The use of natural products in drug manufacturing is an ancient and well-established practice. Marine organisms are known producers of pharmacological and anti-viral agents. In this study, a total of 20 extracts from marine microorganisms were evaluated for their antiviral activity. These extracts were tested against two mammalian viruses, herpes simplex virus (HSV-1 and vesicular stomatitis virus (VSV, using Vero cells as the cell culture system, and two marine virus counterparts, channel catfish virus (CCV and snakehead rhabdovirus (SHRV, in their respective cell cultures (CCO and EPC. Evaluation of these extracts demonstrated that some possess antiviral potential. In sum, extracts 162M(4, 258M(1, 298M(4, 313(2, 331M(2, 367M(1 and 397(1 appear to be effective broad-spectrum antivirals with potential uses as prophylactic agents to prevent infection, as evident by their highly inhibitive effects against both virus types. Extract 313(2 shows the most potential in that it showed significantly high inhibition across all tested viruses. The samples tested in this study were crude extracts; therefore the development of antiviral application of the few potential extracts is dependent on future studies focused on the isolation of the active elements contained in these extracts.

  17. In vitro evaluation of marine-microorganism extracts for anti-viral activity.

    Science.gov (United States)

    Yasuhara-Bell, Jarred; Yang, Yongbo; Barlow, Russell; Trapido-Rosenthal, Hank; Lu, Yuanan

    2010-08-07

    Viral-induced infectious diseases represent a major health threat and their control remains an unachieved goal, due in part to the limited availability of effective anti-viral drugs and measures. The use of natural products in drug manufacturing is an ancient and well-established practice. Marine organisms are known producers of pharmacological and anti-viral agents. In this study, a total of 20 extracts from marine microorganisms were evaluated for their antiviral activity. These extracts were tested against two mammalian viruses, herpes simplex virus (HSV-1) and vesicular stomatitis virus (VSV), using Vero cells as the cell culture system, and two marine virus counterparts, channel catfish virus (CCV) and snakehead rhabdovirus (SHRV), in their respective cell cultures (CCO and EPC). Evaluation of these extracts demonstrated that some possess antiviral potential. In sum, extracts 162M(4), 258M(1), 298M(4), 313(2), 331M(2), 367M(1) and 397(1) appear to be effective broad-spectrum antivirals with potential uses as prophylactic agents to prevent infection, as evident by their highly inhibitive effects against both virus types. Extract 313(2) shows the most potential in that it showed significantly high inhibition across all tested viruses. The samples tested in this study were crude extracts; therefore the development of antiviral application of the few potential extracts is dependent on future studies focused on the isolation of the active elements contained in these extracts.

  18. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  19. 27 CFR 20.21 - Forms prescribed.

    Science.gov (United States)

    2010-04-01

    ... OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF DENATURED ALCOHOL AND RUM Administrative Provisions Authorities § 20.21 Forms prescribed. (a) The appropriate TTB officer is authorized to prescribe all...

  20. Prescribed Fire Plan Union Slough NWR 1994

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document outlines a prescribed burn schedule for Union Slough National Wildlife Refuge. The Prescribed Fire Plan provides the following information; names of...

  1. Why Does My Dentist Prescribe Medication?

    Science.gov (United States)

    ... your desktop! more... Why Does My Dentist Prescribe Medication? Article Chapters Why Does My Dentist Prescribe Medication? ... dentist or pharmacist. Reviewed: January 2012 Related Articles: Medication Epilepsy, Seizure Meds Have Oral Health Implications How ...

  2. Clinical Implications of Antiviral Resistance in Influenza

    OpenAIRE

    Li, Timothy C. M.; Chan, Martin C. W.; Nelson Lee

    2015-01-01

    Influenza is a major cause of severe respiratory infections leading to excessive hospitalizations and deaths globally; annual epidemics, pandemics, and sporadic/endemic avian virus infections occur as a result of rapid, continuous evolution of influenza viruses. Emergence of antiviral resistance is of great clinical and public health concern. Currently available antiviral treatments include four neuraminidase inhibitors (oseltamivir, zanamivir, peramivir, laninamivir), M2-inibitors (amantadin...

  3. Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the efficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice

    Science.gov (United States)

    2013-01-01

    Background Respiratory tract infections are an important burden in primary care and it’s known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics. Methods Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit). Discussion Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care. Trial registration This trial is registered with ClinicalTrials.gov, number http://NCT01363531. PMID:23682979

  4. Silver Nanoparticles as Potential Antiviral Agents

    Directory of Open Access Journals (Sweden)

    Massimiliano Galdiero

    2011-10-01

    Full Text Available Virus infections pose significant global health challenges, especially in view of the fact that the emergence of resistant viral strains and the adverse side effects associated with prolonged use continue to slow down the application of effective antiviral therapies. This makes imperative the need for the development of safe and potent alternatives to conventional antiviral drugs. In the present scenario, nanoscale materials have emerged as novel antiviral agents for the possibilities offered by their unique chemical and physical properties. Silver nanoparticles have mainly been studied for their antimicrobial potential against bacteria, but have also proven to be active against several types of viruses including human imunodeficiency virus, hepatitis B virus, herpes simplex virus, respiratory syncytial virus, and monkey pox virus. The use of metal nanoparticles provides an interesting opportunity for novel antiviral therapies. Since metals may attack a broad range of targets in the virus there is a lower possibility to develop resistance as compared to conventional antivirals. The present review focuses on the development of methods for the production of silver nanoparticles and on their use as antiviral therapeutics against pathogenic viruses.

  5. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    LENUS (Irish Health Repository)

    Lockwood, Emily B

    2008-10-01

    AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers

  6. 'It's showed me the skills that he has': pharmacists' and mentors' views on pharmacist supplementary prescribing.

    Science.gov (United States)

    Lloyd, Fran; Parsons, Carole; Hughes, Carmel M

    2010-02-01

    Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n = 47) were invited to participate in focus groups, while mentors (n = 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Nine pharmacist focus groups were convened (number per group ranging from three to six; total n = 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element. Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice

  7. An intervention modelling experiment to change GPs' intentions to implement evidence-based practice: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2

    Directory of Open Access Journals (Sweden)

    Kaner Eileen FS

    2008-01-01

    Full Text Available Abstract Background Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour. Behaviour change interventions, designed using psychological theory and targeting important motivational beliefs, were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection (URTI. Methods The design was a 2 × 2 factorial randomised controlled trial. A postal questionnaire was developed based on three theories of human behaviour: Theory of Planned Behaviour; Social Cognitive Theory and Operant Learning Theory. The beliefs and attitudes of GPs regarding the management of URTI without antibiotics and rates of prescribing on eight patient scenarios were measured at baseline and post-intervention. Two theory-based interventions, a "graded task" with "action planning" and a "persuasive communication", were incorporated into the post-intervention questionnaire. Trial groups were compared using co-variate analyses. Results Post-intervention questionnaires were returned for 340/397 (86% GPs who responded to the baseline survey. Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25 and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98. Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38 and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74. Conclusion GPs' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so. Two targeted behaviour change interventions differentially affected

  8. An intervention modelling experiment to change GPs' intentions to implement evidence-based practice: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2

    Science.gov (United States)

    Hrisos, Susan; Eccles, Martin; Johnston, Marie; Francis, Jill; Kaner, Eileen FS; Steen, Nick; Grimshaw, Jeremy

    2008-01-01

    Background Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour. Behaviour change interventions, designed using psychological theory and targeting important motivational beliefs, were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection (URTI). Methods The design was a 2 × 2 factorial randomised controlled trial. A postal questionnaire was developed based on three theories of human behaviour: Theory of Planned Behaviour; Social Cognitive Theory and Operant Learning Theory. The beliefs and attitudes of GPs regarding the management of URTI without antibiotics and rates of prescribing on eight patient scenarios were measured at baseline and post-intervention. Two theory-based interventions, a "graded task" with "action planning" and a "persuasive communication", were incorporated into the post-intervention questionnaire. Trial groups were compared using co-variate analyses. Results Post-intervention questionnaires were returned for 340/397 (86%) GPs who responded to the baseline survey. Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25) and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98). Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38) and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74). Conclusion GPs' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so. Two targeted behaviour change interventions differentially affected these beliefs. One

  9. Diurnal variation of prescribing pattern of primary care doctors in Bahrain.

    Science.gov (United States)

    Damanhori, Awatif H H; Al Khaja, Khalid A J; Sequeira, Reginald P; Al-Ansari, Thuraya M

    2007-02-01

    To evaluate the variation in prescribing by primary care doctors during the morning and the evening clinics and to determine whether these prescribing patterns are influenced by doctors' training background. A retrospective prescription-based study was carried out in 17 out of 20 primary care health centres in Bahrain distributed across the Kingdom. A total of 4472 prescriptions containing 10 588 drug-items covering the prescribing practice of approximately 90% primary care doctors were analysed. Paracetamol was the most commonly prescribed drug in both clinics. Drugs such as diclofenac sodium, amoxycillin, ibuprofen, chlorpheniramine, hyoscine butylbromide, Actifed, Benylin and xylometazoline were the most commonly prescribed drugs to patients attending morning and evening clinics with a considerable variation in ordinal ranking of proportions. As regards morning clinic, chlorpheniramine and Fefol were prescribed by the family doctors (FDs) more often than by the general practitioners (GPs) (Pprescription was 2.41+/-1.3. Prescriptions containing three or more drugs comprised 41.7% of all prescriptions. The GPs had a greater tendency to practice polypharmacy than the FDs. A significant diurnal variation in prescribing, and polypharmacy practice were related to the training background of the doctors. This quantitative study provides the baseline data for monitoring primary care prescribing practices in Bahrain. To further evaluate the underlying factors that influence drug use indicators, a qualitative study is needed.

  10. Prescribing pattern in orthopedics outpatient department of a medical college in India

    Directory of Open Access Journals (Sweden)

    Indranil Banerjee

    2015-12-01

    Conclusion: The current piece of work pointed out certain lacunae in the prescribing practices of the orthopedicians of the institute as evidenced by low generic prescribing, inadequate information about the duration of therapy and frequency of administration in many prescriptions. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1175-1177

  11. Developing resilient ponderosa pine forests with mechanical thinning and prescribed fire in central Oregon's pumice region

    Science.gov (United States)

    Matt D. Busse; P.H. Cochran; William E. Hopkins; William H. Johnson; Gregg M. Riegel; Gary O. Fiddler; Alice W. Ratcliff; Carol J. Shestak

    2009-01-01

    Thinning and prescribed burning are common management practices for reducing fuel buildup in ponderosa pine forests. However, it is not well understood if their combined use is required to lower wildfire risk and to help restore natural ecological function. We compared 16 treatment combinations of thinning, prescribed fire, and slash retention for two decades...

  12. Validity of the Prescriber Information in the Danish National Prescription Registry.

    Science.gov (United States)

    Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta; Hallas, Jesper; Pottegård, Anton

    2016-10-01

    The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2000 non-electronic prescriptions at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% confidence interval (CI): 20.6-24.3) when considering individual prescriber identifiers and 17.8% (95% CI: 16.1-19.5) when considering prescriber type. When excluding prescriptions specifically registered as 'missing prescriber identifier', the proportions decreased to 9.5% (95% CI: 8.2-11.0) and 4.1% (95% CI: 3.2-5.1), respectively. The positive predictive values for the classification of prescriber types were in the range of 94.0-99.2%, while the sensitivity ranged between 64.6% and 91.8%. With a maximum of 14% non-electronic prescriptions of all prescriptions in the DNPR in 2015, this corresponds to correct classification of prescriber types in the DNPR of at least 97.5%. In conclusion, the prescriber information in the DNPR was found to be valid, especially in recent years. Researchers should be aware of the low sensitivity towards prescriptions from private practicing specialists.

  13. Prescribing of FDA-approved and compounded hormone therapy differs by specialty.

    Science.gov (United States)

    Constantine, Ginger D; Archer, David F; Graham, Shelli; Bernick, Brian A; Mirkin, Sebastian

    2016-10-01

    To determine the prescribing patterns of general practitioners (GPs), obstetrician/gynecologists (OB/GYNs), and wellness physicians (WPs) of menopausal hormone therapy (HT) for both compounded (CHT) and Food and Drug Administration (FDA)-approved products, using a survey of US physicians. Nine thousand one US physicians were invited to participate in a survey to report on their HT-prescribing patterns. Physicians were eligible if they prescribed HT for at least six patients per month. The survey was completed by 440 eligible physicians (893 responded of 9,001 invited) including 171 GPs, 170 OB/GYNs, and 84 WPs. Physicians prescribed HT for 15% to 30% of their female patients, with WPs numerically most likely to prescribe HT. Menopausal symptoms were the leading reason for HT prescriptions among all specialties. WPs seemed more likely to prescribe HT for general/cardiovascular health (28%), and for shorter durations, than other specialties. WPs prescribed proportionally more compounded (vs FDA-approved) estrogens/progestogens than GPs or OB/GYNs, but OB/GYNs seemed to prescribe more compounded dehydroepiandrosterone and testosterone (prescribed alone) than did others. OB/GYNs seemed least likely to consider CHT being more safe or effective than FDA-approved HT. Symptom relief was the main determinant of efficacy for all specialties; WPs also used blood (61%) or saliva testing (25%) for dose adjustment. Although all physician specialties surveyed prescribed HT, differences in prescribing CHT versus FDA-approved formulations by medical specialty/practice seemed to exist. Of those surveyed, OB/GYNs and GPs prescribed proportionally more FDA-approved HT, whereas WPs, similarly, prescribed more CHT. More discussion is needed concerning physicians' decisions to prescribe CHT versus FDA-approved formulations.

  14. Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial.

    Science.gov (United States)

    Vellinga, Akke; Galvin, Sandra; Duane, Sinead; Callan, Aoife; Bennett, Kathleen; Cormican, Martin; Domegan, Christine; Murphy, Andrew W

    2016-02-02

    Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections. We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing. The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention. A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. ClinicalTrials.gov, no. NCT01913860. © 2016 Canadian Medical Association or its licensors.

  15. Containing pandemic influenza with antiviral agents.

    Science.gov (United States)

    Longini, Ira M; Halloran, M Elizabeth; Nizam, Azhar; Yang, Yang

    2004-04-01

    For the first wave of pandemic influenza or a bioterrorist influenza attack, antiviral agents would be one of the few options to contain the epidemic in the United States until adequate supplies of vaccine were available. The authors use stochastic epidemic simulations to investigate the effectiveness of targeted antiviral prophylaxis to contain influenza. In this strategy, close contacts of suspected index influenza cases take antiviral agents prophylactically. The authors compare targeted antiviral prophylaxis with vaccination strategies. They model an influenza pandemic or bioterrorist attack for an agent similar to influenza A virus (H2N2) that caused the Asian influenza pandemic of 1957-1958. In the absence of intervention, the model predicts an influenza illness attack rate of 33% of the population (95% confidence interval (CI): 30, 37) and an influenza death rate of 0.58 deaths/1,000 persons (95% Cl: 0.4, 0.8). With the use of targeted antiviral prophylaxis, if 80% of the exposed persons maintained prophylaxis for up to 8 weeks, the epidemic would be contained, and the model predicts a reduction to an illness attack rate of 2% (95% Cl: 0.2, 16) and a death rate of 0.04 deaths/1,000 persons (95% CI: 0.0003, 0.25). Such antiviral prophylaxis is nearly as effective as vaccinating 80% of the population. Vaccinating 80% of the children aged less than 19 years is almost as effective as vaccinating 80% of the population. Targeted antiviral prophylaxis has potential as an effective measure for containing influenza until adequate quantities of vaccine are available.

  16. Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department.

    Science.gov (United States)

    Kroening-Roche, Jason C; Soroudi, Arash; Castillo, Edward M; Vilke, Gary M

    2012-08-01

    Although the overuse of antibiotics and underuse of bronchodilators for treatment of acute bronchitis is well known, few studies have analyzed these trends in the emergency department (ED). To characterize the antibiotic and bronchodilator prescribing practices of physicians at two academic EDs in the diagnosis of acute bronchitis, and to identify factors that may or may not be associated with these practices. A computer database was searched retrospectively for all patients with an ED discharge diagnosis of acute bronchitis, and analyzed, looking at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and several other related factors including age, gender, chief complaint, duration of cough, and comorbid conditions. During the study period, there were 836 cases of acute bronchitis in adults. Of these, 622 (74.0%) were prescribed antibiotics. Of those prescribed antibiotics, 480 (77.2%) were prescribed broad-spectrum antibiotics. Using multivariate analysis (odds ratio, 95% confidence interval), antibiotics were prescribed significantly more often in patients aged 50 years or older (1.7, 1.2-2.5) and in smokers (1.5, 1.0-2.2). Of patients without asthma, 346 (49.9%) were discharged without a bronchodilator, and 631 (91.1%) were discharged without a spacer device. Antibiotics are over-prescribed in the ED for acute bronchitis, with broad-spectrum antibiotics making up the majority of the antibiotics prescribed. Age ≥50 years and smoking are associated with higher antibiotic prescribing rates. Copyright © 2012. Published by Elsevier Inc.

  17. Comparisons of anti-diabetic prescriptions of private practitioners and hospital prescribers: A survey

    Directory of Open Access Journals (Sweden)

    Ananya Mandal

    2013-01-01

    Full Text Available Monotherapy as well as effective and safe combination therapy for diabetes is practiced widely by both private and government hospital prescribers. This study attempted to compare the prescriptions of government and private practitioners to obtain a fair idea of the trends of diabetes management in either group. Prescriptions for diabetic patients from both private practitioners and government medical college prescribers were collected. These were analyzed for parameters such as number and type of drugs, cost, and generic prescription. Private prescribers were not significantly different from hospital prescribers in terms of number of drugs per prescription, cost of therapy, and treatment regimens. However, there was a dearth of generic prescriptions from private consultants (33% vs. 9%. Metformin and Glimepiride were the most prescribed drugs in both groups. However, private practitioners preferred Gliclazide, Glipizide, and Glibenclamide more than hospital prescribers.

  18. Views on nurse prescribing: a survey of community mental health nurses in the Republic of Ireland.

    Science.gov (United States)

    Wells, J; Bergin, M; Gooney, M; Jones, A

    2009-02-01

    A nurse prescribing scheme has recently been implemented within the Republic of Ireland. This paper reports on the views of community mental health nurses on nurse prescribing just prior to the implementation of the scheme. Data were gathered through a 13-item questionnaire administered to 103 members of the Association of Community Mental Health Nurses in Ireland. Results indicated a distinct difference of view between male and female community mental health nurses, with female nurses having greater reservations towards the desirability of nurse prescribing in relation to educational preparation and impact on professional relationships. Overall, only 17% of respondents favoured being supervised in their prescribing practice by their consultant psychiatrist. The paper concludes that there is ambivalence towards prescribing in this important group of nurses which may need to be taken into account if nurse prescribing is to be successfully implemented within the Irish mental health service context.

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

    Science.gov (United States)

    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

  20. Antiviral activities of heated dolomite powder.

    Science.gov (United States)

    Motoike, Koichi; Hirano, Shozo; Yamana, Hideaki; Onda, Tetsuhiko; Maeda, Takayoshi; Ito, Toshihiro; Hayakawa, Motozo

    2008-12-01

    The effect of the heating conditions of dolomite powder on its antiviral activity was studied against the H5N3 avian influenza virus. Calcium oxide (CaO) and magnesium oxide (MgO), obtained by the thermal decomposition of dolomite above 800 degrees C, were shown to have strong antiviral activity, but the effect was lessened when the heating temperature exceeded 1400 degrees C. Simultaneous measurement of the crystallite size suggested that the weakening of the activity was due to the considerable grain growth of the oxides. It was found that the presence of Mg in dolomite contributed to the deterrence of grain growth of the oxides during the heating process. Although both CaO and MgO exhibited strong antiviral activity, CaO had the stronger activity but quickly hydrated in the presence of water. On the other hand, the hydration of MgO took place gradually under the same conditions. Separate measurements using MgO and Mg(OH)2 revealed that MgO had a higher antiviral effect than Mg(OH)2. From the overall experiments, it was suggested that the strong antiviral activity of dolomite was related to the hydration reaction of CaO.

  1. SOME ASPECTS OF THE MARKETING STUDIES FOR THE PHARMACEUTICAL MARKET OF ANTIVIRAL DRUGS

    Directory of Open Access Journals (Sweden)

    A. G. Salnikova

    2015-01-01

    Full Text Available Antiviral drugs are widely used in medicinal practice. They suppress the originator and stimulate the protection of an organism. The drugs are used for the treatment of flu and ARVI, herpetic infections, virus hepatitis, HIV-infection. Contemporary pharmaceutical market is represented by a wide range of antiviral drugs. Marketing studies are conducted to develop strategies, used for the enhancement of pharmacy organization activity efficiency. Conduction of the marketing researches of pharmaceutical market is the purpose of this study. We have used State Registry of Drugs, State Record of Drugs, List of vital drugs, questionnaires of pharmaceutical workers during our work. Historical, sociological, mathematical methods, and a method of expert evaluation were used in the paper. As the result of the study we have made the following conclusions. We have studied and generalized the literature data about classification and application of antiviral drugs, marketing, competition. The assortment of antiviral drugs on the pharmaceutical market of the Russian Federation was also studied. We have conducted an analysis for the obtainment of the information about antiviral drugs by pharmaceutical workers. We have determined the competitiveness of antiviral drugs, and on the basis of the research conducted we have submitted an offer for pharmaceutical organizations to form the range of antiviral drugs.

  2. International rigid contact lens prescribing.

    Science.gov (United States)

    Efron, Nathan; Morgan, Philip B; Helland, Magne; Itoi, Motozumi; Jones, Deborah; Nichols, Jason J; van der Worp, Eef; Woods, Craig A

    2010-06-01

    Rigid lenses have been fitted less since the introduction of soft lenses nearly 40 years ago. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 facilitate an accurate characterization of the pattern of the decline of rigid lens fitting during the first decade of this century. There is a trend for rigid lenses to be utilized primarily for refitting those patients who are already successful rigid lens wearers-most typically older females being refit with higher Dk materials. Rigid lenses are generally fitted on a full-time basis (four or more days of wear per week) without a planned replacement schedule. Orthokeratology is especially popular in the Netherlands, but is seldom prescribed in the other countries surveyed.

  3. Quantum measurements with prescribed symmetry

    Science.gov (United States)

    Bruzda, Wojciech; Goyeneche, Dardo; Życzkowski, Karol

    2017-08-01

    We introduce a method to determine whether a given generalized quantum measurement is isolated or if it belongs to a family of measurements having the same prescribed symmetry. The technique proposed reduces to solving a linear system of equations in some relevant cases. As a consequence, we provide a simple derivation of the maximal family of symmetric informationally complete positive operator-valued measure SIC-POVM in dimension 3. Furthermore, we show that the following remarkable geometrical structures are isolated, so that free parameters cannot be introduced: (a) maximal sets of mutually unbiased bases in prime power dimensions from 4 to 16, (b) SIC-POVM in dimensions from 4 to 16, and (c) contextual Kochen-Specker sets in dimension 3, 4, and 6, composed of 13, 18, and 21 vectors, respectively.

  4. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  5. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

    Directory of Open Access Journals (Sweden)

    John H. Burton

    2016-05-01

    Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

  6. A fresh look at an antiviral helicase

    Institute of Scientific and Technical Information of China (English)

    Leonid Gitlin; Marco Colonna

    2007-01-01

    @@ In order to survive,all organlsms must guard against viral infections.Recognition of viruses is accomplished via multiple sensors.Many mammalian proteins can recognize viral products,such as double-stranded RNA(dsRNA),yet feW of them are known to induce interferon,the central antiviral messenger.Since interferon is indispensable for Successful antiviral defense [1],the interferon-inducing sensors have been of particular interest.However,a clear understanding of such sensors has been elusive,and the first well-established sensor family,the toll-like receptors (TLRs),was described relatively recently[2].Antiviral TLRS are positioned in the endosomes,where they report the appearance of viral genetic material(DNA,single-and double-stranded RNA).

  7. Antiviral Defense Mechanisms in Honey Bees

    Science.gov (United States)

    Brutscher, Laura M.; Daughenbaugh, Katie F.; Flenniken, Michelle L.

    2015-01-01

    Honey bees are significant pollinators of agricultural crops and other important plant species. High annual losses of honey bee colonies in North America and in some parts of Europe have profound ecological and economic implications. Colony losses have been attributed to multiple factors including RNA viruses, thus understanding bee antiviral defense mechanisms may result in the development of strategies that mitigate colony losses. Honey bee antiviral defense mechanisms include RNA-interference, pathogen-associated molecular pattern (PAMP) triggered signal transduction cascades, and reactive oxygen species generation. However, the relative importance of these and other pathways is largely uncharacterized. Herein we review the current understanding of honey bee antiviral defense mechanisms and suggest important avenues for future investigation. PMID:26273564

  8. Characteristics, resource utilization and safety profile of patients prescribed with neuropathic pain treatments: a real-world evidence study on general practices in Europe - the role of the lidocaine 5% medicated plaster.

    Science.gov (United States)

    Katz, Pablo; Pegoraro, Valeria; Liedgens, Hiltrud

    2017-08-01

    To identify characteristics, resource utilization, and safety profile of patients prescribed with lidocaine 5% medicated plaster, pregabalin, gabapentin, amitriptyline and duloxetine when experiencing pain in the real-world setting of general practitioners (GPs) in Europe. Retrospective analysis on real world data from IMS Health Longitudinal Patient Database. Patients with at least one prescription of the drugs of interest during 2014 were selected and those with a non-neuropathic pain-related diagnosis were excluded. Patients' demographic and clinical characteristics, resource utilization data and adverse drug reactions (ADRs) as described in the leaflet were extracted. The association between treatments and ADR occurrence was evaluated applying multivariate logistic models. A total of 70,515 patients were selected from Italy, Germany, the UK, Spain and Belgium. Lidocaine 5% medicated plaster patients were the oldest in Italy, the UK and Spain and the most health impaired in Italy, Spain and Belgium. No relevant differences in the number of co-prescriptions, specialist visits, examinations and hospitalizations were found. Significantly less lidocaine 5% plasters patients experienced ADRs, with odds ratios in favor of lidocaine 5% medicated plasters ranging from 3.41 (p = .036) to 52.33 (p plaster patients showing a better safety profile, but also a comparable level of resource utilization. A possible re-evaluation of the scientific value coming from this retrospective study in building up a diagnostic as well as a therapeutic algorithm is suggested.

