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Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.
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Mental Health , Costs and Cost AnalysisABSTRACT
Background: Pediatric diarrhea is the second most common cause of childhood mortality globally. Despite being self-limiting, polypharmacy is rampant in their treatment. The adherence of practitioners to the recommended guidelines can be assessed by drug utilization studies. Aim and Objectives: The aim of the study was to assess the drug utilization pattern of acute diarrhea management in children. Materials and Methods: A prospective observational study was undertaken for 12 months at pediatric inpatient unit of BRIMS, Bidar. Prescriptions of 400 cases of acute diarrhea in children of either gender aged 1?12 years were evaluated for the pattern of drugs prescribing using the WHO core indicators. Results: The study showed male preponderance with 54.75% being males. Every prescription, on an average had five drugs for diarrheal management. About 43.5% prescriptions had at least two antibiotics. Out of a total of 2237 drugs prescribed, 1392 (62.2%) drugs were prescribed as injections. About 78.5% medicines were selected from the National List of Essential Medicines (NLEM), 2015 and 87.12% drugs were from the hospital formulary. Drugs were categorized as per ATC/DDD system using the WHO reference DDDs and ATC codes website. PDD to DDD ratio of majority of drugs was 0.99. Conclusion: We observed polypharmacy in practice for diarrheal illness in our study. Accentuation on evidence-based management and adherence to the treatment guidelines may help in improved and rational drug use in children.
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Resumen Introducción. Los psicofármacos son medicamentos utilizados en la práctica médica para tratar enfermedades mentales. Objetivo. Realizar un análisis comparando indicadores de consumo en la utilización de psicofármacos en una Institución de Salud mental en el Departamento de Córdoba- Colombia. Metodología. Estudio longitudinal, retrospectivo-transversal, estudio de utilización de medicamentos (EUM) para comparar indicadores de consumo como dosis diaria definida (DDD), número de envases, considerando el diagnóstico y variables sociodemográficas. Resultados. población de 3.089 pacientes, donde el 48% presento diagnóstico de trastorno mental y del comportamiento por consumo de sustancias psicoactivas, el 17% presentó trastorno afectivo bipolar y el 15% esquizofrenia paranoide, el 70% de sexo masculino y un 30% sexo femenino. Los medicamentos más consumidos fueron ácido valproico en cápsulas de 250mg, carbonato de litio en tabletas de 300mg y sertralina en tabletas de 50mg; mayor consumo lo obtuvieron los antidepresivos con 45,77%, seguido por antipsicóticos con 23,19% y por último los anticonvulsivantes con 22,39%. Conclusión.Se observó diferencias en la tendencia del aumento en el consumo de psicofármacos utilizando como indicadores de consumo la dosis diaria definida (DDD) 54versus número de envases en los años de estudio. Esta investigación difiere con los resultados a nivel nacional y departamental en el sentido de que la depresión y demás problemas de salud mental se encuentran en mayor incidencia en los hombres
Results.Population of 3,089 patients, where 48% presented a diagnosis of mental and behavioral disorder due to the use of psychoactive substances, 17% presented bipolar affective disorder and 15% paranoid schizophrenia, 70% male and 30% sex feminine. The most used medications were valproic acid in 250mg capsules, lithium carbonate in 300mg tablets and sertraline in 50mg tablets; The highest consumption was obtained by antidepressants with 45.77%, followed by antipsychotics with 23.19% and finally anticonvulsants with 22.39%. Conclusion.Differences were observed in the trend of the increase in the consumption of psychotropic drugs using as consumption indicators the defined daily dose (DDD) versus the number of containers in the years of study. This research differs from the results at the national and departmental levels in the sense that depression and other mental health problems are found to be more prevalent in men
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Humans , Depression , Behavior , Lithium Carbonate , Antidepressive AgentsABSTRACT
The American Transplant Congress (ATC) is an influential academic congress in the field of organ transplantation. In this article, the hotspots of liver transplantation in 2020 ATC were summarized, including the latest research progress in donor liver procurement and quality assessment, donor liver preservation and ischemia-reperfusion injury (IRI), liver transplantation for hepatocellular carcinoma and other hepatic malignancies, complications after liver transplantation, transplantation immunology, perioperative management and donor-derived infection, pediatric liver transplantation and cell therapy, etc.
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The American Transplant Congress (ATC) is an annual international academic conference in the field of transplantation, which includes the latest achievements of scholars around the world in transplantation, and also leads the frontier direction of transplantation research. In this paper, the international forefront hotspots in basic and translational medicine research associated with renal transplantation in 2020 ATC were summarized, including the new discoveries of memory cell function and immune memory mechanism, the latest discovery in the mechanism of rejection and immune tolerance, the current research status of xenotransplantation, the potential solutions of antibody-mediated rejection (AMR), and the application of nanomedicine and single-cell RNA sequencing in renal transplantation, etc.