  9. “If it’s a broad spectrum, it can shoot better”: inappropriate antibiotic prescribing in Cambodia

    Directory of Open Access Journals (Sweden)

    Chhorvoin Om

    2016-12-01

    Full Text Available Abstract Background Cambodia is affected by antibiotic resistance but interventions to reduce the level of resistance require knowledge of the phenomena that lead to inappropriate prescribing. We interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribing. Methods Hospitals participating in a knowledge, attitudes and practices survey prior to this study were purposively selected and physicians were randomly recruited to participate in focus group discussions. Nvivo version 10 was used to inductively code the qualitative transcripts and manage thematic data analysis. Results Inappropriate antibiotic prescribing was a common practice and driven by seven factors: prescribing habit, limited diagnostic capacity, lack of microbiology evidence, non-evidence-based clinical guidelines, perceived patient demand, poor hygiene and infection control, and perceived bacterial resistance to narrow spectrum antibiotics. “Every day, doctors are not performing appropriately. We have made lots of mistakes with our antibiotic prescribing.” When a patient’s clinical condition was not responsive to empiric treatment, physicians changed to a broader spectrum antibiotic and microbiology services were sought only after failure of a treatment with a broad-spectrum antibiotic. This habitual empirical prescribing was a common practice regardless of microbiology service accessibility. Poor hygiene and infection control practices were commonly described as reasons for ‘preventive’ prescribing with full course of antibiotics while perception of bacterial resistance to narrow-spectrum antibiotics due to unrestricted access in the community resulted in unnecessary prescribing of broad spectrum antibiotics in private practices. Conclusions The practice of prescribing antibiotics by Cambodian physicians is inappropriate and based on prescribing habit rather than microbiology evidence. Improvement in prescribing

  10. National prescribing trends for heart failure medications in children.

    Science.gov (United States)

    Moffett, Brady S; Price, Jack F

    2015-01-01

    The treatment of acute decompensated heart failure (ADHF) in adults has changed considerably over the past decade, and these changes have coincided with a reduction in inpatient mortality. At this time, national trends in medication prescribing among children hospitalized with ADHF are unknown. The Pediatric Health Information System (PHIS) database was queried to identify all patients ≤21 years of age who were admitted from 2001 to 2010 with ADHF and a diagnosis of cardiomyopathy. Patients were excluded for potential infectious or inflammatory etiologies of heart failure, congenital heart disease, cardiovascular surgery, acute heart transplant rejection, or isolated diastolic dysfunction. Only the index admission was used, and descriptive statistical methods were employed. A total of 1773 patients (55.8% male) met study criteria (mortality 6.9%). Median length of stay was 9 days (IQR 4-16 days). Vasopressor or inotropic agents were used in 63.6% of patients (milrinone in 82.9% of these) and diuretics in 90.1% (furosemide in 98.4% of these). At discharge, a beta-blocker was prescribed in 36.8% of patients (carvedilol in 77.1% of these), and an angiotensin-converting enzyme (ACE) inhibitor was prescribed in 69.6% (enalapril in 59.9% of these). A wide variability in prescribing practices over time and by pediatric hospital was noted, along with a trend for decreased inotrope use and an increase in beta-blocker discharge prescribing. This is the first national evaluation of prescribing trends in pediatric ADHF medication. A large degree of variability in medication use for ADHF and low rates of beta-blocker and ACE inhibitor use at discharge were identified. © 2014 Wiley Periodicals, Inc.

  11. Drosophila as a model for antiviral immunity

    Institute of Scientific and Technical Information of China (English)

    Susanna; Valanne; Mika; Rmet

    2010-01-01

    The fruit fly Drosophila melanogaster has been successfully used to study numerous biological processes including immune response.Flies are naturally infected with more than twenty RNA viruses making it a valid model organism to study host-pathogen interactions during viral infections.The Drosophila antiviral immunity includes RNA interference,activation of the JAK/STAT and other signaling cascades and other mechanisms such as autophagy and interactions with other microorganisms.Here we review Drosophila as an immunological research model as well as recent advances in the field ofDrosophila antiviral immunity.

  12. [Temporary recommendation for use on off-label baclofen: viewpoint of Prescribers of the CAMTEA system].

    Science.gov (United States)

    Rolland, Benjamin; Deheul, Sylvie; Danel, Thierry; Bence, Camille; Blanquart, Marie-Christine; Bonord, Alexandre; Semal, Robin; Briand, Thierry; Sochala, Michel; Dubocage, Christelle; Dupriez, François; Duquesne, Damien; Gibour, Bernard; Loosfeld, Xavier; Henebelle, Dorothée; Henon, Michael; Vernalde, Elodie; Matton, Christian; Bacquet, Jean-Eudes; Molmy, Lucie; Sarasy, François; Simioni, Nicolas; Richez, Cécile; Gentil-Spinosi, Laure; Vosgien, Véronique; Yguel, Jacques; Ledent, Thierry; Auffret, Marine; Wilquin, Maroussia; Ziolkowski, Danièle; Sochala, Michel; Gautier, Sophie; Bordet, Régis; Cottencin, Olivier

    2015-01-01

    The use of high dose baclofen for alcohol-dependence emerged in France from 2008 based on empirical findings, and is still off-label. However, due to the rapid increase in this prescribing practice, the French health authorities have decided to frame it using an extraordinary regulatory measure named "temporary recommendation for use" (TRU). Baclofen prescribers from CAMTEA, a regional team-based off-label system for supervising baclofen prescribing, which was developed much prior to the TRU, discuss herein the pros and cons of this measure and the applicability of its different aspects in the daily clinical practice.

  13. District nurses: relationships in nurse prescribing.

    OpenAIRE

    Fisher, Richard

    2004-01-01

    Although nurse prescribing has been established in the UK for approximately 8 years, little is known about the effect this additional role is having on those who are involved in its processes. This article reports on the early phrases of an ethnographic study which is aiming to discover how prescribing is altering the ways in which district nurses relate to general practitioners, pharmacists, other community nurses, patients and carers during the experience of nurse prescribing. Using qualita...

  14. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...... most commonly involved in inappropriate prescribing were medications for treatment of peptic ulcer, cardiovascular medications, anti-inflammatory medications, antidepressants, hypnotics and anti-asthmatics. CONCLUSION: The overall prescribing quality in primary care in Copenhagen County, Denmark...

  15. Prescribers' experiences with powered mobility prescription among older adults.

    Science.gov (United States)

    Mortenson, W Ben; Clarke, Laura Hurd; Best, Krista

    2013-01-01

    Despite the potential benefits of powered mobility, many older adults do not have access to this technology. To date, few studies have explored how prescribers make decisions regarding provision of powered mobility. Therefore, we undertook a qualitative study to develop a better understanding of prescribers' attitudes toward and practices with older adult candidates for powered mobility devices. Our analysis of 10 in-depth interviews identified three main themes: (1) "Deciding who should be entitled" explored how therapists decided who should have access to powered mobility, (2) "power wheelchair negotiation" described the discord between clients and therapists that became apparent during this process, and (3) "practical considerations" revealed how contextual factors shaped the provision of powered mobility. The findings suggest that the ways in which powered mobility is funded, provided, and accommodated should be improved so that more older adults have access to these devices and can use them to their full potential.

  16. Bell's Palsy: Treatment with Steroids and Antiviral Drugs

    Science.gov (United States)

    ... PATIENTS and their FAMILIES BELL’S PALSY: TREATMENT WITH STEROIDS AND ANTIVIRAL DRUGS This information sheet is provided to help you understand the role of steroids and antiviral drugs for treating Bell’s palsy. Neurologists ...

  17. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  18. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  19. Prophylactic Antiviral Treatment in Recurrent Herpes Zoster: A Case Report

    Directory of Open Access Journals (Sweden)

    Hatice Gamze Bayram

    2011-06-01

    Full Text Available Herpes zoster (HZ occurs in older ages with activation of varicella-zoster virus (VZV which persists in a dormant phase within the dorsal root ganglia. The incidence of HZ in immunosuppressed patients is 20-100 times higher and the clinical progress is more severe than in immunocompetent individuals. A 48-year-old man who had been diagnosed with acute myelocytic leukemia type M3 and had been treated with immunosuppressive agents was admitted to our clinic. The patient was clinically diagnosed as having HZ. He was treated with acyclovir 800 mg five times daily for 7 days. In the consecutive three months, he attended our clinic again with similar complaints. The left cervical (C5, C6 dermatomes were involved at the fourth attack of HZ. Multinucleated giant cells were determined on the Tzanck smear. VZV DNA was detected by polymerase chain reaction (PCR. Treatment with valacyclovir 1 g three times daily for 14 days was prescribed and then, prophylactic treatment with valacyclovir 500 mg two times a day was administered. Although immunosuppressive treatment was continued, no new attacks of herpes zoster occurred. We think that prophylactic antiviral therapy should be initiated in immunosuppressive individuals who have recurrent herpes zoster attacks.

  20. A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection.

    Science.gov (United States)

    Holt, Stephen G; Gracey, David M; Levy, Miriam T; Mudge, David W; Irish, Ashley B; Walker, Rowan G; Baer, Richard; Sevastos, Jacob; Abbas, Riaz; Boyd, Mark A

    2014-01-01

    A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus (HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate (TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine and dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment and ongoing monitoring of renal function is an important part of routine management of patients with HIV. Given the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring could be performed in Australian patients on ART regimens, especially those involving TDF. A group of nephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical and reasonable renal management strategies for patients particularly those on TDF-based combination regimens (in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group considered which investigations should be performed as part of routine practice, their frequency, and when specialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with plasma phosphate and an assessment of urinary protein (rather than albumin) and glucose. Here we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g. cobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this value used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly thereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment should be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing

  1. Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

    Science.gov (United States)

    Smith, Samuel G; Foy, Robbie; McGowan, Jennifer A; Kobayashi, Lindsay C; DeCensi, Andrea; Brown, Karen; Side, Lucy; Cuzick, Jack

    2017-06-01

    The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. To investigate GPs' attitudes towards prescribing tamoxifen. In an online survey, GPs in England, Northern Ireland, and Wales (n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, PGPs willing to prescribe were more likely to be aware of the NICE guideline (P = 0.039) and to have acknowledged the benefits of tamoxifen (PGPs to continue the patient's care may overcome some prescribing barriers. © British Journal of General Practice 2017.

  2. Antiviral drug resistance of herpes simplex virus

    NARCIS (Netherlands)

    Stranska, Ruzena

    2004-01-01

    Infections with herpes simplex virus (HSV) usually have an asymptomatic or benign course. However, severe infections do occur, particularly in HIV/AIDS patients or transplant recipients, and may be life-threatening unless adequate antiviral therapy is given. Since its introduction in the early 1980

  3. Antiviral drug resistance of herpes simplex virus

    NARCIS (Netherlands)

    Stranska, Ruzena

    2004-01-01

    Infections with herpes simplex virus (HSV) usually have an asymptomatic or benign course. However, severe infections do occur, particularly in HIV/AIDS patients or transplant recipients, and may be life-threatening unless adequate antiviral therapy is given. Since its introduction in the early

  4. IFN-gamma: Novel antiviral cytokines

    DEFF Research Database (Denmark)

    Ank, Nina; West, Hans; Paludan, Søren Riis

    2006-01-01

    and adaptive immune responses. Recently, a novel class of cytokines was discovered and named IFN-lambda (alternatively type III IFN or interleukin-28/29 [IL- 28/29]), based on IFN-like antiviral activity and induction of typical IFN-inducible genes. Here, we review the literature on IFN-lambda and discuss...

  5. Antiviral Prophylaxis and H1N1

    Centers for Disease Control (CDC) Podcasts

    2011-07-14

    Dr. Richard Pebody, a consultant epidemiologist at the Health Protection Agency in London, UK, discusses the use of antiviral post-exposure prophylaxis and pandemic H1N1.  Created: 7/14/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 7/18/2011.

  6. DMPD: Antiviral innate immunity pathways. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 16474426 Antiviral innate immunity pathways. Seth RB, Sun L, Chen ZJ. Cell Res. 200...6 Feb;16(2):141-7. (.png) (.svg) (.html) (.csml) Show Antiviral innate immunity pathways. PubmedID 16474426 ...Title Antiviral innate immunity pathways. Authors Seth RB, Sun L, Chen ZJ. Publication Cell Res. 2006 Feb;16

  7. Interferon induced IFIT family genes in host antiviral defense

    Science.gov (United States)

    Secretion of interferons (IFNs) from virus-infected cells is a hallmark of host antiviral immunity and in fact, IFNs exert their antiviral activities through the induction of antiviral proteins. The IFN-induced protein with tetratricopeptide repeats (IFITs) family is among hundreds of IF stimulated ...

  8. Nurse prescribing: a vehicle for improved collaboration, or a stumbling block to inter-professional working?

    Science.gov (United States)

    Fisher, Richard

    2010-12-01

    Prescribing by community nurses is established practice in the UK National Health Service. Although much has been written about the technical aspects of prescribing, little published work addresses the ways in which prescribing might affect relationships. Part of a PhD project set in southern England, this ethnographic project used semistructured interviews with a purposive sample of district nurses (n = 17), staff nurses (n = 4), pharmacists (n = 2) and a general practitioner to investigate the real world of nurse prescribing. Using theories of domination, power and legitimacy from Weber and Foucault, this paper sets out to demonstrate that despite government efforts to encourage collaborative working, power relationships still play an important part in some areas of practice. Analysis, building from Morrell's notion of naïve functionalism, reveals strategies used by actors in community practice to manage such relationships.

  9. Looking inside the black box: a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM to improve referral and prescribing practices in primary care in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Lemyre Louise

    2007-11-01

    regression to explore the relationships between predictor and dependent variable (intention to advise diabetic patients to have annual retinopathy screening and to prescribe thiazide diuretics for first line treatment of uncomplicated hypertension. We will then compare groups using methods appropriate for comparing independent samples to determine whether there have been changes in the predicted constructs (attitudes, subjective norms, or intentions across the study groups as hypothesised, and will assess the convergence between the process evaluation results and the main trial results. Trial registration number Current controlled trial ISRCTN72772651

  10. Antiviral effect of cationic compounds on bacteriophages

    Directory of Open Access Journals (Sweden)

    Mai Huong eChatain-Ly

    2013-03-01

    Full Text Available The antiviral activity of several cationic compounds - cetytrimethylammonium (CTAB, chitosan, nisin and lysozyme - was investigated on the bacteriophage c2 (DNA head and non-contractile tail infecting Lactococcus strains and the bacteriophage MS2 (F-specific RNA infecting E.coli. Firstly, these activities were evaluated in a phosphate buffer pH 7- 10 mM. The CTAB had a virucidal effect on the Lactococcus bacteriophages, but not on the MS2. After 1 min of contact with 0.125 mM CTAB, the c2 population was reduced from 6 log(pfu/mL to 1,5 log(pfu/mL and completely deactivated at 1 mM. On the contrary, chitosan inhibited the MS2 more than it did the bacteriophages c2. No antiviral effect was observed for the nisin or the lysozyme on bacteriophages after 1 min of treatment. A 1 and 2.5 log reduction was respectively observed for nisin and lysozyme when the treatment time increased (5 or 10 min. These results showed that the antiviral effect depended both on the virus and structure of the antimicrobial compounds. The antiviral activity of these compounds was also evaluated in different physico-chemical conditions and in complex matrices. The antiviral activity of CTAB was impaired in acid pH and with an increase of the ionic strength. These results might be explained by the electrostatic interactions between cationic compounds and negatively charged particles such as bacteriophages or other compounds in a matrix. Milk proved to be protective suggesting the components of food could interfere with antimicrobial compounds.

  11. TRIM25 Enhances the Antiviral Action of Zinc-Finger Antiviral Protein (ZAP)

    Science.gov (United States)

    Lau, Zerlina; Cheung, Pamela; Schneider, William M.; Bozzacco, Leonia; Buehler, Eugen; Takaoka, Akinori; Rice, Charles M.; Felsenfeld, Dan P.; MacDonald, Margaret R.

    2017-01-01

    The host factor and interferon (IFN)-stimulated gene (ISG) product, zinc-finger antiviral protein (ZAP), inhibits a number of diverse viruses by usurping and intersecting with multiple cellular pathways. To elucidate its antiviral mechanism, we perform a loss-of-function genome-wide RNAi screen to identify cellular cofactors required for ZAP antiviral activity against the prototype alphavirus, Sindbis virus (SINV). In order to exclude off-target effects, we carry out stringent confirmatory assays to verify the top hits. Important ZAP-liaising partners identified include proteins involved in membrane ion permeability, type I IFN signaling, and post-translational protein modification. The factor contributing most to the antiviral function of ZAP is TRIM25, an E3 ubiquitin and ISG15 ligase. We demonstrate here that TRIM25 interacts with ZAP through the SPRY domain, and TRIM25 mutants lacking the RING or coiled coil domain fail to stimulate ZAP’s antiviral activity, suggesting that both TRIM25 ligase activity and its ability to form oligomers are critical for its cofactor function. TRIM25 increases the modification of both the short and long ZAP isoforms by K48- and K63-linked polyubiquitin, although ubiquitination of ZAP does not directly affect its antiviral activity. However, TRIM25 is critical for ZAP’s ability to inhibit translation of the incoming SINV genome. Taken together, these data uncover TRIM25 as a bona fide ZAP cofactor that leads to increased ZAP modification enhancing its translational inhibition activity. PMID:28060952

  12. Report of the first Asia-Pacific Forum on antiviral treatment of influenza, Asia-Pacific Alliance for the Control of Influenza, Bangkok, 14 June 2012.

    Science.gov (United States)

    Jennings, Lance C; Smith, David W; Chan, Paul K S

    2013-11-01

    On 14 June 2012, the Asia-Pacific Alliance for the Control of Influenza (APACI) convened the first Antiviral Forum jointly with the Influenza Foundation of Thailand and the Thailand Department of Disease Control. The goals of the meeting were to improve pandemic planning in the region from lessons learned during the 2009 pandemic, particularly with regard to the safety and efficacy of antiviral use; gain a better understanding of the therapeutic use of antivirals in seasonal influenza; review and analyse the official influenza control policies of Asia-Pacific countries and evidence gaps to support policy development; and to establish collaborative relationships to promote best practices in the use of antivirals for the treatment of influenza. The urgent need for education highlighting the importance of influenza and the benefits of antiviral drug use in the Asia-Pacific region was identified.

  13. Prescribed Travel Schedules for Fatigue Management

    Science.gov (United States)

    Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

    2011-01-01

    The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

  14. Teaching Prescribing: Just What the Doctor Ordered? A Thematic Analysis of the Views of Newly Qualified Doctors

    Directory of Open Access Journals (Sweden)

    Christina R. Hansen

    2017-06-01

    Full Text Available Undergraduate medical education has been criticised for failing to adequately prepare doctors for the task of prescribing. Pharmacists have been shown to improve medication use in hospitals. This study aims to elicit the views of intern doctors on the challenges of prescribing, and to suggest changes in education to enhance prescribing practice and potential role of the pharmacist. Semi-structured, qualitative interviews were conducted with intern doctors in their first year post qualification in an Irish hospital. Data collection was conducted until no new themes emerged and thematic analysis was performed. Thirteen interviews took place. Interns described training in practical prescribing as limited and felt the curriculum failed to convey the reality of actual prescribing. Pharmacists were perceived to be a useful, but underutilised, information source in the prescribing process. They requested an earlier introduction, and repeated exposure, to prescribing, and suggested the involvement of peers and pharmacists in this teaching. Intern doctors reported difficulties in applying knowledge gained in medical school to clinical practice. New strategies are needed to enhance the clinical relevance of the medical curriculum by rethinking the learning outcomes regarding prescribing practice and the involvement of pharmacists in prescribing education.

  15. Restrictions for reimbursement of direct-acting antiviral treatment for hepatitis C virus infection in Canada: a descriptive study

    Science.gov (United States)

    Marshall, Alison D.; Saeed, Sahar; Barrett, Lisa; Cooper, Curtis L.; Treloar, Carla; Bruneau, Julie; Feld, Jordan J.; Gallagher, Lesley; Klein, Marina B.; Krajden, Mel; Shoukry, Naglaa H.; Taylor, Lynn E.; Grebely, Jason

    2016-01-01

    Background: In Canada, interferon-free, direct-acting antiviral hepatitis C virus (HCV) regimens are costly. This presents challenges for universal drug coverage of the estimated 220 000 people with chronic HCV infection nationwide. The study objective was to appraise criteria for reimbursement of 4 HCV direct-acting antivirals in Canada. Methods: We reviewed the reimbursement criteria for simeprevir, sofosbuvir, ledipasvir-sofosbuvir and paritaprevir-ritonavir-ombitasvir plus dasabuvir in the 10 provinces and 3 territories. Data were extracted from April 2015 to June 2016. The primary outcomes extracted from health ministerial websites were: 1) minimum fibrosis stage required, 2) drug and alcohol use restrictions, 3) HIV coinfection restrictions and 4) prescriber type restrictions. Results: Overall, 85%-92% of provinces/territories limited access to patients with moderate fibrosis (Meta-Analysis of Histologic Data in Viral Hepatitis stage F2 or greater, or equivalent). There were no drug and alcohol use restrictions; however, several criteria (e.g., active injection drug use) were left to the discretion of the physician. Quebec did not reimburse simeprevir and sofosbuvir for people coinfected with HIV; no restrictions were found in the remaining jurisdictions. Prescriber type was restricted to specialists in up to 42% of provinces/territories. Interpretation: This review of criteria of reimbursement of HCV direct-acting antivirals in Canada showed substantial interjurisdictional heterogeneity. The findings could inform health policy and support the development and adoption of a national HCV strategy. PMID:28018873

  16. Characteristics of physicians who frequently prescribe long-acting benzodiazepines for the elderly.

    Science.gov (United States)

    Monette, J; Tamblyn, R M; McLeod, P J; Gayton, D C

    1997-06-01

    Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identify the characteristics of physicians who frequently prescribe LABZs for elderly patients. The authors examined the prescribing profile of 4,976 physicians who saw at least 20 elderly Quebec medicare registrants in 1990. Physicians who frequently prescribed LABZs for their elderly patients were more likely to have graduated before 1979, to be general practitioners as opposed to specialists, to practice in long-term care settings, and to have graduated from a medical school in Quebec as opposed to other schools in Quebec, in other provinces, or in other countries. The authors have identified several characteristics of physicians who frequently prescribed LABZs for the elderly. Strategies to improve prescribing in this field should target this group of physicians.

  17. Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

    Science.gov (United States)

    Yeh, James S; Franklin, Jessica M; Avorn, Jerry; Landon, Joan; Kesselheim, Aaron S

    2016-06-01

    Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed. Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol. Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011. The exposure variable was a physician's industry payments as listed in the Massachusetts database. The outcome was the physician's rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians' industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments. Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not. Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

  18. Antiviral potential of lactic acid bacteria and their bacteriocins.

    Science.gov (United States)

    Al Kassaa, I; Hober, D; Hamze, M; Chihib, N E; Drider, D

    2014-12-01

    Emerging resistance to antiviral agents is a growing public health concern worldwide as it was reported for respiratory, sexually transmitted and enteric viruses. Therefore, there is a growing demand for new, unconventional antiviral agents which may serve as an alternative to the currently used drugs. Meanwhile, published literature continues shedding the light on the potency of lactic acid bacteria (LAB) and their bacteriocins as antiviral agents. Health-promoting LAB probiotics may exert their antiviral activity by (1) direct probiotic-virus interaction; (2) production of antiviral inhibitory metabolites; and/or (3) via stimulation of the immune system. The aim of this review was to highlight the antiviral activity of LAB and substances they produce with antiviral activity.

  19. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment

    Science.gov (United States)

    Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N

    2016-01-01

    Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month

  20. Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing

    Science.gov (United States)

    Chui, Michelle A

    2012-01-01

    Objective This paper explored pharmacy staff perceptions of the strengths and weaknesses of electronic prescribing (e-prescribing) design in retail pharmacies using the sociotechnical systems framework. This study examined how adoption of e-prescribing technology is affecting clinical practice and patient care. Materials and methods Direct observations and think aloud protocols were used to collect data from seven retail pharmacies. Results Pharmacists and pharmacy technicians reported strengths of e-prescribing design that facilitated pharmacy work which included: legibility, ease of archiving, quick access to prescriptions and consistency in the format of electronic prescriptions (e-prescriptions). Design weaknesses and potential hazards to patient care associated with e-prescribing systems were due to differences between pharmacy and prescriber computer systems which resulted in the selection of wrong patient or drug (name, directions, dose, strength, formulation, package sizes). There were unique strengths and weaknesses in the design of e-prescriptions peculiar to the three pharmacy computer systems examined in this study. Discussion Findings from this study can help inform policy on creating e-prescribing design standards for pharmacy. e-Prescribing system developers can use the results of this study to identify and apply the most usable features of the three main pharmacy computer systems to design systems that support dispensing efficiency and safety. Conclusions This is the first study to highlight design flaws with e-prescribing in retail pharmacies. The sociotechnical systems framework was useful in providing an indepth understanding of the pharmacist and pharmacy technician's interface with e-prescribing technology. This information can be used by policy makers to create e-prescribing standards for pharmacies. PMID:22753809

  1. Questionable prescribing for elderly patients in Quebec.

    Science.gov (United States)

    Tamblyn, R M; McLeod, P J; Abrahamowicz, M; Monette, J; Gayton, D C; Berkson, L; Dauphinee, W D; Grad, R M; Huang, A R; Isaac, L M

    1994-01-01

    OBJECTIVE: To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN: Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Régie de l'assurance-maladie du Québec. SETTING: Quebec. PARTICIPANTS: Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year. MAIN OUTCOME MEASURE: Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people. RESULTS: Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs. CONCLUSION: The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and

  2. Rational use of medicines: prescribing indicators at different levels of health care

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Cardoso Ferreira

    2013-06-01

    Full Text Available This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1% were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

  3. Investigating interactions between UK horse owners and prescribers of anthelmintics.

    Science.gov (United States)

    Easton, Stephanie; Pinchbeck, Gina L; Tzelos, Thomas; Bartley, David J; Hotchkiss, Emily; Hodgkinson, Jane E; Matthews, Jacqueline B

    2016-12-01

    Helminths are common pathogens of equids and anthelmintic resistance is a major issue in cyathostomin species and Parascaris equorum. At the heart of mitigating the impact of increasing anthelmintic resistance levels, is the responsible dissemination and use of these medicines following best practice principles. There is a paucity of information on interactions between horse owners and anthelmintic prescribers and how this shapes control. Here, a study was undertaken to determine opinions and experiences of horse owners as they relate to anthelmintics purchase and implementation of best practice control. An online survey was distributed via email and social media to explore owners' experiences of purchasing anthelmintics from United Kingdom prescribers, these being veterinarians, suitably qualified persons (SQPs) and pharmacists. Owner responses (n=494) were analysed statistically to compare answers of respondents grouped according to: (i) from whom they bought anthelmintics (Veterinarians n=60; SQPs n=256; Pharmacists n=42; More than one channel n=136), and (ii) by which route (Face-to-face n=234; Telephone n=31; Online n=226) they purchased. Owners who purchased from veterinarians predominantly did so face-to-face (81.3%), whilst those that bought from SQPs purchased via face-to-face (48.8%) and online (46.0%) interactions. Those who purchased from pharmacists predominantly bought anthelmintics online (76.2%). Participants who bought from veterinarians were more likely to view certain factors (i.e. time to talk to the supplier, supplier knowledge) as more important than those who purchased from other prescribers. Those who purchased from veterinarians were more likely to be recommended faecal egg count (FEC) test analysis; however, there was high uptake of FEC testing across all groups. There was a low uptake of anthelmintic efficacy testing; regardless of the prescriber type from whom anthelmintics were purchased. Those who purchased from veterinarians were more

  4. Clinical Implications of Antiviral Resistance in Influenza

    Directory of Open Access Journals (Sweden)

    Timothy C. M. Li

    2015-09-01

    Full Text Available Influenza is a major cause of severe respiratory infections leading to excessive hospitalizations and deaths globally; annual epidemics, pandemics, and sporadic/endemic avian virus infections occur as a result of rapid, continuous evolution of influenza viruses. Emergence of antiviral resistance is of great clinical and public health concern. Currently available antiviral treatments include four neuraminidase inhibitors (oseltamivir, zanamivir, peramivir, laninamivir, M2-inibitors (amantadine, rimantadine, and a polymerase inhibitor (favipiravir. In this review, we focus on resistance issues related to the use of neuraminidase inhibitors (NAIs. Data on primary resistance, as well as secondary resistance related to NAI exposure will be presented. Their clinical implications, detection, and novel therapeutic options undergoing clinical trials are discussed.

  5. Clinical Implications of Antiviral Resistance in Influenza.

    Science.gov (United States)

    Li, Timothy C M; Chan, Martin C W; Lee, Nelson

    2015-09-14

    Influenza is a major cause of severe respiratory infections leading to excessive hospitalizations and deaths globally; annual epidemics, pandemics, and sporadic/endemic avian virus infections occur as a result of rapid, continuous evolution of influenza viruses. Emergence of antiviral resistance is of great clinical and public health concern. Currently available antiviral treatments include four neuraminidase inhibitors (oseltamivir, zanamivir, peramivir, laninamivir), M2-inibitors (amantadine, rimantadine), and a polymerase inhibitor (favipiravir). In this review, we focus on resistance issues related to the use of neuraminidase inhibitors (NAIs). Data on primary resistance, as well as secondary resistance related to NAI exposure will be presented. Their clinical implications, detection, and novel therapeutic options undergoing clinical trials are discussed.

  6. Exploiting Genetic Interference for Antiviral Therapy.

    Science.gov (United States)

    Tanner, Elizabeth J; Kirkegaard, Karla A; Weinberger, Leor S

    2016-05-01

    Rapidly evolving viruses are a major threat to human health. Such viruses are often highly pathogenic (e.g., influenza virus, HIV, Ebola virus) and routinely circumvent therapeutic intervention through mutational escape. Error-prone genome replication generates heterogeneous viral populations that rapidly adapt to new selection pressures, leading to resistance that emerges with treatment. However, population heterogeneity bears a cost: when multiple viral variants replicate within a cell, they can potentially interfere with each other, lowering viral fitness. This genetic interference can be exploited for antiviral strategies, either by taking advantage of a virus's inherent genetic diversity or through generating de novo interference by engineering a competing genome. Here, we discuss two such antiviral strategies, dominant drug targeting and therapeutic interfering particles. Both strategies harness the power of genetic interference to surmount two particularly vexing obstacles-the evolution of drug resistance and targeting therapy to high-risk populations-both of which impede treatment in resource-poor settings.

  7. An antiviral furanoquinone from Paulownia tomentosa Steud.

    Science.gov (United States)

    Kang, K H; Huh, H; Kim, B K; Lee, C K

    1999-11-01

    A methanol extract of the stem bark of Paulownia tomentosa showed antiviral activity against poliovirus types 1 and 3. Sequential liquid-liquid extraction with n-hexane, chloroform and water, and a silicagel column chromatography resulted in the purification of a compound. The compound was identified as methyl-5-hydroxy-dinaphthol[1,2-2',3']furan-7,12-dione-6-carbox yla te on the basis of spectroscopic data. The component caused a significant reduction of viral cytopathic effect when it was subjected to a standard antiviral assay by using HeLa cells. The EC(50) of the compound against poliovirus type 1 strain Brunhilde, and type 3 strain Leon were 0.3 microg/mL and 0.6 microg/mL, respectively.

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

    Science.gov (United States)

    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.

  9. Antiviral Strategies for Pandemic and Seasonal Influenza

    Directory of Open Access Journals (Sweden)

    Fang Fang

    2010-08-01

    Full Text Available While vaccines are the primary public health response to seasonal and pandemic flu, short of a universal vaccine there are inherent limitations to this approach. Antiviral drugs provide valuable alternative options for treatment and prophylaxis of influenza. Here, we will review drugs and drug candidates against influenza with an emphasis on the recent progress of a host-targeting entry-blocker drug candidate, DAS181, a sialidase fusion protein.

  10. Antiviral Lead Compounds from Marine Sponges

    Directory of Open Access Journals (Sweden)

    Kenneth P. Minneman

    2010-10-01

    Full Text Available Marine sponges are currently one of the richest sources of pharmacologically active compounds found in the marine environment. These bioactive molecules are often secondary metabolites, whose main function is to enable and/or modulate cellular communication and defense. They are usually produced by functional enzyme clusters in sponges and/or their associated symbiotic microorganisms. Natural product lead compounds from sponges have often been found to be promising pharmaceutical agents. Several of them have successfully been approved as antiviral agents for clinical use or have been advanced to the late stages of clinical trials. Most of these drugs are used for the treatment of human immunodeficiency virus (HIV and herpes simplex virus (HSV. The most important antiviral lead of marine origin reported thus far is nucleoside Ara-A (vidarabine isolated from sponge Tethya crypta. It inhibits viral DNA polymerase and DNA synthesis of herpes, vaccinica and varicella zoster viruses. However due to the discovery of new types of viruses and emergence of drug resistant strains, it is necessary to develop new antiviral lead compounds continuously. Several sponge derived antiviral lead compounds which are hopedto be developed as future drugs are discussed in this review. Supply problems are usually the major bottleneck to the development of these compounds as drugs during clinical trials. However advances in the field of metagenomics and high throughput microbial cultivation has raised the possibility that these techniques could lead to the cost-effective large scale production of such compounds. Perspectives on biotechnological methods with respect to marine drug development are also discussed.

  11. Avian Interferons and Their Antiviral Effectors

    OpenAIRE

    Santhakumar, Diwakar; Rubbenstroth, Dennis; Martinez-Sobrido, Luis; Munir, Muhammad

    2017-01-01

    Interferon (IFN) responses, mediated by a myriad of IFN-stimulated genes (ISGs), are the most profound innate immune responses against viruses. Cumulatively, these IFN effectors establish a multilayered antiviral state to safeguard the host against invading viral pathogens. Considerable genetic and functional characterizations of mammalian IFNs and their effectors have been made, and our understanding on the avian IFNs has started to expand. Similar to mammalian counterparts, three types of I...

  12. Antiviral lead compounds from marine sponges

    KAUST Repository

    Sagar, Sunil

    2010-10-11

    Marine sponges are currently one of the richest sources of pharmacologically active compounds found in the marine environment. These bioactive molecules are often secondary metabolites, whose main function is to enable and/or modulate cellular communication and defense. They are usually produced by functional enzyme clusters in sponges and/or their associated symbiotic microorganisms. Natural product lead compounds from sponges have often been found to be promising pharmaceutical agents. Several of them have successfully been approved as antiviral agents for clinical use or have been advanced to the late stages of clinical trials. Most of these drugs are used for the treatment of human immunodeficiency virus (HIV) and herpes simplex virus (HSV). The most important antiviral lead of marine origin reported thus far is nucleoside Ara-A (vidarabine) isolated from sponge Tethya crypta. It inhibits viral DNA polymerase and DNA synthesis of herpes, vaccinica and varicella zoster viruses. However due to the discovery of new types of viruses and emergence of drug resistant strains, it is necessary to develop new antiviral lead compounds continuously. Several sponge derived antiviral lead compounds which are hopedto be developed as future drugs are discussed in this review. Supply problems are usually the major bottleneck to the development of these compounds as drugs during clinical trials. However advances in the field of metagenomics and high throughput microbial cultivation has raised the possibility that these techniques could lead to the cost-effective large scale production of such compounds. Perspectives on biotechnological methods with respect to marine drug development are also discussed. 2010 by the authors; licensee MDPI.

  13. Antiviral biflavonoids from Radix Wikstroemiae (Liaogewanggen

    Directory of Open Access Journals (Sweden)

    Ye Wencai

    2010-06-01

    Full Text Available Abstract Background Radix Wikstroemiae is a common Chinese herbal medicine. The ethyl acetate fraction of the ethanolic extract of W. indica possesses potent in vitro antiviral activity against respiratory syncytial virus (RSV. This study aims to identify the antiviral components of the active fraction. Methods The active fraction of the Radix Wikstroemiae extract was isolated with chromatographic methods such as silica gel, Sephadex LH-20 and semi-preparative high performance liquid chromatography (HPLC columns. The structures of the isolated compounds were determined based on spectroscopic analyses. The in vitro antiviral activity of the compounds against RSV was tested with the cytopathic effect (CPE reduction assay and the 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT method. Results Four biflavonoids, namely neochamaejasmin B, genkwanol B, genkwanol C and stelleranol, were isolated and characterized. Genkwanol B, genkwanol C and stelleranol, which are stereo isomers of spirobiflavonoids, showed potent anti-RSV activity whereas neochamaejasmin B did not. Conclusion Neochamaejasmin B, genkwanol B, genkwanol C and stelleranol were isolated from Radix Wikstroemiae and the complete absolute configurations of five chiral carbons in stelleranol were substantiated for the first time. Furthermore, the anti-RSV activity of genkwanol B, genkwanol C and stelleranol was reported for the first time.

  14. CRM1 Inhibitors for Antiviral Therapy

    Directory of Open Access Journals (Sweden)

    Cynthia Mathew

    2017-06-01

    Full Text Available Infectious diseases are a major global concern and despite major advancements in medical research, still cause significant morbidity and mortality. Progress in antiviral therapy is particularly hindered by appearance of mutants capable of overcoming the effects of drugs targeting viral components. Alternatively, development of drugs targeting host proteins essential for completion of viral lifecycle holds potential as a viable strategy for antiviral therapy. Nucleocytoplasmic trafficking pathways in particular are involved in several pathological conditions including cancer and viral infections, where hijacking or alteration of function of key transporter proteins, such as Chromosome Region Maintenance1 (CRM1 is observed. Overexpression of CRM1-mediated nuclear export is evident in several solid and hematological malignancies. Interestingly, CRM1-mediated nuclear export of viral components is crucial in various stages of the viral lifecycle and assembly. This review summarizes the role of CRM1 in cancer and selected viruses. Leptomycin B (LMB is the prototypical inhibitor of CRM1 potent against various cancer cell lines overexpressing CRM1 and in limiting viral infections at nanomolar concentrations in vitro. However, the irreversible shutdown of nuclear export results in high cytotoxicity and limited efficacy in vivo. This has prompted search for synthetic and natural CRM1 inhibitors that can potentially be developed as broadly active antivirals, some of which are summarized in this review.

  15. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

    Science.gov (United States)

    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.

  16. Preparing to prescribe: How do clerkship students learn in the midst of complexity?

    OpenAIRE

    McLellan, Lucy; Yardley, Sarah; Norris, Ben; De Bruin, Anique; Tully, Mary P; Dornan, Tim

    2015-01-01

    Prescribing tasks, which involve pharmacological knowledge, clinical decision-making and practical skill, take place within unpredictable social environments and involve interactions within and between endlessly changing health care teams. Despite this, curriculum designers commonly assume them to be simple to learn and perform. This research used mixed methods to explore how undergraduate medical students learn to prescribe in the 'real world'. It was informed by cognitive psychology, socioc...

  17. Smartphone apps to support hospital prescribing and pharmacology education: a review of current provision

    OpenAIRE

    Haffey, Faye; Brady, Richard R W; Maxwell, Simon

    2013-01-01

    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 prof...

  18. The social act of electronic medication prescribing

    NARCIS (Netherlands)

    J.E.C.M. Aarts (Jos)

    2013-01-01

    markdownabstract__Abstract__ Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of

  19. pASELINE SURVEY ON DRUG PRESCRIBING

    African Journals Online (AJOL)

    Baseline Survey On Drug Prescribing Indicators Wubeante K. 147 rr. RIGINAL ... Specialized Hospital where measured values could be used later as baseline data for further follow up of ..... drug management systems in hospital. Moreover the ...

  20. Prescribed fire monitoring protocol : Medicine Lake NWR

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Initial Survey Instructions for prescribed fire monitoring at Medicine Lake National Wildlife Refuge. Instructions contain methods on data collection, an equipment...

  1. The Web site your doctor prescribes

    Science.gov (United States)

    ... 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. Are You Taking Medication as Prescribed?

    Science.gov (United States)

    ... Home For Consumers Consumer Updates Are You Taking Medication as Prescribed? Share Tweet Linkedin Pin it More ... another time. back to top Taking HIV/AIDS Medications People with HIV/AIDS can have a particularly ...

  3. Evaluation of Health Plan Interventions to Influence Chronic Opioid Therapy Prescribing

    Science.gov (United States)

    Saunders, Kathleen; Shortreed, Susan; Thielke, Stephen; Turner, Judith A.; LeResche, Linda; Beck, Randi; Von Korff, Michael

    2015-01-01

    Objectives Evaluate health plan interventions targeting physician chronic opioid therapy (COT) prescribing. Methods In 2006, Group Health’s (GH) integrated group practice (IGP) initiated diverse interventions targeting COT prescriber norms and practices. In 2010, the IGP implemented a COT guideline, including a mandated online course for physicians managing COT. These interventions were not implemented in GH’s network practices. We compared trends in GH-IGP and network practices for 2006–12 in the percent of patients receiving COT and their opioid dose. We compared physician beliefs before versus after the mandated course and pre- to post-course changes in COT dosing for IGP physicians who took the course. Results From 2006 to 2012, mean (SE) daily opioid dose among IGP COT patients (intervention setting) declined from 74.1 (1.9) mg. morphine equivalent dose (MED) to 48.3 (1.0) mg. MED. Dose changes among GH network COT patients (control setting) were modest—88.2 (5.0) mg. MED in 2006 to 75.7 (2.3) mg. MED in 2012. Among physicians taking the mandated course in 2011, we observed pre- to post-course changes toward more conservative opioid prescribing beliefs. However, COT dosing trends did not change pre- to post-course. Discussion Following initiatives implemented to alter physician prescribing practices and norms, mean opioid dose prescribed to COT patients declined more in intervention than control practices. Physicians reported more conservative beliefs regarding opioid prescribing immediately after completing an online course in 2011, but the course was not associated with additional reductions in mean daily opioid dose prescribed by physicians completing the course. PMID:25621426

  4. Evaluation of Health Plan Interventions to Influence Chronic Opioid Therapy Prescribing.

    Science.gov (United States)

    Saunders, Kathleen; Shortreed, Susan; Thielke, Stephen; Turner, Judith A; LeResche, Linda; Beck, Randi; Von Korff, Michael

    2015-01-23

    Evaluate health plan interventions targeting physician chronic opioid therapy (COT) prescribing. In 2006, Group Health's (GH) integrated group practice (IGP) initiated diverse interventions targeting COT prescriber norms and practices. In 2010, the IGP implemented a COT guideline, including a mandated online course for physicians managing COT. These interventions were not implemented in GH's network practices. We compared trends in GH-IGP and network practices for 2006-12 in the percent of patients receiving COT and their opioid dose. We compared physician beliefs before versus after the mandated course and pre- to post-course changes in COT dosing for IGP physicians who took the course. From 2006 to 2012, mean (SE) daily opioid dose among IGP COT patients (intervention setting) declined from 74.1 (1.9) mg. morphine equivalent dose (MED) to 48.3 (1.0) mg. MED. Dose changes among GH network COT patients (control setting) were modest-88.2 (5.0) mg. MED in 2006 to 75.7 (2.3) mg. MED in 2012. Among physicians taking the mandated course in 2011, we observed pre- to post-course changes toward more conservative opioid prescribing beliefs. However, COT dosing trends did not change pre- to post-course. Following initiatives implemented to alter physician prescribing practices and norms, mean opioid dose prescribed to COT patients declined more in intervention than control practices. Physicians reported more conservative beliefs regarding opioid prescribing immediately after completing an online course in 2011, but the course was not associated with additional reductions in mean daily opioid dose prescribed by physicians completing the course.

  5. Self-interest versus group-interest in antiviral control.

    Directory of Open Access Journals (Sweden)

    Michiel van Boven

    Full Text Available Antiviral agents have been hailed to hold considerable promise for the treatment and prevention of emerging viral diseases like H5N1 avian influenza and SARS. However, antiviral drugs are not completely harmless, and the conditions under which individuals are willing to participate in a large-scale antiviral drug treatment program are as yet unknown. We provide population dynamical and game theoretical analyses of large-scale prophylactic antiviral treatment programs. Throughout we compare the antiviral control strategy that is optimal from the public health perspective with the control strategy that would evolve if individuals make their own, rational decisions. To this end we investigate the conditions under which a large-scale antiviral control program can prevent an epidemic, and we analyze at what point in an unfolding epidemic the risk of infection starts to outweigh the cost of antiviral treatment. This enables investigation of how the optimal control strategy is moulded by the efficacy of antiviral drugs, the risk of mortality by antiviral prophylaxis, and the transmissibility of the pathogen. Our analyses show that there can be a strong incentive for an individual to take less antiviral drugs than is optimal from the public health perspective. In particular, when public health asks for early and aggressive control to prevent or curb an emerging pathogen, for the individual antiviral drug treatment is attractive only when the risk of infection has become non-negligible. It is even possible that from a public health perspective a situation in which everybody takes antiviral drugs is optimal, while the process of individual choice leads to a situation where nobody is willing to take antiviral drugs.

  6. Pharmaco-epistemology for the prescribing geriatrician.

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    Le Couteur, David G; Kendig, Hal

    2008-03-01

    Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.

  7. The prescribing pattern of outpatient polyclinic doctors.

    Science.gov (United States)

    Lim, K H; Yap, K B

    1999-06-01

    This study aims to analyse the prescribing pattern of doctors working in a government outpatient polyclinic in Singapore. Retrospective study of 1 week of prescription scripts in 1996. Number, types and duration of drugs prescribed; combination of drugs; age distribution; bad handwriting. Two thousand six hundred and seventy-nine scripts were analysed. The age of patients ranged from 1 to 93 years with a mean of 43.8 years. There were 44.0% males and 56.0% females. The overall mean of 'total number of drugs prescribed' was 2.8 items. The means of 'number of drug items prescribed for more than 1 week' by age-group were: 60 years = 2.4. One way analysis of variance showed significant difference between the means of each age-group. Post hoc analysis revealed that the oldest age group accounted for most of this significant result. The top 10 drugs prescribed in descending order were: antihistamines, paracetamol, throat medications (eg. lozenges, gargles, etc), nifedipine, beta-blockers, antacids, mist benadryl expectorant, Procodin cough syrup (containing codeine and promethazine), amoxycillin and vitamin B. Nifedipine and beta-blockers were the most commonly prescribed anti-hypertensives. Non-steroidal anti-inflammatory drugs were usually prescribed with antacids. One hundred and twenty (4.5%) scripts were illegible. This study provides a baseline data for monitoring future prescribing trends. There may be a need to re-evaluate the appropriateness of nifedipine as the first line anti-hypertensive drug and the usefulness of NSAID-antacid and amoxycillin-cloxacillin combinations. The prevalence of illegible handwriting was high.

  8. Psychotropic drugs: another survey of prescribing patterns.

    Science.gov (United States)

    Morgan, R; Gopalaswamy, A K

    1984-03-01

    We surveyed the psychotropic drug treatment of our hospital's 220 patients, and compared our findings with those of the only previous hospital survey in this country which showed much allegedly inappropriate prescribing. Using simple classifications of the patients' diagnoses and of the drugs prescribed, 30 per cent of our prescriptions appeared inappropriate in the absence of knowledge of the patients' symptoms. With such knowledge we show that only 2 of our 460 prescriptions were inappropriate.

  9. Chemotherapy e-prescribing: opportunities and challenges

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    Elsaid KA

    2015-05-01

    Full Text Available Khaled A Elsaid,1,2 Steven Garguilo,1 Christine M Collins2 1Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, 2Pharmacy Services, Rhode Island Hospital, Providence, RI, USA Abstract: Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to

  10. Ribonuclease, deoxyribonuclease, and antiviral activity of Escherichia coli-expressed Bougainvillea xbuttiana antiviral protein 1.

    Science.gov (United States)

    Choudhary, N L; Yadav, O P; Lodha, M L

    2008-03-01

    A full-length cDNA encoding ribosome-inactivating/antiviral protein from the leaves of Bougainvillea xbuttiana was recently isolated. The coding region of cDNA was cloned and expressed in Escherichia coli, and the protein product was designated as BBAP1 (Bougainvillea xbuttiana antiviral protein 1). BBAP1 showed ribonuclease activity against Torula yeast RNA. It also exhibited depurination activity against supercoiled pBlueScript SK+ plasmid DNA in a concentration dependent manner, and was found to convert nicked circular DNA into linear form only at higher concentration. On bioassay, BBAP1 exhibited antiviral activity against sunnhemp rosette virus infecting Cyamopsis tetragonoloba leaves in which 95% inhibition of local lesion formation was observed.

  11. Neopterin as a Marker of Response to Antiviral Therapy in Hepatitis C Virus Patients

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    Gregory F. Oxenkrug

    2012-01-01

    Full Text Available Predicting the efficacy of antiviral treatment of hepatitis C virus (HCV is of importance for both patient well-being and health care expense. The expression of interferon-stimulated genes (IFN-SGs in the liver was suggested as a marker of response to anti-viral therapy. IFN-SGs encode the guanosine triphosphate cyclohydrolase 1 (GTPCH, a rate-limiting enzyme of pteridines biosynthesis. Neopterin, a stable byproduct of GTPCH-catalyzed reaction, is used as a marker of interferon-induced GTPCH activation. We hypothesized that assessment of neopterin concentrations might predict the response to antiviral therapy. Neopterin concentrations were evaluated in 260 HCV patients treated by pegylated interferon combined with ribavirin. Mean and median pretreatment neopterin concentrations were lower in patients with sustained virological response than in nonresponders. The rate of response was twofold higher among patients with pretreatment neopterin levels <16 nmol/L than in patients with neopterin levels ≥16 nmol/L, even after controlling for HCV genotype status. Our study suggests that the pretreatment level of neopterin might be used in routine clinical practice as rapid and cost-effective marker to predict the response to antiviral therapy in HCV patients.

  12. Although Relatively Few, "Doctor Shoppers" Skew Opioid Prescribing

    Science.gov (United States)

    ... Opioid Prescribing Although Relatively Few, “Doctor Shoppers” Skew Opioid Prescribing Email Facebook Twitter May 27, 2014 One ... patterns and alert both physicians and pharmacies. Extreme Opioid Purchasers Figure 1. Prescriber Utilization Distinguishes Likely “Doctor ...

  13. Patterns of physician prescribing for opioid maintenance treatment in Ontario, Canada in 2014.

    Science.gov (United States)

    Guan, Qi; Khuu, Wayne; Spithoff, Sheryl; Kiran, Tara; Kahan, Meldon; Tadrous, Mina; Martins, Diana; Leece, Pamela; Gomes, Tara

    2017-08-01

    Despite concerns surrounding high patient volumes in methadone clinics, little is known about the practice patterns of opioid maintenance therapy (OMT) providers in Ontario. We examined the distribution of these services and how physician characteristics differ based on prescribing volume. We conducted a cross-sectional study among prescribers of methadone or buprenorphine to Ontario public drug beneficiaries in 2014 by stratifying physicians into low- (lower 50%), moderate- (51-89%) and high-volume (top 10%) prescribers. We summarized the distribution of OMT prescription days dispensed and urine drug screens (UDS) ordered using Lorenz curves and examined physician characteristics using descriptive statistics. We identified 893 OMT prescribers in 2014. Physicians were mostly male (67.5%; N=603), and middle-aged (median was 50). High-volume methadone providers (N=57) prescribed approximately 56% (N=4,115,322) of the total days of methadone (Gini coefficient=0.76, 95% CI 0.74-0.79) while high-volume buprenorphine providers (N=64) prescribed 61% (N=589,463) of the total days of buprenorphine (Gini coefficient=0.78, 95% CI 0.75-0.80). On average, each high-volume methadone prescriber treated 435 OMT patients and billed 43 UDS per patient, while each high-volume buprenorphine prescriber treated 64 OMT patients and billed 22 UDS per patient. Daily OMT patient volume was on average 74 for high-volume methadone prescribers and 6 for high-volume buprenorphine prescribers. OMT services are highly concentrated among a small portion of OMT providers who carry high daily patient volumes. Future research should examine the quality of primary care received by their patients to better elucidate the possible consequences of this highly unequal distribution of services. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. HIV/HCV Antiviral Drug Interactions in the Era of Direct-acting Antivirals

    Science.gov (United States)

    Rice, Donald P.; Faragon, John J.; Banks, Sarah; Chirch, Lisa M.

    2016-01-01

    Abstract Therapy for human immunodeficiency virus (HIV) and chronic hepatitis C has evolved over the past decade, resulting in better control of infection and clinical outcomes; however, drug-drug interactions remain a significant hazard. Joint recommendations from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America regarding drug-drug interactions between HIV antiretroviral agents and direct-acting antiviral agents for treatment of hepatitis C virus (HCV) infection are reviewed here. This review is oriented to facilitate appropriate selection of an antiviral therapy regimen for HCV infection based on the choice of antiretroviral therapy being administered and, if necessary, switching antiretroviral regimens. PMID:27777891

  15. Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care.

    Science.gov (United States)

    Bastida, Carla; Corominas, Núria; Sotoca, José Miguel; Rovira, Marina

    2017-04-01

    Background Few studies assess the use of non-vitamin K antagonist oral anticoagulants (NOACs) in daily practice for the prevention of thromboembolic complications associated to nonvalvular atrial fibrillation (AF). Objectives Describe NOACs' use and analyze its prescribing pattern. Evaluate possible factors associated to adverse events (AEs) and the applicability of prescription support forms. Methods We included patients with AF treated with a NOAC during 2014 in three primary healthcare centers in Barcelona, Spain. Demographic and clinical data was collected, as well as embolic and bleeding risk and reported AEs. Results A total of 101 patients were included, with a median age of 75 years. The NOACs most frequently prescribed were dabigatran and rivaroxaban. An 87.2% of the patients were receiving the recommended dosage. A potential bleeding risk was present in 47% of the subjects. Ten AEs were reported, of which eight hemorrhages. Patients who presented an AE were >65 years and had a higher proportion of concomitant treatment and/or co-morbidities that could prompt to bleeding (p monitoring is especially needed in patients >65 years and at higher risk of bleeding. Prescription support forms help good prescribing and identifying potential individuals at high risk of AEs.

  16. Iatrogenic Cushing Syndrome from Interaction Between Ritonavir and Oral Budesonide During Direct Acting Antiviral Hepatitis C Therapy.

    Science.gov (United States)

    Yeoh, Sern Wei

    2016-09-01

    Direct acting antiviral (DAA) regimens containing ritonavir have been developed to treat hepatitis C, with fewer side effects than that by interferon-based regimens. However prescribers must be aware of drug-drug interactions. There are multiple reports of iatrogenic Cushing syndrome (CS) caused by ritonavir, when used to treat human immunodeficiency virus, increasing the bioavailability of exogenous steroids by inhibiting cytochrome p450 enzymes in the liver and gut wall and thus reducing steroid metabolism. We herein report a novel scenario of CS due to interaction between ritonavir for hepatitis C treatment and oral budesonide for autoimmune hepatitis.