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In this paper, forefront hotspots in clinical and applied basis of organ transplantation as well as translational medicine during 2019 American Transplant Congress (ATC) were summarized. It involved transplantation clinical priorities and difficulties which were concerned by transplant surgeons. These hot topics included the immunological mechanisms, risk factors, prognosis evaluation and important biological markers of donor specific antibody (DSA) and antibody-mediated rejection (AMR), desensitization strategy in highly sensitized patients and progress of AMR prevention and treatment, current status and development direction of clinical immune tolerance, hotspots and prevention progress on transplantation-related infection, and brief evaluation of various donor organ mechanical perfusion methods, etc.
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Background: This study was conducted to determine the drug utilization pattern among geriatric inpatients in general medicine department of the hospital.Methods: An observational, prospective study was conducted for a period of six months (November 2016 to April 2017) among 200 geriatric patients; demographic details, education, occupation, diagnosis and drug details were recorded. The drugs were categorized by anatomical therapeutic classification (ATC) and defined daily dose (DDD) was calculated. The World Health Organization (WHO) prescribing indicators were assessed.Results: The majority of the patients (59%) were in age group of 60-69 years. Cardiovascular diseases were common among geriatrics. Most commonly prescribed drug was Pantoprazole (81.7%). Drugs were assigned with ATC/DDD codes according to the guidelines of WHO. Drugs prescribed by their generic names were 56.64% and 43% of drugs that were included in the National Essential Medicines List.Conclusions: Clinical pharmacist have to collaborate and work together with physicians in selecting and adjusting the dose among geriatric population in order to reduce development of potential adverse drug reactions, serious drug related complications and drug interaction.
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Background: Dengue fever (DF) is a serious public health problem, gaining global attention because of its morbidity and mortality. Less studies on Drug utilization pattern of DF in India. The present study was undertaken to analyze Drug utilization pattern of dengue infection in a tertiary care hospital.Methods: A prospective cross-sectional study was conducted for a period of 2 months in a tertiary care hospital and the data was analyzed by using various drug use indicators.Results: A total of 52 prescriptions were analyzed. Male and female were (46.16%, 53.84%), A total of 330 drugs were prescribed. 86 (26.06%) antibiotics, 70 (21.21%) antipyretics, 51 (15.46%) antacids, 19 (5.76%) multivitamins, 52 (15.76%) anti-emetics and 52 (15.76%) papaya leaf extract was prescribed. 84 (25.46%) oral and 246 (74.54%) injectable drugs. IV-fluids given to all patients. 10 (19.24%) were given blood transfusion. 6.17 drugs per prescription. 96% drugs were prescribed by brand names. High DDD for drugs like diclofenac (184), doxycycline (115), metronidazole (2.5), pantoprazole (161.5), rabeprazole (34.6), ondansetron (200) was observed.Conclusions: Most commonly used drugs are antipyretics, antibiotics, antacids, antiemetic, papaya leaf extract. As the incidence of DF is increasing with epidemics, demand for specific treatment guidelines is in great need. Early recognition of the disease, with a rational approach in case management leads good clinical outcome.
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Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.
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Background: To study the prescribing patterns, rationale of drug usage and use of anatomical, therapeutic, chemical (ATC) and defined daily dosage (DDD) classification for the monitoring of drug utilization in the dermatology department of a tertiary care hospital.Methods: A retrospective, observational study was conducted in out-patients department of dermatology at RIMS, Ranchi over a period of two months. Rationale of drug usage was assessed by analysing the prescriptions. Defined daily dosage/1000 patients/day of the commonly used medications was compared to the defined daily dosage by World Health Organization in 2016. Data was analysed by statistical tools. Most of the results were expressed in percentages.Results: The prescriptions were rational in most of the cases. Emphasis was more towards the branded drugs. Polypharmacy was evident in many of the prescriptions. The number of DDD/1000 patients/day in cases of antifungals was more than the WHO DDD and less than the WHO DDD in case of antihistaminics.Conclusions: The number of drugs per prescription must be rationalized so as to avoid polypharmacy. The drugs should be prescribed by their generic names also along with the brand names. Generic medicines should be available in the hospital pharmacy so that a more cost-effective treatment can be assured. CMEs and stewardship programs for health care professionals regarding rational drug usage should be organized.