  17. Prescribing psychotropic drugs: whose responsibility?

    Science.gov (United States)

    Miller, R S; Wiedeman, G H; Linn, L

    1980-01-01

    Through the use of a questionnaire it has been ascertained that a significant number of second-year graduate school social work students at the Columbia University School of Social Work are called upon to monitor and dispense psychotrophic drugs in various placements where they receive their practical clinical training. In some instances they may even fill out prescription blanks that are signed by psychiatrists who do not have the time to see the patients personally. This situation not only represents the abdication of medical responsibility, frequently leaving non-medical personnel with functions beyond their training and professional competence, but also raises important ethical and legal problems. Non-medical professionals in mental health settings should receive appropriate instruction in the essentials of psychopharmacology. Such training should not be left to chance as apparently is the case now. Non-medically trained members of the mental health team, if properly instructed, could cooperate more effectively with the psychiatrists who must in any event retain primary responsibility for pharmacotherapy.

  18. Understanding veterinarians' prescribing decisions on antibiotic dry cow therapy.

    Science.gov (United States)

    Higgins, H M; Golding, S E; Mouncey, J; Nanjiani, I; Cook, A J C

    2017-04-01

    In the United Kingdom, blanket antibiotic dry cow therapy (BDCT) is commonly prescribed. An alternate strategy is selective dry cow therapy (SDCT) whereby a teat sealant is given instead of an antibiotic to cows with a low probability of infection. Switching from BDCT to SDCT can significantly reduce antibiotic use. The aims of this study were to explore how veterinarians (vets) rationalized their prescribing decisions for mammary treatments at drying off, and the barriers and motivators they perceived to implementing SDCT. Face-to-face interviews were conducted with 20 purposively recruited vets from 6 practices in England, United Kingdom. The data were analyzed qualitatively using an inductive thematic analysis. The majority of participants stated a personal preference for SDCT because it constitutes more responsible antibiotic use. On the majority of farms, the prescribing decision was taken by a senior veterinarian and BDCT was prescribed. Less experienced vets expressed a desire to be more involved in the decision-making process. The first theme, prioritizing responsible antimicrobial prescribing, encapsulated the difficulties vets expressed engaging with farmers, conflicts of interest, and vets' determination to take action. The second theme, the effect of a vet's experience on their ability to influence farmers, focused on the specific challenges faced by less experienced vets and the importance of vets being both trusted by farmers and being knowledgeable. The third theme, vets' perceptions about the risk and complexity of implementing SDCT, revealed markedly different levels of concern and fears about adverse outcomes with teat sealants versus antibiotics. The results also showed differences in perceptions about how difficult SDCT is to implement in practice. The last theme, vets' suggestions for facilitating the introduction of SDCT, was wide ranging and provided useful insight from a veterinary perspective into ways to facilitate SDCT. Initiatives that

  19. Antibiotic-prescribing patterns for Iraqi patients during Ramadan

    Directory of Open Access Journals (Sweden)

    Mikhael EM

    2014-11-01

    Full Text Available Ehab Mudher Mikhael, Ali Lateef Jasim Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Baghdad, Iraq Background: During Ramadan, Muslims fast throughout daylight hours. There is a direct link between fasting and increasing incidence of infections. Antibiotic usage for treatment of infections should be based on accurate diagnosis, with the correct dose and dosing regimen for the shortest period to avoid bacterial resistance. This study aimed to evaluate the practices of physicians in prescribing suitable antibiotics for fasting patients and the compliance of the patients in using such antibiotics at regular intervals.Materials and methods: An observational study was carried out during the middle 10 days of Ramadan 2014 in two pharmacies at Baghdad. A total of 34 prescriptions (Rx for adults who suffered from infections were examined. For each included Rx, the researchers documented the age and sex of the patient, the diagnosis of the case, and the name of the given antibiotic(s with dose and frequency of usage. A direct interview with the patient was also done, at which each patient was asked about fasting and if he/she would like to continue fasting during the remaining period of Ramadan. The patient was also asked if the physician asked him/her about fasting before writing the Rx.Results: More than two-thirds of participating patients were fasting during Ramadan. Antibiotics were prescribed at a higher percentage by dentists and surgeons, for which a single antibiotic with a twice-daily regimen was the most commonly prescribed by physicians for patients during the Ramadan month.Conclusion: Physicians fail to take patient fasting status into consideration when prescribing antibiotics for their fasting patients. Antibiotics with a twice-daily regimen are not suitable and best to be avoided for fasting patients in Iraq during Ramadan – especially if it occurs during summer months – to avoid treatment failure and provoking

  20. Effect of opioid prescribing guidelines in primary care.

    Science.gov (United States)

    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.

  1. Evaluation of antiviral effects of various disinfectants on dental handpieces

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    Hasani Tabatabai M

    2007-01-01

    Full Text Available Background and Aim: Handpieces are in current use in dental practice. Cross contamination from these instruments is very high because of their direct contact with blood and saliva. The purpose of this study was the evaluation of antiviral effects of different disinfectants on dental handpieces. Materials and Methods: In this experimental study, the effects of 5 groups of different materials and methods of sterilization and disinfection on virus elimination from dental handpieces were evaluated. Groups were as follows: 1- autoclave 2- Solarsept 3- Unisepta 4- Sodium hypochlorite (2% solution of household bleach 5- Sanosil. 14 handpieces in each group were washed, dried and autoclaved, then contaminated with polio and Herpes Simplex virus type I. Samples were washed with sterile distilled water. Antiviral agents were applied according to the manufacturer or previous investigations. After washing with water, the instruments were washed with MEM (Minimum Essential Medium and two samples of cell culture from each handpiece were prepared. In each group one handpiece was treated as control. The results were recorded after one week. Results: The percent of negative cell cultures in each group were as follow: A- For Poliovirus: 1- Autoclave: 100%. 2- Solarsept: 28.6%. 3- Unisepta: 0%. 4- Sodium hypochlorite: 28.6%. 5- Sanosil 92.9%. B- For Herpesvirus: 1- Autoclave: 100%. 2- Solarsept: 100%. 3- Unisepta: 100%. 4- Sodium hypochlorite: 57.1%. 5- Sanosil: 100%. Conclusion: According to our findings autoclave is the best method for virus elimination from dental handpieces. Sanosil with 92.9% efficiency was the best solution. Solarsept, hypochlorite with special method and Unisepta had the lowest effectiveness.

  2. Examining prescribed rest as treatment for adolescents who are slow to recover from concussion.

    Science.gov (United States)

    Moser, Rosemarie Scolaro; Schatz, Philip; Glenn, Megan; Kollias, Kelly E; Iverson, Grant L

    2015-01-01

    Rest is a widely recommended treatment for concussion, but its utility is unclear following the acute stage of recovery. This study examined the effects of 1-week of prescribed rest in concussed adolescent athletes. Participants were 13 adolescent athletes with persistent symptoms following a concussion. More than three-quarters (77%) had self-reported ADHD, learning disability or two prior concussions. All completed ImPACT at another facility, but none completed a period of comprehensive rest prior to examination at a specialty practice. Three time points of test data were compared, to control for possible spontaneous recovery: Test 1 (external facility), Test 2 (before prescribed rest) and Test 3 (following prescribed rest). Repeated measures ANOVAs revealed a significant effect of prescribed rest on all ImPACT composite scores and the total symptom score. Post-hoc analyses revealed no significant differences between Time 1 and Time 2, whereas significant differences were present after prescribed rest. Following prescribed rest, having two or more reliably improved cognitive test scores or having improved symptoms was present in eight of the 13 patients (61.5%). A substantial percentage of adolescents with persistent symptoms following concussion showed improvement in symptoms and cognitive functioning following education, reassurance and 1-week of prescribed rest.

  3. Incidences of new prescribing by British child and adolescent psychiatrists: a prospective study over 12 months.

    Science.gov (United States)

    Clark, Andrew F

    2004-03-01

    Little is known about the epidemiology of pharmacotherapy in the treatment of child psychiatric disorder. This study reports on the systematic prospective collection of instances of new prescribing by child and adolescent mental health services serving a population of approximately four million people in North West England. Diagnostic and demographic information regarding new prescribing by child and adolescent mental health services within Greater Manchester and Lancashire was systematically collected prospectively over two 6-month periods between 2000 and 2002. Within the 12 months studied, there were 845 instances of a drug being newly prescribed to a child or adolescent in the treatment of a psychiatric disorder. In total, 48 different drugs were prescribed for 25 different diagnoses. The eight most commonly prescribed drugs were methylphenidate, methylphenidate/placebo trial, paroxetine, fluoxetine, risperidone, imipramine, dexamphetamine and melatonin, accounting for 73% of all prescribing. There was marked variation between services in the amount of prescribing with significant correlation between prescription of stimulants and prescription of selective serotonin reuptake inhibitor antidepressants. Prescription of medications in the treatment of child psychiatric disorder has become a significant part of child and adolescent mental health practice. However, the evidence base underpinning this usage remains limited, and further high quality therapeutic clinical trials are urgently needed.

  4. Prescribing dialysate bicarbonate concentrations for hemodialysis patients.

    Science.gov (United States)

    Heineken, F G; Brady-Smith, M; Haynie, J; Van Stone, J C

    1988-01-01

    A rearranged equation of Sargent and Gotch (1) was used to determine dialysate bicarbonate concentrations for hemodialysis patients. Parameters in this equation include an estimate of the acid generated by each patient between treatments, an estimate for the dialyzer dialysance for bicarbonate, ultrafiltration rate, blood flow rate and a targeted mid-dialysis plasma bicarbonate concentration of 25 mEq/L. Nine patients were studied over a 35 week period to verify this method of determining each patient's dialysate bicarbonate concentration. Prescribed dialysate bicarbonate concentrations for the nine patients varied from 29 to 38 mEq/L with five patients having a prescribed value of 35 mEq/L. After a baseline period of five weeks, five patients switched from a 37 mEq/L acetate dialysate to their prescribed dialysate bicarbonate concentration. Four patients who had already been on bicarbonate dialysis at a concentration of 35 mEq/L were dialyzed with their prescribed dialysate bicarbonate concentrations. Patients were then followed for a study period of 30 weeks. The prescribed dialysate bicarbonate concentration resulted in more normal acid/base chemistries for both groups of patients. The results also demonstrate that chronic hemodialysis patients require individualization of dialysate bicarbonate concentrations.

  5. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Gronseth, Gary S; Paduga, Remia

    2012-11-27

    To review evidence published since the 2001 American Academy of Neurology (AAN) practice parameter regarding the effectiveness, safety, and tolerability of steroids and antiviral agents for Bell palsy. We searched Medline and the Cochrane Database of Controlled Clinical Trials for studies published since January 2000 that compared facial functional outcomes in patients with Bell palsy receiving steroids/antivirals with patients not receiving these medications. We graded each study (Class I-IV) using the AAN therapeutic classification of evidence scheme. We compared the proportion of patients recovering facial function in the treated group with the proportion of patients recovering facial function in the control group. Nine studies published since June 2000 on patients with Bell palsy receiving steroids/antiviral agents were identified. Two of these studies were rated Class I because of high methodologic quality. For patients with new-onset Bell palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function (2 Class I studies, Level A) (risk difference 12.8%-15%). For patients with new-onset Bell palsy, antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best.

  6. Does organisational culture influence prescribing in care homes for older people? A new direction for research.

    Science.gov (United States)

    Hughes, Carmel M; Lapane, Kate; Watson, Margaret C; Davies, Huw T O

    2007-01-01

    Prescribing in care homes for older people has been the focus of much research and debate because of inappropriate drug choice and poor monitoring practices. In the US, this has led to the implementation of punitive and adversarial regulation that has sought to improve the quality of prescribing in this healthcare setting. This approach is unique to the US and has not been replicated elsewhere. The literature has revealed that there are limitations as to how much can be achieved with regulation that is externally imposed (an 'external factor'). Other influences, which may be categorised as 'internal factors' operating within the care home (e.g. patient, physician and care-home characteristics), also affect prescribing. However, these internal and external factors do not appear to affect prescribing uniformly, and poor prescribing practices in care homes continue to be observed. One intangible factor that has received little attention in this area of healthcare is that of organisational culture. This factor has been linked to quality and performance within other health organisations. Consideration of organisational culture within care-home settings may help to understand what drives prescribing decisions in this particularly vulnerable patient group and thus provide new directions for future strategies to promote quality care.

  7. Research progress in the development of direct acting antiviral agents for hepatitis C and the anti-viral resistance

    Directory of Open Access Journals (Sweden)

    Song YANG

    2011-05-01

    Full Text Available Recently,directly acting antiviral agents against hepatitic C virus with different mechanisms have been developed and put into clinical trials.Especially,results of phase Ⅲ clinical trials of Boceprevir and Telaprevir have been published,and these two agents are to be approved for marketing in recent years.Also much attention has been paid on anti-viral resistance against direct acting antiviral agents.Great progresses have been made in field of direct acting antiviral agents against hepatitic C virus.Domestic studies in this area should take characteristics of virus and host of Chinese chronic hepatitis C into consideration.

  8. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

  9. Prescribing restrictions – a necessary strategy among some European countries to enhance future prescribing efficiency?

    Directory of Open Access Journals (Sweden)

    Brian Godman

    2012-01-01

    Full Text Available The unsustainable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower prices of generics and enhance their utilisation. These include prescribing restrictions. However, there have been concerns with their impact on subsequent quality of care as well as their influence in reality. OBJECTIVES: (a Review the influence of prescribing restrictions and whether there are any differences depending on their nature and drug classes; (b Ascertain whether prescribing restrictions can be added to existing demand-side measures to further enhance prescribing efficiency; (c Whether they compromise subsequent quality of care. RESULTS: Prescribing restrictions have a variable impact on subsequent utilisation of patented protected products versus generics in a class, with their influence depending on the nature and follow-up of the restrictions rather than the class of drug. This is seen among the proton pump inhibitors, statins, and renin-angiotensin drugs. Prescribing restrictions can be successfully added to existing measures to further enhance prescribing efficiency, and do not appear to compromise subsequent quality of care. CONCLUSIONS: Prescribing restrictions can be a successful strategy as countries strive to maintain the European ideals for healthcare. However, care is needed when planning these programmes: else health authorities could be disappointed with their outcome.

  10. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    deVries, CS; vanDiepen, NM; Tromp, TFJ; deJongvandenBerg, LTW

    1996-01-01

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs. Next

  11. The use of prescribed and non-prescribed medication by Dutch children.

    NARCIS (Netherlands)

    Dijk, L. van; Lindert, H. van

    2002-01-01

    Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

  12. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    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.

  13. Design of materials with prescribed nonlinear properties

    DEFF Research Database (Denmark)

    Wang, Fengwen; Sigmund, Ole; Jensen, Jakob Søndergaard

    2014-01-01

    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 un....... The numerical examples illustrate optimized materials with rubber-like behavior and also optimized materials with extreme strain-independent Poisson's ratio for axial strain intervals of εi ∈ [0.00,0.30]. © 2014 Elsevier Ltd. All rights reserved....... under finite deformation, i.e. stress-strain relations and Poisson's 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...

  14. Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses.

    Science.gov (United States)

    Ringwalt, Chris; Gugelmann, Hallam; Garrettson, Mariana; Dasgupta, Nabarun; Chung, Arlene E; Proescholdbell, Scott K; Skinner, Asheley Cockrell

    2014-01-01

    Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians' opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown. To examine the relationships between physicians' and other providers' primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP). Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients' pain diagnoses and demographic characteristics. Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner⁄family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races⁄ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8). Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with

  15. Differences between integrated and stand-alone E-prescribing systems have implications for future use.

    Science.gov (United States)

    Desroches, Catherine M; Agarwal, Ritu; Angst, Corey M; Fischer, Michael A

    2010-12-01

    Understanding the benefits of electronic prescribing systems has important implications for quality and efficiency in medical care. We surveyed physicians about their use of e-prescribing in outpatient practices. We found that physicians who use e-prescribing systems integrated into an electronic health record have different characteristics, usage patterns, perceived benefits, and levels of satisfaction than physicians who use stand-alone systems. For example, although only 56 percent of the physicians we surveyed said that they checked a patient's drug history most or all of the time when writing a prescription, those with integrated systems were significantly more likely to report doing so than their counterparts with stand-alone systems. Our findings have implications for the American Recovery and Reinvestment Act's requirements for e-prescribing and the future use of this technology. Because many stand-alone systems cannot meet meaningful-use requirements, there is likely to be a shift toward integrated systems.

  16. Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis.

    Science.gov (United States)

    Lee, Tau-Hong; Wong, Joshua Gx; Lye, David Cb; Chen, Mark Ic; Loh, Victor Wk; Leo, Yee-Sin; Lee, Linda K; Chow, Angela Lp

    2017-03-01

    Acute upper respiratory infections (AURI) are the leading causes of antibiotic prescribing in primary care although antibiotics are often not indicated. To gain an understanding of the knowledge, attitudes, and practices (KAP) of GPs in Singapore and the associated latent factors to guide the implementation of an effective programme to reduce antibiotic use in primary care. An anonymous survey on the KAP of antibiotic use in AURI of GPs in Singapore. KAP survey questionnaires were posted to all GPs from a database. To ascertain the latent factors affecting prescribing patterns, exploratory factor analysis was performed. Among 427 responses, 351 (82.2%) were from GPs working in private practice. It was found that 58.4% of GPs in the private versus 72.4% of those in the public sector recognised that >80% of AURIs were caused by viruses (P = 0.02). The majority of GPs (353/427; 82.7%) felt that antibiotics were overprescribed in primary care. Significant factors associated with low antibiotic prescribing were good medical knowledge and clinical competency (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] = 2.4 to 4.3), good clinical practice (aOR 2.7 [95% CI = 2.0 to 3.6]), availability of diagnostic tests (aOR 1.4 [95% CI = 1.1 to 1.8]), and desire to improve clinical practice (aOR 1.5 [95% CI = 1.2 to 1.9]). The conservative practice of giving antibiotics 'to be on the safe side' is significantly less likely to be associated with low antibiotic prescribing (aOR 0.7 [95% CI = 0.5 to 0.9]). This is the first KAP survey on antibiotic prescribing for AURI among GPs in Singapore. With the latent factors identified, future interventions should be directed at addressing these factors to reduce inappropriate antibiotic prescribing. © British Journal of General Practice 2017.

  17. Errors associated with outpatient computerized prescribing systems

    Science.gov (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G

    2011-01-01

    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  18. Prescribed Fire is Cool on Florida Highway

    OpenAIRE

    Caster, Jeff; McBurney, Willson; Farley, Patricia; Rodriguez, Rose; Green, Lane; McGorty, Kevin

    2007-01-01

    Though unprecedented in the sunshine state, plans for a prescribed fire on US319/SR61, Kate Ireland Parkway in north Florida sparked enthusiasm and excitement among roadside managers. The recently expanded high speed corridor passes for ten miles through the Red Hills Region (www.ttrs.org/rhcp); a rural landscape that is host to America’s largest remnant of the great longleaf pine forest (www.longleafalliance.org). Prescribed fire is a necessary and popular landscape management tool used by g...

  19. A Helping Hand: Individually Prescribed Instruction (IPI

    Directory of Open Access Journals (Sweden)

    Bernard W. Andrews

    2014-10-01

    Full Text Available Individually Prescribed Instruction (IPI is an approach to teaching that emphasizes the diagnosis of learning problems and the provision of prescriptive assignments to assist individual students overcome their difficulties.  When this strategy is employed effectively, the teaching environment is highly adaptive.  The teacher matches the students' abilities to alternate ways of learning, and also provides remedial assistance and positive reinforcement.  Individually Prescribed Instruction has been shown to be effective across the school curriculum.  This writer reviews the success of this strategy for assisting students overcome learning problems, and proposes a model for its implementation in music instruction.

  20. [Appropriateness prescribing and doctor's professional responsibility].

    Science.gov (United States)

    Massoni, F; Simeone, C; Luzi, E; Palla, C; Ricci, S

    2012-07-01

    The public health spending has now reached very significant levels, in this sense, the responsibility of the medical doctor assumes a significant importance in medical law. The aim of this paper is to analyze the profile of responsibilities of the medical doctor in the light of recent case law. The appropriateness of prescribing and risk assessment are, according to the authors, the real test on which to test the skill, prudence and diligence which are called prescribers. Guidelines can be a valuable tool for the professional help, knowing, however, limits application of the recommendations where to be reconciling with the prevailing protection of personal rights of the user.

  1. Evoking prescribed spike times in stochastic neurons

    Science.gov (United States)

    Doose, Jens; Lindner, Benjamin

    2017-09-01

    Single cell stimulation in vivo is a powerful tool to investigate the properties of single neurons and their functionality in neural networks. We present a method to determine a cell-specific stimulus that reliably evokes a prescribed spike train with high temporal precision of action potentials. We test the performance of this stimulus in simulations for two different stochastic neuron models. For a broad range of parameters and a neuron firing with intermediate firing rates (20-40 Hz) the reliability in evoking the prescribed spike train is close to its theoretical maximum that is mainly determined by the level of intrinsic noise.

  2. Avian Interferons and Their Antiviral Effectors.

    Science.gov (United States)

    Santhakumar, Diwakar; Rubbenstroth, Dennis; Martinez-Sobrido, Luis; Munir, Muhammad

    2017-01-01

    Interferon (IFN) responses, mediated by a myriad of IFN-stimulated genes (ISGs), are the most profound innate immune responses against viruses. Cumulatively, these IFN effectors establish a multilayered antiviral state to safeguard the host against invading viral pathogens. Considerable genetic and functional characterizations of mammalian IFNs and their effectors have been made, and our understanding on the avian IFNs has started to expand. Similar to mammalian counterparts, three types of IFNs have been genetically characterized in most avian species with available annotated genomes. Intriguingly, chickens are capable of mounting potent innate immune responses upon various stimuli in the absence of essential components of IFN pathways including retinoic acid-inducible gene I, IFN regulatory factor 3 (IRF3), and possibility IRF9. Understanding these unique properties of the chicken IFN system would propose valuable targets for the development of potential therapeutics for a broader range of viruses of both veterinary and zoonotic importance. This review outlines recent developments in the roles of avian IFNs and ISGs against viruses and highlights important areas of research toward our understanding of the antiviral functions of IFN effectors against viral infections in birds.

  3. Avian Interferons and Their Antiviral Effectors

    Science.gov (United States)

    Santhakumar, Diwakar; Rubbenstroth, Dennis; Martinez-Sobrido, Luis; Munir, Muhammad

    2017-01-01

    Interferon (IFN) responses, mediated by a myriad of IFN-stimulated genes (ISGs), are the most profound innate immune responses against viruses. Cumulatively, these IFN effectors establish a multilayered antiviral state to safeguard the host against invading viral pathogens. Considerable genetic and functional characterizations of mammalian IFNs and their effectors have been made, and our understanding on the avian IFNs has started to expand. Similar to mammalian counterparts, three types of IFNs have been genetically characterized in most avian species with available annotated genomes. Intriguingly, chickens are capable of mounting potent innate immune responses upon various stimuli in the absence of essential components of IFN pathways including retinoic acid-inducible gene I, IFN regulatory factor 3 (IRF3), and possibility IRF9. Understanding these unique properties of the chicken IFN system would propose valuable targets for the development of potential therapeutics for a broader range of viruses of both veterinary and zoonotic importance. This review outlines recent developments in the roles of avian IFNs and ISGs against viruses and highlights important areas of research toward our understanding of the antiviral functions of IFN effectors against viral infections in birds. PMID:28197148

  4. Antiviral Defenses in Plants through Genome Editing

    Science.gov (United States)

    Romay, Gustavo; Bragard, Claude

    2017-01-01

    Plant–virus interactions based-studies have contributed to increase our understanding on plant resistance mechanisms, providing new tools for crop improvement. In the last two decades, RNA interference, a post-transcriptional gene silencing approach, has been used to induce antiviral defenses in plants with the help of genetic engineering technologies. More recently, the new genome editing systems (GES) are revolutionizing the scope of tools available to confer virus resistance in plants. The most explored GES are zinc finger nucleases, transcription activator-like effector nucleases, and clustered regularly interspaced short palindromic repeats/Cas9 endonuclease. GES are engineered to target and introduce mutations, which can be deleterious, via double-strand breaks at specific DNA sequences by the error-prone non-homologous recombination end-joining pathway. Although GES have been engineered to target DNA, recent discoveries of GES targeting ssRNA molecules, including virus genomes, pave the way for further studies programming plant defense against RNA viruses. Most of plant virus species have an RNA genome and at least 784 species have positive ssRNA. Here, we provide a summary of the latest progress in plant antiviral defenses mediated by GES. In addition, we also discuss briefly the GES perspectives in light of the rebooted debate on genetic modified organisms (GMOs) and the current regulatory frame for agricultural products involving the use of such engineering technologies. PMID:28167937

  5. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

    prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200&emsp14......;000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. RESULTS: The rate of primary non-adherence was 6...

  6. Rationale of azithromycin prescribing practices for enteric fever in India

    Directory of Open Access Journals (Sweden)

    S Rai

    2012-01-01

    Full Text Available Purpose: The present study was performed to assess the current susceptibility pattern of blood isolates of Salmonella spp from a super specialty hospital in North India against nalidixic acid, ciprofloxacin and azithromycin and compare the in vitro and in vivo response against azithromycin. Materials and Methods: We evaluated the minimum inhibitory concentration′s (MIC′s of 107 blood isolates of Salmonella spp against nalidixic acid, azithromycin and ciprofloxacin and correlated in vitro and in vivo response of azithromycin from the treatment and discharge summaries from the Hospital Information System (HIS software. Results: Among the 107 isolates evaluated, 94 (87.8% were nalidixic acid-resistant (NAR Salmonella and 36 were resistant to azithromycin by MIC testing. The MIC 90 value for azithromycin was 24 μg/mL. Among the 57 treatment histories evaluated using the HIS software, 19 (33% patients had documented clinical non-response to azithromycin which required change of therapy. Conclusions: The present study observed a higher MIC 90 values for azithromycin compared to Salmonella isolates from Western studies. There was also a documented clinical non-response against azithromycin. The in vitro and in vivo findings in this study suggest a guarded use of azithromycin for cases of enteric fever in India. The study also augments the reversal of resistance pattern in favour of chloramphenicol, ampicillin and trimethoprim - sulfamethoxazole.

  7. Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs.

    Directory of Open Access Journals (Sweden)

    Roy H Perlis

    Full Text Available 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.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.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.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.

  8. Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey

    Directory of Open Access Journals (Sweden)

    Beyhun Nazim E

    2007-06-01

    Full Text Available Abstract Background Commercial sources of information are known to have greater influence than scientific sources on general practitioners' (GPs prescribing behavior in under developed and developing countries. The study aimed to determine the self-reported impact of pharmaceutical promotion on the decision-making process of prescription of GPs in Eastern Turkey. Methods A cross-sectional, exploratory survey was performed among 152 GPs working in the primary health centers and hospitals in Erzurum province of Eastern Turkey in 2006. A self-administered structured questionnaire was used. The questionnaire included questions regarding sociodemographics, number of patients per day, time per patient, frequency of sales representative visits to GPs, participation of GPs in training courses on prescribing (in-service training, drug companies, factors affecting prescribing decision, reference sources concerning prescribing and self-reported and self-rated effect of the activities of sales representatives on GPs prescribing decisions. Results Of 152 subjects, 53.3% were male and 65.8% were working at primary health care centers, respectively. Mean patient per day was 58.3 ± 28.8 patients per GP. For majority of the GPs (73.7%, the most frequent resource used in case of any problems in prescribing process was drug guides of pharmaceutical companies. According to self-report of the GPs, their prescribing decisions were affected by participation in any training activity of drug companies, frequent visits by sales representatives, high number of patient examinations per day and low year of practice (p Conclusion The results of this study suggest that for the majority of the GPs, primary reference sources concerning prescribing was commercial information provided by sales representatives of pharmaceutical companies, which were reported to be highly influential on their decision-making process of prescribing by GPs. Since this study was based on self

  9. Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs.

    Science.gov (United States)

    Perlis, Roy H; Perlis, Clifford S

    2016-01-01

    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. 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. 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. 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.

  10. Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

    Directory of Open Access Journals (Sweden)

    Hare Monika

    2010-05-01

    Full Text Available Abstract Background The Stemming the Tide of Antibiotic Resistance (STAR Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and

  11. Induction and suppression of the innate antiviral responses by picornaviruses

    NARCIS (Netherlands)

    Feng, Q.

    2014-01-01

    On the front line of innate antiviral immune reactions is the type I interferon (IFN-α/β) system. IFN-α/β are small signaling molecules that can be produced by virtually all nucleated cells in our body upon virus infections, and induce a so-called “antiviral state” in neighboring cells by activating

  12. Self-interest versus group-interest in antiviral control

    NARCIS (Netherlands)

    Boven, M. van; Klinkenberg, D.; Pen, I.; Weissing, F.J.; Heesterbeek, J.A.P.

    2008-01-01

    Antiviral agents have been hailed to hold considerable promise for the treatment and prevention of emerging viral diseases like H5N1 avian influenza and SARS. However, antiviral drugs are not completely harmless, and the conditions under which individuals are willing to participate in a large-scale

  13. Beyond RNAi: antiviral defense strategies in Drosophila and mosquito

    NARCIS (Netherlands)

    Merkling, S.H.; Rij, R.P. van

    2013-01-01

    Virus transmission and spread by arthropods is a major economic and public health concern. The ongoing dissemination of arthropod-borne viruses by blood-feeding insects is an important incentive to study antiviral immunity in these animals. RNA interference is a major mechanism for antiviral defense

  14. Learning from escaped prescribed fire reviews

    Science.gov (United States)

    Anne E. Black; Dave Thomas; James Saveland; Jennifer D. Ziegler

    2011-01-01

    The U.S. wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire (expanding on the typical regional or local reviews, to include more of a learning focus - expanded After Action Reviews, reviews that incorporate High Reliability Organizing, Facilitated Learning Analyses, etc). The stated purpose...

  15. Learning from escaped prescribed fire reviews [Abstract

    Science.gov (United States)

    Anne Black; Dave Thomas; James Saveland

    2011-01-01

    Over the past decade, the wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire. The stated purpose been to identify methods that not only meet policy requirements, but to reduce future escapes. Implicit is the assumption that a review leads to learning. Yet, as organizational learning expert...

  16. A Comparison between Prescribed Exercise Programs.

    Science.gov (United States)

    Hultgren, Philip B.; Burke, Edmund J., Jr.

    This paper compares the methods for prescribing exercise according to various contemporary authorities. The programs are compared as to their goals, the testing modalities and physiological parameters used for prescription of the initial training session, and the methods and the progression of training. Regarding goals, there is a general…

  17. 27 CFR 24.20 - Forms prescribed.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 24.20 Section 24.20 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Authorities § 24.20...

  18. Prescribing behavior of general practitioners : Competition matters!

    NARCIS (Netherlands)

    Schaumans, C.B.C.

    Background General Practitioners (GP) have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives I investigate whether GPs prescribe more units when confronted with more competition. As

  19. 7 CFR 28.956 - Prescribed fees.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Prescribed fees. 28.956 Section 28.956 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... continental United States 135.00 1.1High Volume Instrument (HVI) System Check Level. Furnishing two...

  20. Antidepressant prescribing in five European countries

    DEFF Research Database (Denmark)

    Abbing-Karahagopian, V; Huerta, C; Souverein, P C

    2014-01-01

    PURPOSE: Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalen...

  1. Photographic cockpit model for prescribing multifocals.

    Science.gov (United States)

    Powell, J H

    1992-01-01

    Recent interest in the relevancy of near vision tests for presbyopic aircrew members has led to the development of a photographic cockpit model. This model is used to prescribe more accurately for flying personnel. Prescriptions can be evaluated by use of trial lenses. This allows the aircrew members to experience the effect of viewing instruments in the cockpit of a C-130 aircraft.

  2. BIFURCATION IN PRESCRIBED MEAN CURVATURE PROBLEM

    Institute of Scientific and Technical Information of China (English)

    马力

    2002-01-01

    This paper discusses the existence problem in the study of some partial differential equations. The author gets some bifurcation on the prescribed mean curvature problem on the unit ball, the scalar curvature problem on the n-sphere, and some field equations. The author gives some natural conditions such that the standard bifurcation or Thom-Mather theory can be used.

  3. Prescribing of benzodiazepines by casualty officers.

    OpenAIRE

    1989-01-01

    The prescribing of benzodiazepines by casualty officers in a busy district hospital over a three month period was examined by a retrospective review of case notes. Benzodiazepines, mainly diazepam, were given to 1.1% of attenders, the majority of whom had disorders involving minor muscle spasm. The efficacy of diazepam in these conditions, as well as its potential for dependence, is discussed.

  4. Optimization of electronic prescribing in pediatric patients

    NARCIS (Netherlands)

    Maat, B.

    2014-01-01

    Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between s

  5. 16 CFR 315.5 - Prescriber verification.

    Science.gov (United States)

    2010-01-01

    ... time of verification request; (6) The name of a contact person at the seller's company, including... that the same company manufactures and sells under different labels. (f) Recordkeeping requirement... digital image of the prescription), that was presented to the seller by the patient or prescriber. (2)...

  6. Nonlinear Differential Systems with Prescribed Invariant Sets

    DEFF Research Database (Denmark)

    Sandqvist, Allan

    1999-01-01

    We present a class of nonlinear differential systems for which invariant sets can be prescribed.Moreover,we show that a system in this class can be explicitly solved if a certain associated linear homogeneous system can be solved.As a simple application we construct a plane autonomous system having...

  7. Assessment of the knowledge and attitudes of intern doctors to medication prescribing errors in a Nigeria tertiary hospital.

    Science.gov (United States)

    Ajemigbitse, Adetutu A; Omole, Moses Kayode; Ezike, Nnamdi Chika; Erhun, Wilson O

    2013-12-01

    Junior doctors are reported to make most of the prescribing errors in the hospital setting. The aim of the following study is to determine the knowledge intern doctors have about prescribing errors and circumstances contributing to making them. A structured questionnaire was distributed to intern doctors in National Hospital Abuja Nigeria. Respondents gave information about their experience with prescribing medicines, the extent to which they agreed with the definition of a clinically meaningful prescribing error and events that constituted such. Their experience with prescribing certain categories of medicines was also sought. Data was analyzed with Statistical Package for the Social Sciences (SPSS) software version 17 (SPSS Inc Chicago, Ill, USA). Chi-squared analysis contrasted differences in proportions; P Interns were least confident prescribing antibiotics (12, 25.5%), opioid analgesics (12, 25.5%) cytotoxics (10, 21.3%) and antipsychotics (9, 19.1%) unsupervised. Respondents seemed to have a low awareness of making prescribing errors. Principles of rational prescribing and events that constitute prescribing errors should be taught in the practice setting.

  8. The Antiviral Activities and Mechanisms of Marine Polysaccharides: An Overview

    Science.gov (United States)

    Wang, Wei; Wang, Shi-Xin; Guan, Hua-Shi

    2012-01-01

    Recently, the studies on the antiviral activities of marine natural products, especially marine polysaccharides, are attracting more and more attention all over the world. Marine-derived polysaccharides and their lower molecular weight oligosaccharide derivatives have been shown to possess a variety of antiviral activities. This paper will review the recent progress in research on the antiviral activities and the mechanisms of these polysaccharides obtained from marine organisms. In particular, it will provide an update on the antiviral actions of the sulfated polysaccharides derived from marine algae including carrageenans, alginates, and fucans, relating to their structure features and the structure–activity relationships. In addition, the recent findings on the different mechanisms of antiviral actions of marine polysaccharides and their potential for therapeutic application will also be summarized in detail. PMID:23235364

  9. The Antiviral Activities and Mechanisms of Marine Polysaccharides: An Overview

    Directory of Open Access Journals (Sweden)

    Hua-Shi Guan

    2012-12-01

    Full Text Available Recently, the studies on the antiviral activities of marine natural products, especially marine polysaccharides, are attracting more and more attention all over the world. Marine-derived polysaccharides and their lower molecular weight oligosaccharide derivatives have been shown to possess a variety of antiviral activities. This paper will review the recent progress in research on the antiviral activities and the mechanisms of these polysaccharides obtained from marine organisms. In particular, it will provide an update on the antiviral actions of the sulfated polysaccharides derived from marine algae including carrageenans, alginates, and fucans, relating to their structure features and the structure–activity relationships. In addition, the recent findings on the different mechanisms of antiviral actions of marine polysaccharides and their potential for therapeutic application will also be summarized in detail.

  10. Top 200 Prescribed Drugs Mostly Prescribed by the Physician in Pharmacies at Medan City

    Science.gov (United States)

    Tanjung, H. R.; Nasution, E. S.

    2017-03-01

    The drug information literatures usually contains thousands of drugs, which much of them were rare or never prescribed by the physicians. It caused pharmacy students must learn thousands of drugs that will depleted resources and the study result was not effective. The aim of the study was to identify 200 items of drugs that mostly prescribed by the physicians in the pharmacies at Medan City. The study was a descriptive study that used a cross sectional survey methodology. The 200 items of drugs that mostly prescribed by the physician obtained from the pharmacies selected regarding to random sampling method. The study was conducted from August to September 2016. The 200 items of drugs that mostly prescribed by the physician resulted from 21.962 prescribed drugs item of 16.352 prescriptions of 100 pharmacies. The list revealed that the most prescribed drugs was amoxicilline (5.55 %), followed by dexamethasone (4.44%), mefenamic acid (3.73%), cetirizine (3.16%), and ciprofloxacine (2.97%). It shows that the antibiotic drug was the most prescribed drug by the physician in pharmacies at Medan City. Further studies are required to develop the study card from the list.

  11. RNAi:antiviral therapy against dengue virus

    Institute of Scientific and Technical Information of China (English)

    Sobia Idrees; Usman A Ashfaq

    2013-01-01

    Dengue virus infection has become a global threat affecting around 100 countries in the world. Currently, there is no licensed antiviral agent available against dengue. Thus, there is a strong need to develop therapeutic strategies that can tackle this life threatening disease. RNA interference is an important and effective gene silencing process which degrades targeted RNA by a sequence specific process. Several studies have been conducted during the last decade to evaluate the efficiency of siRNA in inhibiting dengue virus replication. This review summarizes siRNAs as a therapeutic approach against dengue virus serotypes and concludes that siRNAs against virus and host genes can be next generation treatment of dengue virus infection.

  12. Social Adversity and Regional Differences in Prescribing of ADHD Medication for School-Age Children

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Skovgaard, Anne Mette; Thielen, Karsten

    2015-01-01

    Objectives: To explore whether regional variations in the initiation of attention-deficit hyperactivity disorder (ADHD) medication among school-age children are explained by differences in sociodemographic composition and/or ADHD prescribing practice, especially in children who face social...... adversity (low parental education and single parenthood). Methods: A cohort of Danish school-age children (ages 5–17) without previous psychiatric conditions (N = 813,416) was followed during 2010–2011 for incident ADHD prescribing in the individual-level Danish registers. Register information was retrieved...... regional differences prevail in prescribing practices for children facing social adversity, indicating that local cultures shape the interpretation and handling of children with ADHD-like behaviors....

  13. Atividade antiviral de Musa acuminata Colla, Musaceae Antiviral activity of Musa acuminata Colla, Musaceae

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    Fernanda Otaviano Martins

    2009-09-01

    Full Text Available O presente trabalho avalia a atividade antiviral de extratos e frações de Musa acuminata Colla, Musaceae, coletada em duas regiões do Estado do Rio de Janeiro (Petrópolis e Santo Antônio de Pádua. As inflorescências de M. acuminata apresentaram excelente atividade para os dois vírus avaliados: herpesvírus simples humano tipo 1 e herpesvírus simples humano tipo 2, ambos resistentes ao Aciclovir. Os resultados indicam que os extratos de M. acuminata testados podem constituir alvo potencial para uso em terapias antivirais.This study evaluates the antiviral activity of extracts and fractions of Musa acuminata Colla collected in two regions of Rio de Janeiro State (Petrópolis and Santo Antônio de Pádua. The inflorescences of M. acuminata showed excellent activity for the two virus evaluated: simple human herpesvirus type 1 and simple human herpesvirus type 2, both resistant to Acyclovir. The results indicate that the tested extracts of M. acuminata can be potential target for use in antiviral therapy.

  14. Cherry Valley ducks mitochondrial antiviral-signaling protein (MAVS mediated signaling pathway and antiviral activity research

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    Ning Li

    2016-09-01

    Full Text Available Mitochondrial antiviral-signaling protein (MAVS, an adaptor protein of retinoic acid-inducible gene I (RIG-I like receptors (RLRs-mediated signal pathway, is involved in innate immunity. In this study, Cherry Valley duck MAVS (duMAVS was cloned from the spleen and analyzed. duMAVS was determined to have a caspase activation and recruitment domain at N-terminal, followed by a proline rich domain and a transmembrane domain at C-terminal. Quantitative real time PCR indicated that duMAVS was expressed in all tissues tested across a broad expression spectrum. The expression of duMAVS was significantly up-regulated after infection with duck Tembusu virus. Overexpression of duMAVS could drive the activation of interferon-β, nuclear factor-κB, interferon regulatory factor 7, and many downstream factors (such as Mx, PKR, OAS, and IL-8 in duck embryo fibroblast cells. What’s more, RNA interference further confirmed that duMAVS was an important adaptor for IFN-β activation. The antiviral assay showed that duMAVS could suppress the various viral replications (duck Tembusu virus, novel reovirus, and duck plague virus at early stages of infection. Overall, these results showed that the main signal pathway mediated by duMAVS and it had a broad-spectrum antiviral ability. This research will be helpful to better understanding the innate immune system of ducks.

  15. Prescribing and using self-injectable antiretrovirals: How concordant are physician and patient perspectives?

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    Cohen Calvin

    2009-02-01

    Full Text Available Abstract Background The selection of agents for any treatment regimen is in part influenced by physician and patient attitudes. This study investigated attitudinal motivators and barriers to the use of self-injectable antiretroviral agents among physicians and patients and measured the degree of concordance between physician and patient perspectives. Methods Attitudes toward prescribing and usage of self-injectable antiretroviral therapy (SIAT were assessed by structured interview in 2 cohorts sampled from the European Union and the USA: 499 HIV-treating physicians and 603 treatment-experienced HIV-infected patients. Motivators and barriers to prescribing SIAT were identified from statistical analysis of the associations between physicians' ratings of enfuvirtide-based therapy compared to standard oral-based therapy and 2 indicators of enfuvirtide prescribing behavior. Patients' attitudes were assessed by their responses to a written profile of enfuvirtide and their ratings of the likelihood of accepting a treatment offer. Results Both indicators of SIAT prescribing behavior were predicted by the same pattern of physician beliefs. Nonprescribing was associated with: (1 the belief that offering enfuvirtide would be perceived negatively by patients, leading to treatment refusal and nonadherence; (2 the belief that prescribing enfuvirtide is harder to justify in terms of time/resources; and (3 a lack of confidence in the efficacy and use of enfuvirtide in practice (all p Conclusion Physician and patient beliefs about SIAT influence prescribing behavior and compliance yet may not be concordant, with patients having more positive attitudes towards SIAT than anticipated by physicians.

  16. A ranking system for prescribed burn prioritization in Table Mountain National Park, South Africa.

    Science.gov (United States)

    Cowell, Carly Ruth; Cheney, Chad

    2017-04-01

    To aid prescribed burn decision making in Table Mountain National Park, in South Africa a priority ranking system was tested. Historically a wildfire suppression strategy was adopted due to wildfires threatening urban areas close to the park, with few prescribed burns conducted. A large percentage of vegetation across the park exceeded the ecological threshold of 15 years. We held a multidisciplinary workshop, to prioritize areas for prescribed burning. Fire Management Blocks were mapped and assessed using the following seven categories: (1) ecological, (2) management, (3) tourism, (4) infrastructure, (5) invasive alien vegetation, (6) wildland-urban interface and (7) heritage. A priority ranking system was used to score each block. The oldest or most threatened vegetation types were not necessarily the top priority blocks. Selected blocks were burnt and burning fewer large blocks proved more effective economically, ecologically and practically due to the limited burning days permitted. The prioritization process was efficient as it could be updated annually following prescribed burns and wildfire incidents. Integration of prescribed burn planning and wildfire suppression strategies resulted in a reduction in operational costs. We recommend protected areas make use of a priority ranking system developed with expert knowledge and stakeholder engagement to determine objective prescribed burn plans.

  17. Prescribing vitamins at primary health care level: Exploration of facts, factors and solution

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    Adhir Kumar Das

    2010-06-01

    Full Text Available The impact of educational intervention on prescribing trend of vitamins at primary health care level was investigated by analyzing 2000 prescriptions containing vitamins. Prevalence of vitamin prescribing was 30.16%, 38.69% and 45.35% and contribution of vitamins in the cost of drugs prescribed in vitamin containing prescription was 27.58%, 30.40% and 41.85% at Upazilla Health Complexes (UHC, non-government organizations (NGO and private practices (PP respectively. Both parameters significantly (p<0.001 decreased after intervention. Prescribing of single vitamin preparations was 3.75%, 13.87% and 7.75% and appropriateness of the vitamin prescribing was 14.63%, 24.13% and 14.75% at UHC, NGO and PP respectively. Both parameters significantly (p<0.001 increased after intervention. Negligible emphasis on vitamin in pharmacology teaching at MBBS level was observed. Dependency on promotional materials of manufacturers were changed after intervention. In conclusion, knowledge deficiency due to inadequate professional training and dependency on biased information perhaps contributed in irrational prescribing of vitamins.

  18. Educational Outreach to Opioid Prescribers: The Case for Academic Detailing.

    Science.gov (United States)

    Trotter Davis, Margot; Bateman, Brian; Avorn, Jerry

    2017-02-01

    Nonmedical use of opioid medications constitutes a serious health threat as the rates of addiction, overdoses, and deaths have risen in recent years. Increasingly, inappropriate and excessively liberal prescribing of opioids by physicians is understood to be a central part of the crisis. Public health officials, hospital systems, and legislators are developing programs and regulations to address the problem in sustained and systematic ways that both insures effective treatment of pain and appropriate limits on the availability of opioids. Three approaches have obtained prominence as means of avoiding excessive and inappropriate prescribing, including: providing financial incentives to physicians to change their clinical decision through pay-for-performance contracts, monitoring patient medications through Prescription Drug Monitoring Programs, and educational outreach to physicians. A promising approach to educational outreach to physicians is an intervention known as "academic detailing." It was developed in the 1980s to provide one-on-one educational outreach to physicians using similar methods as the pharmaceutical industry that sends "detailers" to market their products to physician practices. Core to academic detailing, however, is the idea that medical decisions should be based on evidence-based information, including managing conditions with updated assessment measures, behavioral, and nonpharmacological interventions. With the pharmaceutical industry spending billions of dollars to advertise their products, individual practitioners can have difficulty gathering unbiased information, especially as the number of approved medications grows each year. Academic detailing has successfully affected the management of health conditions, such as atrial fibrillation, chronic obstructive pulmonary disease, and recently, has targeted physicians who prescribe opioids. This article discusses the approach as a potentially effective preventative intervention to address the

  19. Drug Use Evaluation of Three Widely Prescribed Antibiotics in a

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    Mehdi Mohammadi

    2015-10-01

    Full Text Available Background: Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching hospital in Iran.  The results of this study may be of help for clinicians to improve the patient care.Methods: Patients who received parenteral ceftazidim, vancomycin and amikacin from December2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined Daily Dose (DDD of each drug extracted from Anatomic and Therapeutic Chemical classification system (ATC/DDD and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD.Results: The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86% received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90% and 44 patients (88%. The renal function tests (Blood Urea Nitrogen, Serum Creatinin were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group.Conclusion: The results of this study indicate the need to establish continuing medical education (CME courses for physicians to familiarize them with standards required to use and monitor these agents.

  20. Concomitant prescribing and dispensing errors at a Brazilian hospital: a descriptive study

    Directory of Open Access Journals (Sweden)

    Maria das Dores Graciano Silva

    2011-01-01

    Full Text Available OBJECTIVE: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. INTRODUCTION: The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. METHODS: Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. RESULTS: One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6% of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4% content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. CONCLUSION: The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.

  1. Determinants associated with veterinary antimicrobial prescribing in farm animals in the Netherlands: a qualitative study.

    Science.gov (United States)

    Speksnijder, D C; Jaarsma, A D C; van der Gugten, A C; Verheij, T J M; Wagenaar, J A

    2015-04-01

    Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A thorough understanding of veterinarians' current prescribing practices and their reasons to prescribe antimicrobials might offer leads for interventions to reduce antimicrobial use in farm animals. This paper presents the results of a qualitative study of factors that influence prescribing behaviour of farm animal veterinarians. Semi-structured interviews with eleven farm animal veterinarians were conducted, which were taped, transcribed and iteratively analysed. This preliminary analysis was further discussed and refined in an expert meeting. A final conceptual model was derived from the analysis and sent to all the respondents for validation. Many conflicting interests are identifiable when it comes to antimicrobial prescribing by farm animal veterinarians. Belief in the professional obligation to alleviate animal suffering, financial dependency on clients, risk avoidance, shortcomings in advisory skills, financial barriers for structural veterinary herd health advisory services, lack of farmers' compliance to veterinary recommendations, public health interests, personal beliefs regarding the veterinary contribution to antimicrobial resistance and major economic powers are all influential determinants in antimicrobial prescribing behaviour of farm animal veterinarians. Interventions to change prescribing behaviour of farm animal veterinarians could address attitudes and advisory skills of veterinarians, as well as provide tools to deal with (perceived) pressure from farmers and advisors to prescribe antimicrobials. Additional (policy) measures could probably support farm animal veterinarians in acting as a more independent animal health consultant.

  2. What drives prescribing of asthma medication to preschool wheezing children? A primary care study.

    Science.gov (United States)

    Montella, Silvia; Baraldi, Eugenio; Bruzzese, Dario; Mirra, Virginia; Di Giorgio, Angela; Santamaria, Francesca

    2013-12-01

    There is limited information on which data primary care pediatricians (PCPs) use to decide whether to prescribe or not asthma maintenance treatment, and what drives prescribing a specific therapy. The study aim was to investigate how prescribing anti-asthma maintenance treatment to preschool wheezing children is influenced by patient, family, environmental, and PCP characteristics. We conducted a cross-sectional study at 32 PCPs sites in Campania, Italy. Medical, family, and environmental information of 376 preschool wheezy children, and characteristics of the enrolled PCPs were collected. Main outcome measures of multilevel multivariate logistic regression analyses were the prescribing of maintenance treatment, and the prescription of a combined therapy as opposed to monotherapy. Variables significantly associated with long-term inhaled corticosteroids (ICS) and/or leukotriene modifiers prescription included frequent wheezing (OR = 7.19), emergency department (ED) visits (OR = 2.21), personal allergic diseases (OR = 8.49), day-care/kindergarten attendance (OR = 2.67), a high PCP prescribing volume (OR = 2.74), and a low proportion of 0- to 5-year-old patients with wheezing diagnosis (OR = 1.16). Leukotriene modifiers plus ICS were much more likely prescribed than ICS or leukotriene modifiers alone to older children (OR = 1.06) and to patients experiencing frequent wheezing (OR = 3.00), ED visits (OR = 3.12), or tobacco smoke exposure during the first 2 years of life (OR = 2.04). Finally, PCP's characteristics significantly associated with ICS plus leukotriene modifiers prescription were group practice (OR = 4.16) and a high prescribing volume (OR = 1.45). Our findings suggest that child characteristics alone are not sufficient to explain how PCPs decide to prescribe maintenance treatment and which therapy to assign, but variables associated to PCPs are crucial as well.

  3. PREVALANCE OF VARIOUS SKIN DISORDERS AND PRESCRIBING PATTERN OF ANTIHISTAMINES IN TERTIARY CARE HOSPITAL, PUNE

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    Mrs. Manjusha Sajith

    2014-03-01

    Full Text Available Objectives: Dermatological conditions account for up to 2% of consultations in general practice worldwide. Skin diseases in developing countries have a serious impact on quality of life. The objective of the present study is to assess the prevalence of various skin diseases and to assess the drug utilization pattern of antihistamines in Dermatology Outpatient Department. Methods: A prospective study was carried out in Dermatology department of Bharati Hospital and Research Centre, Pune. The data collection form was prepared which includes patient and medication related information. The prescriptions were analyzed for common skin conditions and prescription patterns. Results: During the study period 320 prescriptions were analyzed including males 158 (49.37% and females 162 (50.62%. The maximum number of patients (38.75% were in the age group of adults (20 to 30years and minimum were children (<10 yrs is 6.25%. Most of them were having Acne problems (31.25%, followed by Eczema (8.75. Antibiotics (31.91% were mostly prescribed class of drugs, followed by steroids (20.33% and antihistamines (17.73%. Among antihistamines, Levocetirizine is mostly prescribed (66.66%. Antihistamines were mostly prescribed in skin problems like Urticaria (20.0%, followed by Dermatitis (18.66%. Ranitidine is prescribed along with other antihistamines to treat Urticaria( hives. Conclusion: Most of the patients were having Acne problems. Antihistamines were mostly prescribed in allergic conditions and rashes. Majority of drugs were prescribed in brand names. Periodic evaluation of prescribing pattern is necessary to improve prescribing standards.

  4. Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?

    Directory of Open Access Journals (Sweden)

    Peters Jean

    2006-05-01

    Full Text Available Abstract Background There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. Methods Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. Results The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. Conclusion These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care.

  5. Identifying Pedagogy and Teaching Strategies for Achieving Nationally Prescribed Learning Outcomes

    Science.gov (United States)

    Delany, Clare; Kosta, Lauren; Ewen, Shaun; Nicholson, Patricia; Remedios, Louisa; Harms, Louise

    2016-01-01

    With the globalisation of university education, national frameworks are commonly used to prescribe standardised learning outcomes and achieve accountability. However, these frameworks are generally not accompanied by guiding pedagogy to support academics in adjusting their teaching practices to achieve the set outcomes. This paper reports the…

  6. Identifying Pedagogy and Teaching Strategies for Achieving Nationally Prescribed Learning Outcomes

    Science.gov (United States)

    Delany, Clare; Kosta, Lauren; Ewen, Shaun; Nicholson, Patricia; Remedios, Louisa; Harms, Louise

    2016-01-01

    With the globalisation of university education, national frameworks are commonly used to prescribe standardised learning outcomes and achieve accountability. However, these frameworks are generally not accompanied by guiding pedagogy to support academics in adjusting their teaching practices to achieve the set outcomes. This paper reports the…

  7. The Perils of Prescribed Grade Distributions: What Every Medical Educator Should Know

    Science.gov (United States)

    Royal, Kenneth D.; Guskey, Thomas R.