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Background: Fixed drug combinations (FDCs)have various advantages and disadvantages. In countries like India there are numerous irrational prescriptions as highlighted by the recent banning of FDCs in October 2018. Studying the prescription pattern helps in developing national database which can be used to promote rational use of drugs.Methods: All the Outdoor Patient Department (OPD) prescriptions from department of Obstetrics and Gynecology (OBG) during the study period were used for the study. The drugs were classified according to Anatomical Therapeutic Chemical (ATC) classification. Other data studied were the number of FDCs and the number of currently banned combinations which were used during the study period.Results: The 41% of the drugs prescribed as FDCs. Most FDCs belonged to alimentary system followed by anti-infectives and blood and blood forming organs group. Vitamin D3 and Calcium combination was the most commonly prescribed FDC. Approximately 20% of these prescribed drugs are currently banned.Conclusions: A significant number of drugs are being prescribed as FDCs which also includes various irrational combinations.
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Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using ?2-test and multinomial logistic regression.Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (>7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.
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Background & objectives: Information available on drug consumption is inadequate in most low and middle income countries. This systematic review was conducted to analyse published work on drug utilization research/studies (DUR) in the SEARO region of WHO for study objectives, methodology, results and recommendations and to identify the need for improving DUR and the use of the ATC/DDD system. Methods: A literature search for DUR was carried out in biomedical databases (PubMed, Scirus, Scopus and Google Scholar) up to May 2012. Publications were selected if those were in the English language, describing DUR or prescription practices, and study conducted in the WHO-SEARO countries. Results: A total of 318 publications were included in the review. Of these, 67 per cent were from India and 13 per cent were from Thailand. Majority of the publications were hospital based; only 16 per cent were community based. The ATC/DDD system was used in only 20 per cent of the publications, of which 73 per cent publications used DDD indicators. Several publications focused on antibiotics (31%). Publications that recommended the need for a policy or intervention to improve prescription practices/rational drug use amounted to 35 per cent. Interpretation & conclusions: Drug utilization studies using ATC/DDD system need to be promoted and carried out on an ongoing basis. DUR is important for rational use of drugs. Its relevance to policy making and resource allocation needs to be emphasized.
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PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.
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Adolescent , Child , Female , Humans , Male , Middle Aged , Young Adult , Bone Diseases, Developmental/surgery , External Fixators , Femur/abnormalities , Leg Length Inequality/surgery , Lower Extremity Deformities, Congenital/surgery , Osteochondrosis/congenital , Osteogenesis, Distraction/instrumentation , Osteotomy , Tibia/abnormalities , Treatment OutcomeABSTRACT
The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) as a measuring unit was developed along with an increased concern about drug utilization studies in Europe in the 1960s. Its use was recommended by the WHO Regional Office of Europe on 1981, then by the WHO Headquarters in Geneva in 1996. It is maintained by the WHO Collaborating Centre on Drug Statistics Methodology in Olso (http://www.whocc.no/) and widely used in Europe. However, it is rarely used in other parts of the world. This paper aims to inform the Japanese public about the ATC/ DDD system towards a more rational use of drugs in Japan. It attempts to answer the five Ws on ATC/ DDD, i.e., “What is ATC/DDD?”; “Why is ATC/DDD used?”; “When was ATC/DDD established?”; “Who decide ATC/DDD and how?”; and “Where is ATC/DDD used?”
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This study is tried to suggest the new model to shorten the patient's waiting time from counting department to receiving drugs from pharmacy after doctor's diagnosis. The method of this study is designed to simulate from counting time to finishing time of dispensing drugs for internal medicine outpatients. The results are as follows : First, the increasing the numbers of server at pharmacy and counting department in present model don't effect on shortening outpatient's waiting time. Second, in the case of application of OCS, the outpatient's waiting time for receiving dispensed drugs from pharmacy is rather delayed because of no waiting time for counting. Third, in the case of application OCS and ATC simultaneously, the outpatient's waiting time for receiving dispensed drugs is shortened, and in this case, the increasing the numbers of server at pharmacy effect more greatly on the changes of patient's waiting time for receiving dispensed drugs from pharmacy. From the results of this study, it is noted that the best optimal for shortening outpatient's waiting time in general hospital is to introduce the OCS and ATC simultaneously in the process between the counting department and pharmacy, and increasing the numbers of server at pharmacy.
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Humans , Diagnosis , Hospitals, General , Internal Medicine , Outpatients , PharmacyABSTRACT
The L-ATC hydrolase and L-SCC amidohydrolase which convert L-ATC to L-cysteine in Pseudomonas sp.TS-1138 are purified about 83.9 and 90.3 fold by salting-out method, Sephadex G-75 gel chromatography, DEAE-cellulose 52 ion exchange and Sephadex G-100 gel chromatography, etc. The purified enzyemes are both demonstrated by SDS-PAGE to be a homogeneous protein. Their molecular weight are about 37.5kD and42.8kDa respectively. The optimum reaction temperature are both 35℃, and the optimum pH are 7.0 and 8.0 respectively. The Km of the two enzymes are 0.67 mmol/L and 0.15 mmol/L, and the Vmax are 0.39?10 -3mmol/L?min and 0.42?10 -3mmol/L?min respectively.