    2014-01-01

    A common practice in medical education is to create a prescribed distribution of grades, or ratings, so that only a certain percentage of students receive the highest marks. This approach typically is employed to curb grade inflation and as a means to help faculty distinguish outstanding performers. Despite the well-intentioned reasoning for using…

  8. PRESENTING CLINICAL-PHARMACOLOGY AND THERAPEUTICS - A PROBLEM-BASED APPROACH FOR CHOOSING AND PRESCRIBING DRUGS

    NARCIS (Netherlands)

    DEVRIES, TPGM

    1993-01-01

    As a guide to the rational choice and prescribing of drugs a normative (ideal) problem-solving model has been developed. This model combines medical problem solving and decision analysis, practical medical aspects, and pharmacological facts and basic principles. It consists of a set of actions or st

  9. Human factors perspective on the prescribing behavior of recent medical graduates: implications for educators

    Directory of Open Access Journals (Sweden)

    Gordon M

    2013-01-01

    Full Text Available Morris Gordon,1,2 Ken Catchpole,3 Paul Baker1,41Faculty of Health and Social Care, University of Salford, Salford, UK; 2Department of Paediatrics, Fairfield General Hospital, Bury, UK; 3Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 4North Western Deanery, Manchester, UKBackground: Junior doctors are at high risk of involvement in medication errors. Educational interventions to enhance human factors and specifically nontechnical skills in health care are increasingly reported, but there is no work in the context of prescribing improvement to guide such education. We set out to determine the elements that influence prescribing from a human factors perspective by recent medical graduates and use this to guide education in this area.Methods: A total of 206 recent medical graduates of the North Western Foundation School were asked to describe their views on safety practices and behaviors. Free text data regarding prescribing behaviors were collected 1, 2, and 4 months after starting their posts. A 94.1% response rate was achieved. Qualitative analysis of data was completed using the constant comparison method. Five initial categories were developed, and the researchers subsequently developed thematic indices according to their understanding of the emerging content of the data. Further data were collected through group interviews 8–9 months into the placement to ensure thematic saturation.Results: Six themes were established at the axial coding level, ie, contributors to inappropriate prescribing, contributors to appropriate prescribing, professional responsibility, prescribing error, current practices, and methods for improvement of prescribing. Utilizing appropriate theoretical elements, we describe how recent medical graduates employ situational and error awareness to guide risk assessment.Conclusion: We have modeled the human factors of prescribing behavior by recent medical graduates. As these factors are related to

  10. An antiviral protein from Bougainvillea spectabilis roots; purification and characterisation.

    Science.gov (United States)

    Balasaraswathi, R; Sadasivam, S; Ward, M; Walker, J M

    1998-04-01

    An antiviral protein active against mechanical transmission of tomato spotted wilt virus was identified in the root tissues of Bougainvillea spectabilis Willd. Bougainvillea Antiviral Protein I (BAP I) was purified to apparent homogeneity from the roots of Bougainvillea by ammonium sulphate precipitation, CM- and DEAE-Sepharose chromatography and reverse phase HPLC. BAP I is a highly basic protein (pI value > 8.6) with an Mr of 28,000. The N-terminal sequence of BAP I showed homology with other plant antiviral proteins. Preliminary tests suggest that purified BAP I is capable of interfering with in vitro protein synthesis.

  11. Prescribing trends of statins in Scotland: A drug utilization study

    Directory of Open Access Journals (Sweden)

    Asadul M. Helali

    2013-12-01

    Full Text Available Statins are highly effective in managing hypercholesterolaemia in patients with or without chronic heart disease due to extensive evidence for safety, efficacy and cost effectiveness. Observational cross sectional retrospective cohort study was done in approximately 200 primary care practices in Scotland. Frequency, rates and time trends for statin prescriptions together with demographic data and the prescribing patterns for high dose simvastatin and newer statins in its place was measured. 63%, 27%, 5%, 4% and 1% patients were prescribed simvastatin, atorvastatin, pravastatin, rosuvastatin and fluvastatin respectively (n=1,91370. Prevalence for individual statin as well as for all statin prescriptions, significantly increased (p<0.05. Except rosuvastatin the incidence of other statins prescription significantly decreased (p<0.05. The highest number of patients, 884 (24% switched to atorvastatin from high dose simvastatin. Increase in prevalent use and decrease in incident use of statins, implies the diminished cardiovascular disease related mortality and subsequent increased life expectancy of patients with cardiovascular disease.

  12. Bio-mathematical models of viral dynamics to tailor antiviral therapy in chronic viral hepatitis

    Institute of Scientific and Technical Information of China (English)

    Maurizia Rossana Brunetto; Piero Colombatto; Ferruccio Bonino

    2009-01-01

    The simulation of the dynamics of viral infections by mathematical equations has been applied successfully to the study of viral infections during antiviral therapy. Standard models applied to viral hepatitis describe the viral load decline in the first 2-4 wk of antiviral therapy, but do not adequately simulate the dynamics of viral infection for the following period. The hypothesis of a constant clearance rate of the infected cells provides an unrealistic estimation of the time necessary to reach the control or the clearance of hepatitis B virus (HBV)/ hepatitis C virus (HCV) infection. To overcome the problem, we have developed a new multiphasic model in which the immune system activity is modulated by a negative feedback caused by the infected cells reduction, and alanine aminotransferase kinetics serve as a surrogate marker of infected-cell clearance. By this approach, we can compute the dynamics of infected cells during the whole treatment course, and find a good correlation between the number of infected cells at the end of therapy and the long-term virological response in patients with chronic hepatitis C. The new model successfully describes the HBV infection dynamics far beyond the third month of antiviral therapy under the assumption that the sum of infected and non-infected cells remains roughly constant during therapy, and both target and infected cells concur in the hepatocyte turnover. In clinical practice, these new models will allow the development of simulators of treatment response that will be used as an "automatic pilot" for tailoring antiviral therapy in chronic hepatitis B as well as chronic hepatitis C patients.

  13. Bio-mathematical models of viral dynamics to tailor antiviral therapy in chronic viral hepatitis

    Science.gov (United States)

    Brunetto, Maurizia Rossana; Colombatto, Piero; Bonino, Ferruccio

    2009-01-01

    The simulation of the dynamics of viral infections by mathematical equations has been applied successfully to the study of viral infections during antiviral therapy. Standard models applied to viral hepatitis describe the viral load decline in the first 2-4 wk of antiviral therapy, but do not adequately simulate the dynamics of viral infection for the following period. The hypothesis of a constant clearance rate of the infected cells provides an unrealistic estimation of the time necessary to reach the control or the clearance of hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. To overcome the problem, we have developed a new multiphasic model in which the immune system activity is modulated by a negative feedback caused by the infected cells reduction, and alanine aminotransferase kinetics serve as a surrogate marker of infected-cell clearance. By this approach, we can compute the dynamics of infected cells during the whole treatment course, and find a good correlation between the number of infected cells at the end of therapy and the long-term virological response in patients with chronic hepatitis C. The new model successfully describes the HBV infection dynamics far beyond the third month of antiviral therapy under the assumption that the sum of infected and non-infected cells remains roughly constant during therapy, and both target and infected cells concur in the hepatocyte turnover. In clinical practice, these new models will allow the development of simulators of treatment response that will be used as an “automatic pilot” for tailoring antiviral therapy in chronic hepatitis B as well as chronic hepatitis C patients. PMID:19195054

  14. ASSESSING THE IMPACT OF A NEWLY INTRODUCED ELECTRONIC PRESCRIBING SYSTEM ACROSS A PAEDIATRIC DEPARTMENT - LESSONS LEARNED.

    Science.gov (United States)

    Tsyben, Anastasia; Gooding, Nigel; Kelsall, Wilf

    2016-09-01

    incorrect weight resulted in all drug dosages being inaccurate; the timing of drug levels for Vancomycin and Gentamicin and the administration of subsequent doses have been problematic. Communication difficulties between all staff groups has led to dosage omission, duplicate administration and confusion around start and stop dates. The ability to prescribe away from the bedside and indeed the ward has compounded some of these problems. The implementation of a new electronic system has reduced prescribing errors but has also resulted in new challenges, some with significant patient safety implications. The lessons learned and good practice introduced following previous audits of "traditional paper based" prescribing are equally important with electronic prescribing. Communication between staff groups is crucial. It is likely that the full benefits of the system will be realized a year after its introduction. On-going audit is required to assess the impact and safety of the electronic prescribing and lessons learned. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. A qualitative study of GPs' and PCO stakeholders' views on the importance and influence of cost on prescribing.

    Science.gov (United States)

    Prosser, Helen; Walley, Tom

    2005-03-01

    With prescribing expenditure rising and evidence of prescribing costs variation, general practitioners (GPs) in the UK are under increasing pressure to contain spending. The introduction of cash-limited, unified budgets and increased monitoring of prescribing within Primary Care Organizations (PCO) are intended to increase efficiency and enhance GPs financial responsibility. Whilst GPs regularly receive data on the costs of their prescribing and also performance against a set prescribing budget, little is known about the extent to which GPs take cost into account in their prescribing decisions. This study undertook a qualitative exploration of the attitudes of various stakeholders on the relative importance and influence of cost on general practice prescribing. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key PCO stakeholders. The data suggest that although almost all GPs believed costs should be taken into account when prescribing, there was great variation in the extent to which this was applied and to how sensitive GPs were to costs. Cost was secondary to clinical effectiveness and safety, whilst individual patient need was emphasized above other forms of rationality or notions of opportunity costs. Conflict was apparent between a PCO policy of cost-containment and GPs' resistance to cost-cutting. GPs largely applied simple cost-minimization while cost-consideration was undermined by contextual factors. Implications for research and policy are discussed.

  16. The antiviral response to gamma interferon.

    Science.gov (United States)

    Costa-Pereira, Ana P; Williams, Timothy M; Strobl, Birgit; Watling, Diane; Briscoe, James; Kerr, Ian M

    2002-09-01

    A role for alpha/beta interferon (IFN-alpha/beta) in the IFN-gamma antiviral response has long been suggested. Accordingly, possible roles for autocrine or double-stranded-RNA (dsRNA)-induced IFN-alpha/beta in the IFN-gamma response were investigated. Use was made of wild-type and a variety of mutant human fibrosarcoma cell lines, including mutant U5A cells, which lack a functional IFN-alpha/beta receptor and hence an IFN-alpha/beta response. IFN-gamma did not induce detectable levels of IFN-alpha/beta in any of the cell lines, nor was the IFN-gamma response per se dependent on autocrine IFN-alpha/beta. On the other hand, a number of responses to dsRNA [poly(I). poly(C)] and encephalomyocarditis virus were greatly enhanced by IFN-gamma pretreatment (priming) of wild-type cells or of mutant cells lacking an IFN-alpha/beta response; these include the primary induction of dsRNA-inducible mRNAs, including IFN-beta mRNA, and, to a lesser extent, the dsRNA-mediated activation of the p38 mitogen-activated protein (MAP) kinase(s). IFN-gamma priming of mRNA induction by dsRNA is dependent on JAK1 and shows biphasic kinetics, with an initial rapid (<30-min) response being followed by a more substantial effect on overnight incubation. The IFN-gamma-primed dsRNA responses appear to be subject to modulation through the p38, phosphatidylinositol 3-kinase, and ERK1/ERK2 MAP kinase pathways. It can be concluded that despite efficient priming of IFN-beta production, the IFN-alpha/beta pathways play no significant role in the primary IFN-gamma antiviral response in these cell-virus systems. The observed IFN-gamma priming of dsRNA responses, on the other hand, will likely play a significant role in combating virus infection in vivo.

  17. Effect of antiviral prophylaxis on influenza outbreaks om aged care facilities in three local health districts in New South Wales, Australia, 2014

    Directory of Open Access Journals (Sweden)

    Tony Merritt

    2016-02-01

    Full Text Available Background: There was a record number (n = 111 of influenza outbreaks in aged care facilities in New South Wales, Australia during 2014. To determine the impact of antiviral prophylaxis recommendations in practice, influenza outbreak data were compared for facilities in which antiviral prophylaxis and treatment were recommended and for those in which antivirals were recommended for treatment only. Methods: Routinely collected outbreak data were extracted from the Notifiable Conditions Information Management System for two Local Health Districts where antiviral prophylaxis was routinely recommended and one Local Health District where antivirals were recommended for treatment but not routinely for prophylaxis. Data collected on residents included counts of influenza-like illness, confirmed influenza, hospitalizations and related deaths. Dates of onset, notification, influenza confirmation and antiviral recommendations were also collected for analysis. The Mann–Whitney U test was used to assess the significance of differences between group medians for key parameters. Results: A total of 41 outbreaks (12 in the prophylaxis group and 29 in the treatment-only group were included in the analysis. There was no significant difference in overall outbreak duration; outbreak duration after notification; or attack, hospitalization or case fatality rates between the two groups. The prophylaxis group had significantly higher cases with influenza-like illness (P = 0.03 and cases recommended antiviral treatment per facility (P = 0.01. Discussion: This study found no significant difference in key outbreak parameters between the two groups. However, further high quality evidence is needed to guide the use of antivirals in responding to influenza outbreaks in aged care facilities.

  18. 20 CFR 404.1530 - Need to follow prescribed treatment.

    Science.gov (United States)

    2010-04-01

    ... English language) when determining if you have an acceptable reason for failure to follow prescribed... treatment is contrary to the established teaching and tenets of your religion. (2) The prescribed treatment...

  19. Prescribing Patterns and Medicine Use at the University Teaching ...

    African Journals Online (AJOL)

    Prescribing Patterns and Medicine Use at the University Teaching Hospital, Lusaka, ... was conducted at the adult and paediatric outpatient departments of UTH. ... High rate of antibiotic prescribing was irrational going by WHO standards for ...

  20. What You Need to Know When Prescribed an Opioid Painkiller

    Science.gov (United States)

    ... You Need to Know When Prescribed an Opioid Painkiller Tell your doctor if you or anyone in ... doctor or other health care provider prescribes opioid painkillers such as Oxycontin, Vicodin, codeine and morphine, the ...

  1. Review: Pharmaceutical policies : effects of financial incentives for prescribers

    NARCIS (Netherlands)

    Sturm, H.; Austvoll-Dahlgren, A.; Aaserud, M.; Oxman, A. D.; Ramsay, C.; Vernby, A.; Koesters, J. P.

    2007-01-01

    Background Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased

  2. Antiviral activity and mechanism of action of arbidol against Hantaan ...

    African Journals Online (AJOL)

    Methods: HUVEC cells infected with HTNV 76-118 were treated with serially diluted arbidol solutions at. -2h (2 h before viral infection, .... murine leukemia virus (M-MLV) Reverse .... DISCUSSION. Arbidol is a small antiviral compound with a.

  3. Regulation of antiviral innate immunity by deubiquitinase CYLD

    Institute of Scientific and Technical Information of China (English)

    Minying Zhang; Andrew J Lee; Xuefeng Wu; Shao-Cong Sun

    2011-01-01

    An antiviral innate immune response involves induction of type Ⅰ interferons (IFNs) and their subsequent autocrine and paracrine actions,but the underlying regulatory mechanisms are incompletely understood.Here we report that CYLD,a deubiquitinase that specifically digests lysine 63-1inked ubiquitin chains,is required for antiviral host defense.Loss of CYLD renders mice considerably more susceptible to infection by vesicular stomatitis virus (VSV).Consistently,CYLD-deficient dendritic cells are more sensitive to VSV infection.This functional defect was not due to lack of type I IFN production but rather because of attenuated IFN receptor signaling.In the absence of CYLD,IFN-β is ineffective in the induction of antiviral genes and protection of cells from viral infection.These findings establish CYLD as a novel regulator of antiviral innate immunity and suggest a role for CYLD in regulating IFN receptor signaling.

  4. Anti-viral Effect of Caulis Tripterygii Wilfordii

    Institute of Scientific and Technical Information of China (English)

    WU Guo-qin

    2005-01-01

    @@ There have appeared more and more antibiotics to antagonize against causative organism, but in comparison few antivirals have. Hence, many viral diseases remain refractory and fatal due to lack of effective medicine.

  5. Antiviral chemotherapy in veterinary medicine: current applications and perspectives.

    Science.gov (United States)

    Dal Pozzo, F; Thiry, E

    2014-12-01

    The current situation in the use of antiviral drugs in veterinary medicine is characterised by a novel and optimistic approach.Viruses of veterinary importance are still used as animal models in the developmentof human therapeutics, but there is growing interest in many of these viruses in the identification of antiviral molecules for use in both livestock and companion animals. The use of antiviral drugs in livestock animals is envisaged for the treatment or control of disease on a large scale (mass treatment), whereas in companion animals an individual approach is favoured. An overview of the most recent examples of research in the use of antivirals in veterinary medicine is presented, with particular emphasis on their in vivo applications.

  6. STUDY OF ANTIVIRAL ACTIVITY OF SOME HYDRAZONE PINOSTROBIN DERIVATIVES

    Directory of Open Access Journals (Sweden)

    G. K. Mukusheva

    2014-01-01

    Full Text Available New derivatives on the basis of hydrazone pinostrobin molecule were synthesized. Significant antiviral activity of received samples of new hydrazone pinstrobin derivatives was identified.

  7. The Defense of Involuntary Intoxication by Prescribed Medications: An Appellate Case Review.

    Science.gov (United States)

    Piel, Jennifer

    2015-09-01

    The defense of involuntary intoxication has long been an exception to the general notion that intoxication is not a defense to criminal liability. The consumption of medications prescribed by a physician can form the basis of an involuntary-intoxication defense. In this article, I review cases where defendants relied on the use of prescribed medications for an involuntary-intoxication defense. The medications most frequently implicated by defendants are listed by name and by class. From the case law, I provide a summary of the defense and a review of the pitfalls of the defense to serve as practice pointers for forensic evaluators.

  8. Prescribing Patterns of Intravenous Golimumab for Rheumatoid Arthritis.

    Science.gov (United States)

    Brady, Brenna L; Tkacz, Joseph P; Lofland, Jennifer; Meyer, Roxanne; Bolge, Susan C

    2015-09-01

    The use of intravenous golimumab (GLM-IV), in combination with methotrexate, was approved by the US Food and Drug Administration in July 2013 for the treatment of moderate to severe, active rheumatoid arthritis (RA). GLM-IV is available in 50-mg vials, and the prescribing information specifies a dosing regimen of 2 mg/kg at 0 and 4 weeks and then every 8 weeks thereafter. The purpose of this study was to examine the patterns of prescribing and administration of GLM-IV, including the demographic, clinical, and utilization characteristics of patients with RA newly treated with GLM-IV. Rheumatology practices across the continental United States were solicited for a chart-review study. Inclusion criteria were: (1) diagnosis of RA; (2) current treatment with GLM-IV; (3) age ≥18 years; and (4) lack of pregnancy (in female patients). Physicians were offered a monetary incentive for each eligible chart provided. An electronic case-report form was developed to aid in the chart data extraction and included fields for demographic characteristics, available comorbid diagnoses, prior RA treatments, and doses and dates of GLM-IV administration. A total of 117 eligible patient charts from 15 rheumatologist practices were reviewed. The patient sample was predominantly female (81.2%), with a mean (SD) age of 55.4 (14.5) years. A total of 55.6% of patients had evidence of biologic treatment before receiving GLM-IV, and 53% had at least 1 comorbid condition. In total, 300 individual GLM-IV infusions from this sample were reviewed. Due to the relatively recent approval of GLM-IV use by the US Food and Drug Administration, the majority of patients in this sample (69.2%) had received only between 2 and 4 infusions at the time of the review. For infusion records with valid dose data, the mean number of administered vials was 3.6 (0.8) (total dose, 180 mg); the majority of patients received a dose consistent with the prescribed dose of 2 mg/kg. Combination therapy with methotrexate was

  9. Antiviral resistance and the control of pandemic influenza.

    Directory of Open Access Journals (Sweden)

    Marc Lipsitch

    2007-01-01

    Full Text Available The response to the next influenza pandemic will likely include extensive use of antiviral drugs (mainly oseltamivir, combined with other transmission-reducing measures. Animal and in vitro studies suggest that some strains of influenza may become resistant to oseltamivir while maintaining infectiousness (fitness. Use of antiviral agents on the scale anticipated for the control of pandemic influenza will create an unprecedented selective pressure for the emergence and spread of these strains. Nonetheless, antiviral resistance has received little attention when evaluating these plans.We designed and analyzed a deterministic compartmental model of the transmission of oseltamivir-sensitive and -resistant influenza infections during a pandemic. The model predicts that even if antiviral treatment or prophylaxis leads to the emergence of a transmissible resistant strain in as few as 1 in 50,000 treated persons and 1 in 500,000 prophylaxed persons, widespread use of antivirals may strongly promote the spread of resistant strains at the population level, leading to a prevalence of tens of percent by the end of a pandemic. On the other hand, even in circumstances in which a resistant strain spreads widely, the use of antivirals may significantly delay and/or reduce the total size of the pandemic. If resistant strains carry some fitness cost, then, despite widespread emergence of resistance, antivirals could slow pandemic spread by months or more, and buy time for vaccine development; this delay would be prolonged by nondrug control measures (e.g., social distancing that reduce transmission, or use of a stockpiled suboptimal vaccine. Surprisingly, the model suggests that such nondrug control measures would increase the proportion of the epidemic caused by resistant strains.The benefits of antiviral drug use to control an influenza pandemic may be reduced, although not completely offset, by drug resistance in the virus. Therefore, the risk of resistance

  10. Phytochemical, antioxidant, antiviral and cytotoxic evaluation of Opuntia dillenii flowers

    OpenAIRE

    Arthanari Saravana Kumar; Mani Ganesh; Mei Mei Peng; Jang Hyun Tae

    2014-01-01

    Opuntia dillenii used in Asian traditional medicine especially in China. We here report on the investigation of the phytochemical content, antioxidant, cytotoxicity and antiviral activity of methanolic extract of O. dillenii flowers. The antioxidant activity was measured with the DPPH, hydrogen peroxide and hydroxyl radicals scavenging method. In the antiviral and cytotoxic assay we used different viruses in different cell lines. In antioxidant assay, the DPPH assay exhibited potent antioxid...

  11. Antiviral activities of coffee extracts in vitro.

    Science.gov (United States)

    Utsunomiya, Hirotoshi; Ichinose, Masao; Uozaki, Misao; Tsujimoto, Kazuko; Yamasaki, Hisashi; Koyama, A Hajime

    2008-06-01

    Both hot water extracts of coffee grinds and instant coffee solutions inhibited the multiplication of herpes simplex virus type 1, a representative enveloped DNA virus, when they were added to the culture medium of the virus-infected cells at a dose of one fifth the concentration suitable for drinking. The antiherpetic activity was independent of the suppliers (companies) of the coffee grinds and of the locations where the coffee beans were produced. Further characterization revealed that there are two different mechanisms, by which the coffee extracts exert inhibitory activities on the virus infection; (1) a direct inactivation of the infectivity of virus particle (i.e., a virucidal activity) and (2) the inhibition of progeny infectious virus formation at the late stage of viral multiplication in the infected cells. Caffeine, but not quinic acid and chlorogenic acid, inhibited the virus multiplication to some extent, but none of them showed the virucidal activity, suggesting that other component(s) in the coffee extracts must play a role in the observed antiviral activity. In addition, the coffee extracts inhibited the multiplication of poliovirus, a non-enveloped RNA virus, but showed no virucidal effect on this virus.

  12. RNA interference: Antiviral weapon and beyond

    Institute of Scientific and Technical Information of China (English)

    Quan-Chu Wang; Qing-He Nie; Zhi-Hua Feng

    2003-01-01

    RNA interference (RNAi) is a remarkable type of gene regulation based on sequence-specific targeting and degradation of RNA. The term encompasses related pathways found in a broad range of eukaryotic organisms, including fungi, plants, and animals. RNA interference is part of a sophisticated network of interconnected pathways for cellular defense, RNA surveillance, and development and it may become a powerful tool to manipulate gene expression experimentally. RNAi technology is currently being evaluated not only as an extremely powerful instrument for functional genomic analyses, but also as a potentially useful method to develop specific dsRNA based gene-silencing therapeutics.Several laboratories have been interested in using RNAi to control viral infection and many reports in Nature and in Cell show that short interfering (si) RNAs can inhibit infection by HIV-1, polio and hepatitis C viruses in a sequence-specific manner. RNA-based strategies for gene inhibition in mammalian cells have recently been described, which offer the promise of antiviral therapy.

  13. Probiotics as Antiviral Agents in Shrimp Aquaculture

    Directory of Open Access Journals (Sweden)

    Bestha Lakshmi

    2013-01-01

    Full Text Available Shrimp farming is an aquaculture business for the cultivation of marine shrimps or prawns for human consumption and is now considered as a major economic and food production sector as it is an increasingly important source of protein available for human consumption. Intensification of shrimp farming had led to the development of a number of diseases, which resulted in the excessive use of antimicrobial agents, which is finally responsible for many adverse effects. Currently, probiotics are chosen as the best alternatives to these antimicrobial agents and they act as natural immune enhancers, which provoke the disease resistance in shrimp farm. Viral diseases stand as the major constraint causing an enormous loss in the production in shrimp farms. Probiotics besides being beneficial bacteria also possess antiviral activity. Exploitation of these probiotics in treatment and prevention of viral diseases in shrimp aquaculture is a novel and efficient method. This review discusses the benefits of probiotics and their criteria for selection in shrimp aquaculture and their role in immune power enhancement towards viral diseases.

  14. Probiotics as antiviral agents in shrimp aquaculture.

    Science.gov (United States)

    Lakshmi, Bestha; Viswanath, Buddolla; Sai Gopal, D V R

    2013-01-01

    Shrimp farming is an aquaculture business for the cultivation of marine shrimps or prawns for human consumption and is now considered as a major economic and food production sector as it is an increasingly important source of protein available for human consumption. Intensification of shrimp farming had led to the development of a number of diseases, which resulted in the excessive use of antimicrobial agents, which is finally responsible for many adverse effects. Currently, probiotics are chosen as the best alternatives to these antimicrobial agents and they act as natural immune enhancers, which provoke the disease resistance in shrimp farm. Viral diseases stand as the major constraint causing an enormous loss in the production in shrimp farms. Probiotics besides being beneficial bacteria also possess antiviral activity. Exploitation of these probiotics in treatment and prevention of viral diseases in shrimp aquaculture is a novel and efficient method. This review discusses the benefits of probiotics and their criteria for selection in shrimp aquaculture and their role in immune power enhancement towards viral diseases.

  15. Antiviral Warrior-APOBEC3G

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-xia; MA Yi-cai

    2005-01-01

    This paper is to further understand how APOBEC3G can defend the retroviruses and to find new approaches to AIDs (acquired immure deficiency syndrome).The viral infectivity factor (Vif) induces rapid degradation of APOBEC3G by ubiquitination, which is a proteosome-dependent pathway. Precisely speaking, only in the virus-producing cell Vif expression is necessary; in its absence, infection of a subsequent target cell terminates at a postentry step through the action of the human APOBEC3G antiviral mechanism. Vif protein has two domains: one binds to APOBEC3G and the other regulates the degradation of APOBEC3G by a conserved sequence, SLQ (Y/F) LA motif. Recently, the research on Vif has also revealed APOBEC3G is a novel component of innate immune system. In fact, APOBEC3G not only acts in DNA editing to block the replication of retroviruses such as HIV-1, but also is able to defend a wide spectrum of distantly related retroviruses and interferes with HBV through a different mechanism from HIV.

  16. Ribozymes:an anti-viral agent

    Institute of Scientific and Technical Information of China (English)

    Asad U.Khan; Shahper N.Khan

    2008-01-01

    The discovery that RNA can act as an enzyme led Thomas Cech to win the Nobel Prize in Chemistry and led immediately to the next wave of attempts to find an effective RNA-based therapy.The tantalizing idea that RNA enzymes called trans-cleaving ribozymes enables them to act as potential antiviral and powerful tool for functional genomic studies.The efficacy of ribozyme function in a complex intracellular environment is depend-ent on the intracellular fate of the RNA that is being targeted.Recently,ribozymes have been used successfully to inhibit gene expression in a variety of biological systems in vitro and in vivo.Ribozyme has also been used successfully to combat many cases of viral infection,as clinical trial.Despite it needs to be investigated and explored as far as its structural and functional aspects are concern.In view of the significance of ribozyme in modern medicine,we reviewed the recent literature on general approach to control viral infection.

  17. Antiviral activity of lactoferrin towards naked viruses.

    Science.gov (United States)

    Seganti, Lucilla; Di Biase, Assunta Maria; Marchetti, Magda; Pietrantoni, Agostina; Tinari, Antonella; Superti, Fabiana

    2004-06-01

    It is well known that lactoferrin (Lf) is a potent inhibitor towards several enveloped and naked viruses, such as rotavirus, enterovirus and adenovirus. Lf is resistant to tryptic digestion and breast-fed infants excrete high levels of faecal Lf, so that its effect on viruses replicating in the gastrointestinal tract is of great interest. In this report, we analysed the mechanism of the antiviral action of this protein in three viral models which, despite representing different genoma and replication strategies, share the ability to infect the gut. Concerning the mechanism of action against rotavirus, Lf from bovine milk (BLf) possesses a dual role, preventing virus attachment to intestinal cells by binding to viral particles, and inhibiting a post adsorption step. The BLf effect towards poliovirus is due to the interference with an early infection step but, when the BLf molecule is saturated with Zn+2 ions, it is also capable of inhibiting viral replication after the viral adsorption phase. The anti-adenovirus action of BLf takes place on virus attachment to cell membranes through competition for common glycosaminoglycan receptors and a specific interaction with viral structural polypeptides. Taken together, these findings provide further evidence that Lf is an excellent candidate in the search of natural agents against viral enteric diseases, as it mainly acts by hindering adsorption and internalisation into cells through specific binding to cell receptors and/or viral particles.

  18. ANTIVIRAL POTENTIAL OF MEDICINAL PLANTS: AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    Ruwali Pushpa

    2013-06-01

    Full Text Available The term ‘Antiviral agents’ has been defined in very broad terms as substances other than a virus or virus containing vaccine or specific antibody which can produce either a protective or therapeutic effect to the clear detectable advantage of the virus infected host. The herbal medicine has a long traditional use and the major advantage over other medicines is their wide therapeutic window with rare side effects. There are some disadvantages of synthetic drugs like narrow therapeutic window and more importantly the various adverse side effects which occur quite frequently. Due to these disadvantages and other limitations, there is an increasing trend in the field of research for discovering new and noble drugs based on various herbal formulations. This review attempts to address the importance of developing therapeutic herbal formulations from various medicinal plants using the knowledge based on traditional system of medicines, the Ayurveda. Although natural products have been used by civilization since ancient times, only in recent decades has there been growing research into alternative therapies and the therapeutics use of natural products, especially those derived from plants. Plants synthesize and preserve a variety of biochemical products, many of which are extractable and used for various scientific investigations. Therefore, medicinal plants proved to be a major resort for the treatment of diseases and sicknesses by traditional healers in many societies.

  19. The effects of nurse prescribing: a systematic review.

    NARCIS (Netherlands)

    Gielen, S.C.; Dekker, J.; Francke, A.L.; Mistiaen, P.; Kroezen, M.

    2014-01-01

    Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently,

  20. Undergraduate Medical Students' Reasoning with Regard to the Prescribing Process

    Science.gov (United States)

    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…

  1. Is new drug prescribing in primary care specialist induced?

    NARCIS (Netherlands)

    Florentinus, S.R.; Heerdink, R.; Dijk, L. van; Griens, F.A.M.G.; Groenewegen, P.P.; Leufkens, H.G.M

    2009-01-01

    Background: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. Methods: This study estimates the influence of medical specialists on new drug prescribing in primary care

  2. Is new drug prescribing in primary care specialist induced?

    NARCIS (Netherlands)

    Florentinus, S.R.; Heerdink, E.R.; Dijk, L. van; Griens, F.; Groenewegen, P.P.; Leufkens, H.G.M.

    2009-01-01

    BACKGROUND: Medical specialists are often seen as the first prescribers of new drugs. However, the extent to which specialists influence new drug prescribing in primary care is largely unknown. METHODS: This study estimates the influence of medical specialists on new drug prescribing in primary care

  3. ASSET (Age/Sex Standardised Estimates of Treatment: a research model to improve the governance of prescribing funds in Italy.

    Directory of Open Access Journals (Sweden)

    Giampiero Favato

    Full Text Available BACKGROUND: The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment. METHODS AND MAJOR FINDINGS: Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro and females (195.12 euro. After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. CONCLUSIONS: If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing

  4. ASSET (Age/Sex Standardised Estimates of Treatment): a research model to improve the governance of prescribing funds in Italy.

    Science.gov (United States)

    Favato, Giampiero; Mariani, Paolo; Mills, Roger W; Capone, Alessandro; Pelagatti, Matteo; Pieri, Vasco; Marcobelli, Alberico; Trotta, Maria G; Zucchi, Alberto; Catapano, Alberico L

    2007-07-04

    The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment). Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro) and females (195.12 euro). After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25-34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000-2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources to regional authorities and general practices.

  5. Perspective of Use of Antiviral Peptides against Influenza Virus

    Directory of Open Access Journals (Sweden)

    Sylvie Skalickova

    2015-10-01

    Full Text Available The threat of a worldwide influenza pandemic has greatly increased over the past decade with the emergence of highly virulent avian influenza strains. The increased frequency of drug-resistant influenza strains against currently available antiviral drugs requires urgent development of new strategies for antiviral therapy, too. The research in the field of therapeutic peptides began to develop extensively in the second half of the 20th century. Since then, the mechanisms of action for several peptides and their antiviral prospect received large attention due to the global threat posed by viruses. Here, we discussed the therapeutic properties of peptides used in influenza treatment. Peptides with antiviral activity against influenza can be divided into three main groups. First, entry blocker peptides such as a Flupep that interact with influenza hemagglutinin, block its binding to host cells and prevent viral fusion. Second, several peptides display virucidal activity, disrupting viral envelopes, e.g., Melittin. Finally, a third set of peptides interacts with the viral polymerase complex and act as viral replication inhibitors such as PB1 derived peptides. Here, we present a review of the current literature describing the antiviral activity, mechanism and future therapeutic potential of these influenza antiviral peptides.

  6. Natural Products as Source of Potential Dengue Antivirals

    Directory of Open Access Journals (Sweden)

    Róbson Ricardo Teixeira

    2014-06-01

    Full Text Available Dengue is a neglected disease responsible for 22,000 deaths each year in areas where it is endemic. To date, there is no clinically approved dengue vaccine or antiviral for human beings, even though there have been great efforts to accomplish these goals. Several approaches have been used in the search for dengue antivirals such as screening of compounds against dengue virus enzymes and structure-based computational discovery. During the last decades, researchers have turned their attention to nature, trying to identify compounds that can be used as dengue antivirals. Nature represents a vast reservoir of substances that can be explored with the aim of discovering new leads that can be either used directly as pharmaceuticals or can serve as lead structures that can be optimized towards the development of new antiviral agents against dengue. In this review we describe an assortment of natural products that have been reported as possessing dengue antiviral activity. The natural products are organized into classes of substances. When appropriate, structure-activity relationships are outlined. The biological assays used to assess antiviral activity are briefly described.

  7. Factors influencing antimicrobial prescribing by veterinarians and usage by dairy farmers in New Zealand.

    Science.gov (United States)

    McDougall, S; Compton, Cwr; Botha, N

    2017-03-01

    To determine the factors associated with the selection of antimicrobials by dairy veterinarians, and the attitudes of those veterinarians and dairy farmers to antimicrobial usage and resistance. Facilitated focus groups of dairy farmers (n=22) and an anonymous online survey of dairy cattle veterinarians (n=206 respondents) were used to determine prescribing behaviour, factors affecting prescribing of antimicrobials, and the attitudes of veterinarians and farmers to the use of antimicrobials and the risk of antimicrobial resistance (AMR). Amongst the 22 farmers, the most common primary reason for choosing an antimicrobial was veterinary advice (87%) followed by personal experience (68%). Farmers had limited knowledge or concern about the risk of AMR, particularly outside their farm, with only 47% and 26% agreeing or strongly agreeing that use of antimicrobials on their farm would increase the risk of resistance in their herd and in humans, respectively. Prescribing of antimicrobials by veterinarians was predominantly based on diagnosis (168/206; 82%), and response to previous therapy (134/206; 65%), while duration above the minimum inhibitory concentration (43/206; 21%) was also considered important. Non-clinical factors such as withholding period (52/206; 25%) and farmers' preferences (45/206; 22%) also influenced prescribing. Antimicrobial culture and susceptibility testing was not widely used, with 126/166 (76%) having culture results for less than four of the last 10 clinical mastitis cases for which they prescribed antimicrobials. Attitudes about prescribing and AMR varied with years of practice, gender and employment status. Veterinarians primarily considered technical reasons when prescribing antimicrobials. However non-technical factors did influence prescribing, in particular client feedback about perceived efficacy and perceptions of cost/benefit. Farmers stated that veterinarians were the most credible source of advice for selection of antimicrobials, but

  8. How to prescribe physical exercise in rheumatology

    Directory of Open Access Journals (Sweden)

    S. Maddali Bongi

    2011-06-01

    Full Text Available Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.

  9. Prescribing tests must have curriculum support

    Directory of Open Access Journals (Sweden)

    Lemon TI

    2013-05-01

    Full Text Available Rupali D Shah, Thomas I LemonSchool of Medicine, Cardiff University, University Hospital of Wales, Cardiff, WalesGordon, Catchpole and Baker1 have discussed and investigated a very interesting, currently relevant, subject in medical education; particularly with the introduction of the prescribing test for undergraduates trialled in the UK this year and set to become a fully-fledged part of the curriculum and assessment criteria for 2014 graduates.2 It would of course be of great interest to compare the themes discussed in this paper and see they how would compare to recent graduates in late 2014.View original paper by Gordon and colleagues.

  10. Prescribed fire and air quality in the American South: a review of conflicting interests and a technique for incorporating the land manager into regional air quality modeling

    Science.gov (United States)

    Gary L. Achtemeier

    2013-01-01

    In this paper, conflicting interests in prescribed burn practice and improving air quality in the South are reviewed. Conflicting societal interests and legislative actions threaten to curtail the use of prescribed fire to manage for endangered species and for other land management objectives in the South. This comes at a time when efforts are being made to increase...

  11. Short- and long-term effects on fuels, forest structure, and wildfire potential from prescribed fire and resource benefit fire in southwestern forests, USA

    Science.gov (United States)

    Molly E. Hunter; Jose M. Iniguez; Leigh B. Lentile

    2011-01-01

    Prescribed and resource benefit fires are used to manage fuels in fire-prone landscapes in the Southwest. These practices, however, typically occur under different conditions, potentially leading to differences in fire behavior and effects. The objectives of this study were to investigate the effects of recent prescribed fires, resource benefit fires, and repeated...

  12. Impact of pharmacist and clinician dual intervention on prescribed benzodiazepines in prisoner patients: a retrospective study.

    Science.gov (United States)

    Lerat, Marie-Cecile; Cabelguenne, Delphine; Lassia, Jerome; Meunier, Frederic; Zimmer, Luc

    2011-12-01

    High-dose benzodiazepine (BDZs) represents an important risk factor for dependence, particularly in a prison environment. In Lyon's prison, BDZs and/or opioid maintenance treatment are often prescribed to patients with mental disorders. The aim of this retrospective study was to assess the impact of psychiatrist and pharmacist collaboration on reducing the BDZs dose prescribed to prisoner patients. Since 2001, clinicians and pharmacists have been holding monthly meetings to develop prescribing guidelines and discuss those patients receiving high-dose BDZs. All prescribed psychotropic drugs were noted for each included patient in the control (before guidelines) and intervention groups. Criteria used to define each patient profile included age, diagnosis (mental disorder), and concomitant treatment (opioids, antidepressants). To compare each group, the daily dose of prescribed BDZs was used as a quantitative variable and expressed in diazepam equivalent. Four hundred and seventy-three patients were included, 222 in the control group and 251 in the intervention group. The two groups showed no difference in terms of diagnosis. The daily dose of BDZ was higher in the control group when all patients were considered (mean(CONTROL GROUP) = 46 mg in diazepam equivalent vs. mean(INTERVENTIION GROUP) = 34 mg) and for each of the following patient categories: 'mental disorder' (48 mg vs. 30 mg), 'no opioid treatment' (44 mg vs. 31 mg), 'buprenorphin treatment' (58 mg vs. 63 mg), 'no antidepressant treatment' (41 mg vs. 29 mg), and 'antidepressant treatment' (53 mg vs. 38 mg). The results of this retrospective study show the positive impact of multidisciplinary intervention on reducing the prescribed daily dose of BDZs. This experience confirms the positive impact that pharmacist feedback on prescriptions and the development of treatment guidelines by clinician and pharmacist collaboration have on improving the prescribing practice in a prison environment.

  13. Multilevel analysis of the influence of patients' and general practitioners' characteristics on patented versus multiple-sourced statin prescribing in France.

    Science.gov (United States)

    Pichetti, Sylvain; Sermet, Catherine; Godman, Brian; Campbell, Stephen M; Gustafsson, Lars L

    2013-06-01

    The French National Health Insurance and the Ministry of Health have introduced multiple reforms in recent years to increase prescribing efficiency. These include guidelines, academic detailing, financial incentives for the prescribing and dispensing of generics drugs as well as a voluntary pay-for-performance programme. However, the quality and efficiency of prescribing could be enhanced potentially if there was better understanding of the dynamics of prescribing behaviour in France. To analyse the patient and general practitioner characteristics that influence patented versus multiple-sourced statin prescribing in France. Statistical analysis was performed on the statin prescribing habits from 341 general practitioners (GPs) that were included in the IMS-Health Permanent Survey on Medical Prescription in France, which was conducted between 2009 and 2010 and involved 14,360 patients. Patient characteristics included their age and gender as well as five medical profiles that were constructed from the diagnoses obtained during consultations. These were (1) disorders of lipoprotein metabolism, (2) heart disease, (3) diabetes, (4) complex profiles and (5) profiles based on other diagnoses. Physician characteristics included their age, gender, solo or group practice, weekly workload and payment scheme. Patient age had a statistically significant impact on statin prescribing for patients in profile 1 (disorders of lipoprotein metabolism) and profile 3 (complex profiles) with a greater number of patented statins being prescribed for the youngest patients. For instance, patients older than 76 years with a complex profile were prescribed fewer patented statins than patients aged 68-76 years old with the same medical profile (coefficient: -0.225; p = 0.0008). By contrast, regardless of the patient's age, the medical profile did not affect the probability of prescribing a patented statin except in young patients with heart diseases who were prescribed a greater number of

  14. Civilian primary care prescribing psychologist in an army medical center.

    Science.gov (United States)

    Shearer, David S

    2012-12-01

    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  15. ANTI-VIRAL ACTIVITY OF GLYCIRRHETINIC AND GLYCIRRHIZIC ACIDS

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    V. V. Zarubaev

    2016-01-01

    Full Text Available Influenza is a highly contagious human disease. In the course of use of antiviral drugs drug-resistant strains of the virus are formed, resulting in reduced efficiency of the chemotherapy. The review describes the biological activity of glycirrhetinic (GLA and glycirrhizic (GA acids in terms of their use as a therapeutic agent for viral infections. So, these compounds are against a broad spectrum of viruses, including herpes, corona-, alphaand flaviviruses, human immunodeficiency virus, vaccinia virus, poliovirus type I, vesicular stomatitis virus and influenza A virus. These data indicate that anti-viral effect of these compounds is due to several types of activity — direct antiviral effects, effects on cellular proand anti-viral and immunomodulating pathways, in particular by activation of innate immunity system. GA interferes with early steps of the viral reproductive cycle such as virus binding to its receptor, the absorption of the virus by endocytosis or virus decapsidation in the cytoplasm. This is due to the effect of GA-induced reduction of membrane fluidity. Thus, one mechanism for the antiviral activity of GA is that GA molecule increases the rigidity of cellular and viral membranes after incorporation in there. This results in increasing of energy threshold required for the formation of negative curvature at the fusion zones, as well as difficult lateral migration of the virus-receptor complexes. In addition, glycyrrhizin prevents interaction of viral nucleoprotein with cellular protein HMGB1, which is necessary for the viral life cycle. Glycyrrhizin also inhibits the induction of oxidative stress during influenza infection, exhibiting antioxidant properties, which leads to a reduction of virus-induced production of cytokines/chemokines, without affecting the replication of the virus. A wide spectrum of biological activity and effect on various aspects of the viral pathogenesis substantiate the effect of GA and GLA as a component

  16. When and why placebo-prescribing is acceptable and unacceptable: a focus group study of patients' views.

    Directory of Open Access Journals (Sweden)

    Felicity L Bishop

    Full Text Available Surveys of doctors suggest that they use placebos and placebo effects clinically to help patients. However, patients' views are not well-understood. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients.A purposive diverse sample of 58 English-speaking adults (18 men; aged 19-80 years participated in 11 focus groups. Vignettes describing doctors prescribing placebos in primary care were used to initiate discussions. Data were analyzed inductively.Participants discussed diverse harms and benefits of placebo-prescribing for individual patients, carers, healthcare providers, and society. Two perspectives on placebo-prescribing were identified. First, the "consequentialist" perspective focused on the potential for beneficial outcomes of placebo-prescribing. Here, some participants thought placebos are beneficial and should be used clinically; they often invoked the power of the mind or mind-body interactions. Others saw placebos as ineffective and therefore a waste of time and money. Second, the "respecting autonomy" perspective emphasized the harms caused by the deceptive processes thought necessary for placebo-prescribing. Here, participants judged placebo-prescribing unacceptable because placebo-prescribers deceive patients, thus a doctor who prescribes placebos cannot be trusted and patients' autonomy is compromised. They also saw placebo-responders as gullible, which deterred them from trying placebos themselves. Overall, the word "placebo" was often thought to imply "ineffective"; some participants suggested alternative carefully chosen language that could enable doctors to prescribe placebos without directly lying to patients.Negative views of placebos derive from beliefs that placebos do not work and/or that they require deception by the doctor. Positive views are pragmatic in that if placebos work then any associated processes (e.g. mechanisms, deception are deemed unimportant

  17. What Does ePrescribing Mean for Patients? A Case Study of the Perspectives of Hospital Renal Patients

    Directory of Open Access Journals (Sweden)

    Lisa Lee

    2015-11-01

    Full Text Available BACKGROUND: Hospital ePrescribing systems are expected to improve quality of care for patients, yet the perspectives of patients themselves have seldom been explored in the context of ePrescribing deployments.OBJECTIVE: We sought to understand the significance of ePrescribing for patients through a case study of renal in-patients on a hospital ward, before and after the introduction of an ePrescribing system.METHODS: Three data sources were drawn on as part of the case study: interviews with representatives from national patient groups (n = 10, in-patients on a renal ward (n = 11 pre-implementation; n = 12 post-implementation and fieldnotes (n = 25 of observations made on the case study ward. Data were analysed thematically focusing on: (1 perceived benefits of ePrescribing; (2 patient awareness and understanding of the medications prescribed and (3 patient views on medicines reconciliation at admission and discharge.RESULTS: While ePrescribing was viewed positively overall, its implementation in the case study site failed to address the lack of patient involvement in the prescribing process and poor medication counselling upon discharge. Importantly, the limited impact of the ePrescribing system in these particular areas appeared to be the result of institutional and cultural practices rather than solely technological factors.CONCLUSIONS: The introduction of ePrescribing systems offers new opportunities to improve sharing of knowledge and communication with all those involved in the patient’s care pathways, including patients, carers and healthcare professionals across diverse care settings. Achieving this will, first and foremost, require significant cultural and policy shifts in how the patient’s role is perceived by clinicians in relation to medicines management.

  18. Contact between doctors and the pharmaceutical industry, their perceptions, and the effects on prescribing habits.

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    Klaus Lieb

    Full Text Available BACKGROUND: The prescribing behaviour of doctors is influenced by the pharmaceutical industry. This study investigated the extent to which contacts with pharmaceutical sales representatives (PSR and the perception of these contacts influence prescribing habits. METHOD: An online questionnaire regarding contact with PSRs and perceptions of this contact was sent to 1,388 doctors, 11.5% (n = 160 of whom completed the survey. Individual prescribing data over a year (number of prescriptions, expenditure, and daily doses for all on-patent branded, off-patent branded, and generic drugs were obtained from the Bavarian Association of Statutory Health Insurance Physicians. RESULTS: 84% of the doctors saw PSR at least once a week, and 14% daily. 69% accepted drug samples, 39% accepted stationery and 37% took part in sponsored continuing medical education (CME frequently. 5 physicians (3% accepted no benefits at all. 43% of doctors believed that they received adequate and accurate information from PSRs frequently or always and 42% believed that their prescribing habits were influenced by PSR visits occasionally or frequently. Practices that saw PSRs frequently had significantly higher total prescriptions and total daily doses (but not expenditure than practices that were less frequently visited. Doctors who believed that they received accurate information from PSRs showed higher expenditures on off-patent branded drugs (thus available as generics and a lower proportion of generics. The eschewal of sponsored CME was associated with a lower proportion of on patent-branded drug prescriptions, lower expenditure on off-patent branded drug prescriptions and a higher proportion of generics. Acceptance of office stationery was associated with higher daily doses. CONCLUSIONS: Avoidance of industry-sponsored CME is associated with more rational prescribing habits. Furthermore, gift acceptance and the belief that one is receiving adequate information from a PSR are

  19. Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions

    Directory of Open Access Journals (Sweden)

    Robert L Page II

    2010-03-01

    Full Text Available Robert L Page II1, Sunny A Linnebur2, Lucinda L Bryant3, J Mark Ruscin41Associate Professor of Clinical Pharmacy and Physical Medicine, Clinical Specialist, Division of Cardiology and Heart Transplantation, 2Associate Professor of Clinical Pharmacy, Clinical Specialist, Center on the Aging, Schools of Pharmacy and Medicine, 3Assistant Professor of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA; 4Professor, Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, USAAbstract: Potentially inappropriate medication (PIM prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. In the acute care setting, PIM prescribing can be even more problematic due to multiple physicians and specialists who may be prescribing for a single patient as well as difficulty with medication reconciliation at transitions and limitations imposed by hospital formularies. This article highlights critical issues surrounding PIM prescribing in the acute care setting such as risk factors, screening tools, and potential strategies to minimize this significant public health problem.Keywords: inappropriate prescribing, aged, elderly, adverse drug events, adverse drug reactions, Beers’ criteria, screening

  20. Does prescribed fire benefit wetland vegetation?

    Science.gov (United States)

    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.

  1. Antiviral treatment for Bell's palsy (idiopathic facial paralysis

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    Ildiko Gagyor

    Full Text Available ABSTRACTBACKGROUND: Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy, but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy.OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.METHODS:Search methods:On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.Selection criteria:We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.We excluded trials that had a high risk of bias in several domains.Data collection and analysis:Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery:We found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR 0.69, 95% confidence interval (CI 0.47 to 1.02, n = 1715. For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales, we found a

  2. Determinants of Antiviral Treatment Initiation in a Hepatitis C-infected Population Benefiting from Universal Health Care Coverage

    Directory of Open Access Journals (Sweden)

    Romain Moirand

    2007-01-01

    Full Text Available BACKGROUND AND AIMS: In view of increasing therapeutic efficacy, the delivery of hepatitis C virus (HCV antiviral treatment is expected to increase. Yet practical experience reveals a low rate of treatment, particularly among intravenous drug users. The aim of the present study was to examine the prevalence of HCV treatment and identify factors associated with HCV treatment in a population of patients evaluated in an academic hepatology outpatient clinic between 2001 and 2002.

  3. In vitro evaluation of antiviral and virucidal activity of a high molecular weight hyaluronic acid

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    Blasi Elisabetta

    2011-03-01

    Full Text Available Abstract Background hyaluronic acid (HA, a non-sulphated glycosaminoglycan, is present in synovial fluid, vitreous humour serum and many connective tissues. Pharmaceutical preparations of HA are used in clinical practice for wound healing, joint pain, kerato-conjunctivitis, asthma, mouth care, oesophageal-reflux, and gastritis. Moreover, it is used as a filler to counteract ageing and facial lipoatrophy. Our study aims at investigating the in vitro antiviral activity of a high molecular weight HA. Methods the MTT test was used to rule out the potential toxic effects of HA on the different cell lines used in the antiviral assays. The antiviral activity of HA against Coxsackievirus B5, Herpes Simplex Virus-1, Mumps Virus, Adenovirus-5, Influenza Virus A/H1N1, Human Herpesvirus-6, Porcine Parvovirus, Porcine Reproductive and Respiratory Syndrome Virus was assessed by virus yield assays. Results the most effective inhibition was observed against Coxsackievirus B5, with 3Log reduction of the virus yield at 4 mg/ml, and a reduction of 3.5Log and 2Log, at 2 mg/ml and 1 mg/ml, respectively: the selectivity index was 16. Mumps virus was highly inhibited too showing a reduction of 1.7Log at 1 mg/ml and 1Log at 4 mg/ml and 2 mg/ml (selectivity index = 12. The selectivity index for Influenza Virus was 12 with the highest inhibition (1Log observed at 4 mg/ml. Herpes Simplex Virus-1 and Porcine Parvovirus were mildly inhibited, whereas no antiviral activity was observed with respect to Adenovirus-5, Human Herpesvirus-6, Porcine Reproductive and Respiratory Syndrome Virus. No HA virucidal activity was ever observed against any of the viruses tested. Kinetic experiments showed that both Coxsackievirus B5 and Herpes simplex virus-1 replication were consistently inhibited, not influenced by the time of HA addition, during the virus replication cycle. Conclusions the spectrum of the antiviral activity exhibited by HA against both RNA and DNA viruses, known to have

  4. Prescribing patterns of celecoxib and prescribers' perceptions among three general hospitals in Northern Malaysia

    National Research Council Canada - National Science Library

    Chan, Huan-Keat; Bakri, Ema; Tan, Sing-Yi; Hassali, Mohamed Azmi; Saleem, Fahad; Khan, Tahir Mehmood

    2014-01-01

    ... expenditure on nonsteroidal anti-inflammatory drugs (NSAIDs) in 2012. To date, no reviews were found in the literature of its prescribing patterns in Malaysia. Since celecoxib was marketed, it has been consistently proven to have similar efficacy to the nonselective NSAIDs in OA and RA. [4] A subsequent trial had confirmed that both dosages of c...

  5. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia

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    Rowa Al-Ramahi

    2012-01-01

    Full Text Available To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients′ medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 res-pectively (P-value = 0.066. The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  6. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia.

    Science.gov (United States)

    Al-Ramahi, Rowa

    2012-03-01

    To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD) in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients' medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 respectively (P-value = 0.066). The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  7. ADDRESSING RATIONAL PRESCRIBERS THROUGH THE PHARMACOLOGY AND THERAPEUTICS COURSE WORK OF MBBS SYLLABUS IN BANGLADESH

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    Abdus Salam

    2013-07-01

    Full Text Available Pharmacology is most rapidly expanding science in medical discipline which leads to the development of many important drugs to treat many medical conditions that was previously untreatable. This paper focuses on the necessity of integration of pharmacology in the medical curriculum in all clinical phases and ethical aspects of medicine in terms of irrational prescribing. Irrational prescribing of drugs is a major global health problem in medical practice. Currently Pharmacology is taught at phase-II, a 2 year period in a 5 years undergraduate medical Programme in Bangladesh under the name ‘Pharmacology and Therapeutics’. Indiscriminate use of clinically inappropriate and ineffective medicines are a serious problem. Medicines in Bangladesh are inappropriately prescribed, again all kinds of drugs including controlled products are dispensed and sold out frequently without prescription. Henceforth there are regular violation of medical ethics and professionalism. As only pharmacology and therapeutics deals with the correct selection of drugs, the subject should be continued to teach up to phase-III. In addition, therapeutic discussion should be incorporated with proper logbook during internship in order to make safe and efficient prescribers. Supreme priority should be given to legal and ethical aspects of medicine. Medical professionals must uphold social order by ensuring ethical practices of medicine and appropriate role modelling especially by the faculty.

  8. Potentially inappropriate prescribing in older primary care patients.

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    Sandra Vezmar Kovačević

    Full Text Available OBJECTIVES: The aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM and Potential Prescription Omissions (PPO according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START criteria. STUDY DESIGN: A cross-sectional survey in community pharmacy. METHOD: A prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner. RESULTS: 509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%. The most common were: long-term use of long-acting benzodiazepines (20.7%, use of non-steroidal antiinflammatory drugs (NSAID in patients with moderate-severe hypertension (20.1%, use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9% and use of aspirin without appropriate indication (15.2%. Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97-4.14, p<0.001. There were 439 PPO, identified in 257, (50.5% patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris. CONCLUSION: STOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an

  9. Public health management of antiviral drugs during the 2009 H1N1 influenza pandemic: a survey of local health departments in California

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    Hunter Jennifer C

    2012-01-01

    in the management of antiviral response activities during a real public health emergency. Results of this study offer an important descriptive account of LHD management of publicly purchased antivirals, and provide practitioners, policy makers, and academics with a practice-based assessment of these events. The issues raised and the challenges faced by LHDs should be leveraged to inform public health planning for future pandemics and other emergency events that require medical countermeasure dispensing activities.

  10. Mechanisms of virus resistance and antiviral activity of snake venoms

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    JVR Rivero

    2011-01-01

    Full Text Available Viruses depend on cell metabolism for their own propagation. The need to foster an intimate relationship with the host has resulted in the development of various strategies designed to help virus escape from the defense mechanisms present in the host. Over millions of years, the unremitting battle between pathogens and their hosts has led to changes in evolution of the immune system. Snake venoms are biological resources that have antiviral activity, hence substances of significant pharmacological value. The biodiversity in Brazil with respect to snakes is one of the richest on the planet; nevertheless, studies on the antiviral activity of venom from Brazilian snakes are scarce. The antiviral properties of snake venom appear as new promising therapeutic alternative against the defense mechanisms developed by viruses. In the current study, scientific papers published in recent years on the antiviral activity of venom from various species of snakes were reviewed. The objective of this review is to discuss the mechanisms of resistance developed by viruses and the components of snake venoms that present antiviral activity, particularly, enzymes, amino acids, peptides and proteins.

  11. Bioprospecting of Red Sea Sponges for Novel Antiviral Pharmacophores

    KAUST Repository

    O'Rourke, Aubrie

    2015-05-01

    Natural products offer many possibilities for the treatment of disease. More than 70% of the Earth’s surface is ocean, and recent exploration and access has allowed for new additions to this catalog of natural treasures. The Central Red Sea off the coast of Saudi Arabia serves as a newly accessible location, which provides the opportunity to bioprospect marine sponges with the purpose of identifying novel antiviral scaffolds. Antivirals are underrepresented in present day clinical trials, as well as in the academic screens of marine natural product libraries. Here a high-throughput pipeline was initiated by prefacing the antiviral screen with an Image-based High-Content Screening (HCS) technique in order to identify candidates with antiviral potential. Prospective candidates were tested in a biochemical or cell-based assay for the ability to inhibit the NS3 protease of the West Nile Virus (WNV NS protease) as well as replication and reverse transcription of the Human Immunodeficiency Virus 1 (HIV-1). The analytical chemistry techniques of High-Performance Liquid Chromatograpy (HPLC), Liquid Chromatography-Mass Spectrometry (LC-MS), and Nuclear Magnetic Resonance (NMR) where used in order to identify the compounds responsible for the characteristic antiviral activity of the selected sponge fractions. We have identified a 3-alkyl pyridinium from Amphimedon chloros as the causative agent of the observed WNV NS3 protease inhibition in vitro. Additionally, we identified debromohymenialdisine, hymenialdisine, and oroidin from Stylissa carteri as prospective scaffolds capable of HIV-1 inhibition.

  12. Screening for Antiviral Activities of Isolated Compounds from Essential Oils

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    Akram Astani

    2011-01-01

    Full Text Available Essential oil of star anise as well as phenylpropanoids and sesquiterpenes, for example, trans-anethole, eugenol, β-eudesmol, farnesol, β-caryophyllene and β-caryophyllene oxide, which are present in many essential oils, were examined for their antiviral activity against herpes simplex virus type 1 (HSV-1 in vitro. Antiviral activity was analyzed by plaque reduction assays and mode of antiviral action was determined by addition of the drugs to uninfected cells, to the virus prior to infection or to herpesvirus-infected cells. Star anise oil reduced viral infectivity by >99%, phenylpropanoids inhibited HSV infectivity by about 60–80% and sesquiterpenes suppressed herpes virus infection by 40–98%. Both, star anise essential oil and all isolated compounds exhibited anti-HSV-1 activity by direct inactivation of free virus particles in viral suspension assays. All tested drugs interacted in a dose-dependent manner with herpesvirus particles, thereby inactivating viral infectivity. Star anise oil, rich in trans-anethole, revealed a high selectivity index of 160 against HSV, whereas among the isolated compounds only β-caryophyllene displayed a high selectivity index of 140. The presence of β-caryophyllene in many essential oils might contribute strongly to their antiviral ability. These results indicate that phenylpropanoids and sesquiterpenes present in essential oils contribute to their antiviral activity against HSV.

  13. Antiviral Screening of Multiple Compounds against Ebola Virus

    Directory of Open Access Journals (Sweden)

    Stuart D. Dowall

    2016-10-01

    Full Text Available In light of the recent outbreak of Ebola virus (EBOV disease in West Africa, there have been renewed efforts to search for effective antiviral countermeasures. A range of compounds currently available with broad antimicrobial activity have been tested for activity against EBOV. Using live EBOV, eighteen candidate compounds were screened for antiviral activity in vitro. The compounds were selected on a rational basis because their mechanisms of action suggested that they had the potential to disrupt EBOV entry, replication or exit from cells or because they had displayed some antiviral activity against EBOV in previous tests. Nine compounds caused no reduction in viral replication despite cells remaining healthy, so they were excluded from further analysis (zidovudine; didanosine; stavudine; abacavir sulphate; entecavir; JB1a; Aimspro; celgosivir; and castanospermine. A second screen of the remaining compounds and the feasibility of appropriateness for in vivo testing removed six further compounds (ouabain; omeprazole; esomeprazole; Gleevec; D-LANA-14; and Tasigna. The three most promising compounds (17-DMAG; BGB324; and NCK-8 were further screened for in vivo activity in the guinea pig model of EBOV disease. Two of the compounds, BGB324 and NCK-8, showed some effect against lethal infection in vivo at the concentrations tested, which warrants further investigation. Further, these data add to the body of knowledge on the antiviral activities of multiple compounds against EBOV and indicate that the scientific community should invest more effort into the development of novel and specific antiviral compounds to treat Ebola virus disease.

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

    Science.gov (United States)

    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.

  15. Lorentzian Einstein metrics with prescribed conformal infinity

    CERN Document Server

    Enciso, Alberto

    2014-01-01

    We prove that there are asymptotically anti-de Sitter Einstein metrics with prescribed conformal infinity. More precisely we show that, given any suitably small perturbation $\\hat g$ of the conformal metric of the $(n+1)$-dimensional anti-de Sitter space at timelike infinity, which is given by the canonical Lorentzian metric on the $n$-dimensional cylinder, there is a Lorentzian Einstein metric on $(-T,T)\\times \\mathbb{B}^n$ whose conformal geometry is given by $\\hat g$. This is a Lorentzian counterpart of the Graham-Lee theorem in Riemannian geometry and is motivated by the holographic prescription problem in the context of the AdS/CFT correspondence in string theory.

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

    Science.gov (United States)

    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.

  17. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history.

    Science.gov (United States)

    Zeng, Wenjie; Gustafsson, Lars L; Bennie, Marion; Finlayson, Alexander E; Godman, Brian

    2015-02-01

    Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. Considerable opportunities to improve prescribing efficiency in China.

  18. Sudden sensorineural hearing loss: Is antiviral treatment really necessary?

    Science.gov (United States)

    Övet, Gültekin; Alataş, Necat; Kocacan, Fatma Nur; Gürcüoğlu, Sermin Selver; Görgülü, Hakan; Güzelkara, Fatih; Övet, Habibe

    2015-01-01

    It was aimed to investigate the necessity of antiviral agents in the ISSHL treatment. In this study, the patients, diagnosed with sudden hearing loss and admitted in the first 7 days of hearing loss were divided into two groups; a combination therapy was administered to one of the groups, and famciclovir was administered to the other group as an antiviral treatment in addition to the combined therapy. Both groups were compared in terms of levels of recovery. No statistically significant difference was found in the recovery rates between the two groups (p=0.7). In this study, the additional antiviral treatment was found to have no effect on the remission rates in patients with ISSHL treated with combined therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Phytochemistry, cytotoxicity and antiviral activity of Eleusine indica (sambau)

    Science.gov (United States)

    Iberahim, Rashidah; Yaacob, Wan Ahmad; Ibrahim, Nazlina

    2015-09-01

    Goose grass also known as Eleusine indica (EI) is a local medicinal plant that displays antioxidant, antimicrobial and anticancer activities. The present study is to determine the phytochemical constituents, cytotoxicity and antiviral activities for both crude extract and fraction obtained from the plant. The crude extract contained more secondary metabolites compared to the hexane fraction as gauged using standard phytochemical tests. Cytotoxicity screening against Vero cells using MTT assay showed that the CC50 values for crude extract and hexane fraction were 2.07 and 5.62 mg/ml respectively. The antiviral activity towards Herpes Simplex Virus type 1 (HSV-1) was determined using plaque reduction assay. The selective indices (SI = CC50 / EC50) for both methanol extract and hexane fraction were 12.2 and 6.2 respectively. These results demonstrate that the extract prepared from E. indica possesses phytochemical compound that was non cytotoxic to the cell with potential antiviral activity.

  20. Host Cell Factors as Antiviral Targets in Arenavirus Infection

    Directory of Open Access Journals (Sweden)

    Elsa B. Damonte

    2012-09-01

    Full Text Available Among the members of the Arenaviridae family, Lassa virus and Junin virus generate periodic annual outbreaks of severe human hemorrhagic fever (HF in endemic areas of West Africa and Argentina, respectively. Given the human health threat that arenaviruses represent and the lack of a specific and safe chemotherapy, the search for effective antiviral compounds is a continuous demanding effort. Since diverse host cell pathways and enzymes are used by RNA viruses to fulfill their replicative cycle, the targeting of a host process has turned an attractive antiviral approach in the last years for many unrelated virus types. This strategy has the additional benefit to reduce the serious challenge for therapy of RNA viruses to escape from drug effects through selection of resistant variants triggered by their high mutation rate. This article focuses on novel strategies to identify inhibitors for arenavirus therapy, analyzing the potential for antiviral developments of diverse host factors essential for virus infection.

  1. Host cell factors as antiviral targets in arenavirus infection.

    Science.gov (United States)

    Linero, Florencia N; Sepúlveda, Claudia S; Giovannoni, Federico; Castilla, Viviana; García, Cybele C; Scolaro, Luis A; Damonte, Elsa B

    2012-09-01

    Among the members of the Arenaviridae family, Lassa virus and Junin virus generate periodic annual outbreaks of severe human hemorrhagic fever (HF) in endemic areas of West Africa and Argentina, respectively. Given the human health threat that arenaviruses represent and the lack of a specific and safe chemotherapy, the search for effective antiviral compounds is a continuous demanding effort. Since diverse host cell pathways and enzymes are used by RNA viruses to fulfill their replicative cycle, the targeting of a host process has turned an attractive antiviral approach in the last years for many unrelated virus types. This strategy has the additional benefit to reduce the serious challenge for therapy of RNA viruses to escape from drug effects through selection of resistant variants triggered by their high mutation rate. This article focuses on novel strategies to identify inhibitors for arenavirus therapy, analyzing the potential for antiviral developments of diverse host factors essential for virus infection.

  2. The Antiviral Effect of Baicalin on Enterovirus 71 In Vitro

    Directory of Open Access Journals (Sweden)

    Xiang Li

    2015-08-01

    Full Text Available Baicalin is a flavonoid compound extracted from Scutellaria roots that has been reported to possess antibacterial, anti-inflammatory, and antiviral activities. However, the antiviral effect of baicalin on enterovirus 71 (EV71 is still unknown. In this study, we found that baicalin showed inhibitory activity on EV71 infection and was independent of direct virucidal or prophylactic effect and inhibitory viral absorption. The expressions of EV71/3D mRNA and polymerase were significantly blocked by baicalin treatment at early stages of EV71 infection. In addition, baicalin could decrease the expressions of FasL and caspase-3, as well as inhibit the apoptosis of EV71-infected human embryonal rhabdomyosarcoma (RD cells. Altogether, these results indicate that baicalin exhibits potent antiviral effect on EV71 infection, probably through inhibiting EV71/3D polymerase expression and Fas/FasL signaling pathways.

  3. Antiviral properties from plants of the Mediterranean flora.

    Science.gov (United States)

    Sanna, G; Farci, P; Busonera, B; Murgia, G; La Colla, P; Giliberti, G

    2015-01-01

    Natural products are a successful source in drug discovery, playing a significant role in maintaining human health. We investigated the in vitro cytotoxicity and antiviral activity of extracts from 18 traditionally used Mediterranean plants. Noteworthy antiviral activity was found in the extract obtained from the branches of Daphne gnidium L. against human immunodeficiency virus type-1 (EC50 = 0.08 μg/mL) and coxsackievirus B5 (EC50 = 0.10 μg/mL). Other relevant activities were found against BVDV, YFV, Sb-1, RSV and HSV-1. Interestingly, extracts from Artemisia arborescens L. and Rubus ulmifolius Schott, as well as those from D. gnidium L., showed activities against two different viruses. This extensive antiviral screening allowed us to identify attractive activities, offering opportunities to develop lead compounds with a great pharmaceutical potential.

  4. Antiviral defense in shrimp: from innate immunity to viral infection.

    Science.gov (United States)

    Wang, Pei-Hui; Huang, Tianzhi; Zhang, Xiaobo; He, Jian-Guo

    2014-08-01

    The culture of penaeid shrimp is rapidly developing as a major business endeavor worldwide. However, viral diseases have caused huge economic loss in penaeid shrimp culture industries. Knowledge of shrimp innate immunity and antiviral responses has made important progress in recent years, allowing the design of better strategies for the prevention and control of shrimp diseases. In this study, we have updated information on shrimp antiviral immunity and interactions between shrimp hosts and viral pathogens. Current knowledge and recent progress in immune signaling pathways (e.g., Toll/IMD-NF-κB and JAK-STAT signaling pathways), RNAi, phagocytosis, and apoptosis in shrimp antiviral immunity are discussed. The mechanism of viral infection in shrimp hosts and the interactions between viruses and shrimp innate immune systems are also analyzed.

  5. Commensal bacteria calibrate the activation threshold of innate antiviral immunity.

    Science.gov (United States)

    Abt, Michael C; Osborne, Lisa C; Monticelli, Laurel A; Doering, Travis A; Alenghat, Theresa; Sonnenberg, Gregory F; Paley, Michael A; Antenus, Marcelo; Williams, Katie L; Erikson, Jan; Wherry, E John; Artis, David

    2012-07-27

    Signals from commensal bacteria can influence immune cell development and susceptibility to infectious or inflammatory diseases. However, the mechanisms by which commensal bacteria regulate protective immunity after exposure to systemic pathogens remain poorly understood. Here, we demonstrate that antibiotic-treated (ABX) mice exhibit impaired innate and adaptive antiviral immune responses and substantially delayed viral clearance after exposure to systemic LCMV or mucosal influenza virus. Furthermore, ABX mice exhibited severe bronchiole epithelial degeneration and increased host mortality after influenza virus infection. Genome-wide transcriptional profiling of macrophages isolated from ABX mice revealed decreased expression of genes associated with antiviral immunity. Moreover, macrophages from ABX mice exhibited defective responses to type I and type II IFNs and impaired capacity to limit viral replication. Collectively, these data indicate that commensal-derived signals provide tonic immune stimulation that establishes the activation threshold of the innate immune system required for optimal antiviral immunity. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners.

    Science.gov (United States)

    Holliday, Simon Mark; Hayes, Chris; Dunlop, Adrian J; Morgan, Simon; Tapley, Amanda; Henderson, Kim M; van Driel, Mieke L; Holliday, Elizabeth G; Ball, Jean I; Davey, Andrew; Spike, Neil Allan; McArthur, Lawrence Andrew; Magin, Parker John

    2017-02-01

    We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced "hypothetical" opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on "actual" prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of individual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01; 95% CI: 0.75-1.35; P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74; 95% CI: 0.48-1.16; P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with "hypothetical" prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.

  7. Patterns of drug prescribing in a hospital in Dubai, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Wess L

    2008-01-01

    Full Text Available To determine the pattern of drug prescription by consultants in a private hospital in Dubai, UnitedArab Emirates, 1190 prescriptions were collected from the hospital’s pharmacy over 30 days. In total,2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of alldrugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters.Information about the prescribing physician and the patient was invariably deficient. Name of patient,age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, noneof the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician,signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principaldrug in each class were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenacsodium being 51.6%, 21.4% antibiotics (amoxicillin-clavulanate 13.5%, and 11.5% gastrointestinaldrugs (GI, Hyoscine-N-butylbromide 28.1%. Other therapeutic classes included endocrine drugs(6.1%, vitamin supplements (5.9%, nasal decongestants (4%, antihistaminics (3.8% andcardiovascular drugs (2.6%. Antibiotic injections accounted for 7.4% of all antibiotics prescribed,which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions ofencounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicatespossible areas of improvement in prescription practice.

  8. Using Think Aloud Protocols to Assess E-Prescribing in Community Pharmacies

    Directory of Open Access Journals (Sweden)

    Olufunmilola K. Odukoya, BPharm, MS

    2012-01-01

    Full Text Available Introduction: Think aloud protocol has rarely been used as a method of data collection in community pharmacies.Purpose: The aim of the report is to describe how think aloud protocols were used to identify issues that arise when using e-prescribing technology in pharmacies. In this paper, we report on the benefits and challenges of using think aloud protocols in pharmacies to examine the use of e-prescribing systems.Methods: Sixteen pharmacists and pharmacy technicians were recruited from seven community pharmacies in Wisconsin. Data were collected using direct observation alongside think aloud protocol. Direct observations and think aloud protocols took place between January-February, 2011. Participants were asked to verbalize their thoughts as they process electronic prescriptions.Results: Participants identified weaknesses in e-prescribing that they had previously not conceived. This created heightened awareness for vigilance when processing e-prescriptions. The main challenge with using think aloud protocols was due to interruptions in the pharmacies. Also, a few participants found it challenging to remember to continue verbalizing their thought process during think aloud sessions.Conclusion: The use of think aloud protocols as method of data collection is a new way for understanding the issues related to technology use in community pharmacy practice. Think aloud protocol was beneficial in providing objective information on e-prescribing use not solely based on pharmacist’s or technician’s opinion of the technology. This method provided detailed information on a wide variety of real time challenges with e-prescribing technology use in community pharmacies. Using this data collection method can help identify potential patient safety issues when using e-prescribing and suggestions for redesign.

  9. One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis

    Science.gov (United States)

    2013-01-01

    Background Overuse of antibiotics for upper respiratory tract infections (URIs) and acute bronchitis is a persistent and vexing problem. In the U.S., more than half of all patients with upper respiratory tract infections and acute bronchitis are treated with antibiotics annually, despite the fact that most cases are viral in etiology and are not responsive to antibiotics. Interventions aiming to reduce unnecessary antibiotic prescribing have had mixed results, and successes have been modest. The objective of this evaluation is to use mixed methods to understand why a multi-level intervention to reduce antibiotic prescribing for acute bronchitis among primary care providers resulted in measurable improvement in only one third of participating clinicians. Methods Clinician perspectives on print-based and electronic intervention strategies, and antibiotic prescribing more generally, were elicited through structured telephone surveys at high and low performing sites after the first year of intervention at the Geisinger Health System in Pennsylvania (n = 29). Results Compared with a survey on antibiotic use conducted 10 years earlier, clinicians demonstrated greater awareness of antibiotic resistance and how it is impacted by individual prescribing decisions—including their own. However, persistent perceived barriers to reducing prescribing included patient expectations, time pressure, and diagnostic uncertainty, and these factors were reported as differentially undermining specific intervention components’ effectiveness. An exam room poster depicting a diagnostic algorithm was the most popular strategy. Conclusions Future efforts to reduce antibiotic prescribing should address multi-level barriers identified by clinicians and tailor strategies to differences at individual clinician and group practice levels, focusing in particular on changing how patients and providers make decisions together about antibiotic use. PMID:24188573

  10. Patterns of drug prescribing in a hospital in dubai, United arab emirates.

    Science.gov (United States)

    Sharif, Si; Al-Shaqra, M; Hajjar, H; Shamout, A; Wess, L

    2008-03-01

    To determine the pattern of drug prescription by consultants in a private hospital in Dubai, United Arab Emirates, 1190 prescriptions were collected from the hospital's pharmacy over 30 days. In total, 2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of all drugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters. Information about the prescribing physician and the patient was invariably deficient. Name of patient, age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, none of the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician, signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and 54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principal drug in each class) were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenac sodium being 51.6%), 21.4% antibiotics (amoxicillin-clavulanate 13.5%), and 11.5% gastrointestinal drugs (GI, Hyoscine-N-butylbromide 28.1%). Other therapeutic classes included endocrine drugs (6.1%), vitamin supplements (5.9%), nasal decongestants (4%), antihistaminics (3.8%) and cardiovascular drugs (2.6%). Antibiotic injections accounted for 7.4% of all antibiotics prescribed, which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions of encounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicates possible areas of improvement in prescription practice.

  11. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao;

    2015-01-01

    and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy...... co-prescribed with high-dose folic acid: ranging from 1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales. Conclusion The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care....

  12. Antiviral drugs for viruses other than human immunodeficiency virus.

    Science.gov (United States)

    Razonable, Raymund R

    2011-10-01

    Most viral diseases, with the exception of those caused by human immunodeficiency virus, are self-limited illnesses that do not require specific antiviral therapy. The currently available antiviral drugs target 3 main groups of viruses: herpes, hepatitis, and influenza viruses. With the exception of the antisense molecule fomivirsen, all antiherpes drugs inhibit viral replication by serving as competitive substrates for viral DNA polymerase. Drugs for the treatment of influenza inhibit the ion channel M(2) protein or the enzyme neuraminidase. Combination therapy with Interferon-α and ribavirin remains the backbone treatment for chronic hepatitis C; the addition of serine protease inhibitors improves the treatment outcome of patients infected with hepatitis C virus genotype 1. Chronic hepatitis B can be treated with interferon or a combination of nucleos(t)ide analogues. Notably, almost all the nucleos(t) ide analogues for the treatment of chronic hepatitis B possess anti-human immunodeficiency virus properties, and they inhibit replication of hepatitis B virus by serving as competitive substrates for its DNA polymerase. Some antiviral drugs possess multiple potential clinical applications, such as ribavirin for the treatment of chronic hepatitis C and respiratory syncytial virus and cidofovir for the treatment of cytomegalovirus and other DNA viruses. Drug resistance is an emerging threat to the clinical utility of antiviral drugs. The major mechanisms for drug resistance are mutations in the viral DNA polymerase gene or in genes that encode for the viral kinases required for the activation of certain drugs such as acyclovir and ganciclovir. Widespread antiviral resistance has limited the clinical utility of M(2) inhibitors for the prevention and treatment of influenza infections. This article provides an overview of clinically available antiviral drugs for the primary care physician, with a special focus on pharmacology, clinical uses, and adverse effects.

  13. 中药超声雾化联合抗病毒药物对病毒性角膜炎的疗效分析%Efficacy Analysis of Viral Keratitis Treated with Chinese Medicine Ultrasonic Atomization and Antiviral Medicine

    Institute of Scientific and Technical Information of China (English)

    佟甜; 王昕华; 李若溪

    2012-01-01

    Objective To study the efficacy on viral keratitis treated with ultrasonic atomization of Chinese medicine combined with antiviral medicine. Methods The random, double -blind, parallel, controlled method was adopted. 114 cases were divided into a treatment group and a control group. In the control group,ganciclovir eye drop was prescribed,4 to 6 times a day;recombinant human interferon a2b eye drop,4 to 6 times a day. In the treatment, the antiviral medicines were prescribed and the usages of them were same as the control group. Meanwhile, the ultrasonic atomization was used at the eyes with the self - prepared Chinese herbal decoction,once a day,20min each time. In either group,7 days treatment made 1 session. The duration of treatment was 1 to 2 sessions. Results The curative rate and the improvement rate in the treatment group were higher than those in the control group( P < 0. 05 ). The duration of treatment in the treatment group was shorter than that in the control group,presenting the statistical significant difference( P <0.01 ). The vision improvement was different significantly after treatment between two groups in statistics ( P < 0.01 ). Conclusion The ultrasonic atomization of Chinese medicine combined with antiviral medicine is effective on viral keratitis and this therapy deserves to be promoted in clinical practice.%目的 研究中药超声雾化联合抗病毒药物对病毒性角膜炎的疗效.方法 采取随机、双盲、平行对照的方法将114例患者分为治疗组和对照组.对照组以0.1 %更昔洛韦滴眼液,每天点眼4~6 次;重组人干扰素滴眼液,每天点眼4~6次.治疗组抗病毒药物及用法同对照组,同时应用超声雾化,以自拟中药煎剂熏眼,每日1次,每次20 min.两组均以7 d为1个疗程,治疗时间为1~2个疗程.结果 治疗组的痊愈率、好转率均高于对照组,两组痊愈率比较,差异有统计学意义(P<0.05);治疗组疗程较对照组

  14. An inna