Consideraciones para el uso de tramadol en dolor crónico no oncológico en atención primaria de salud (APS)

Introducción: tramadol es un analgésico opioide usado frecuentemente para el manejo del dolor crónico no oncológico (DCNO). En Chile, es parte del arsenal farmacológico de los centros de atención primaria para el tratamiento de patologías como artrosis de cadera y rodilla. Es considerado seguro y efectivo, sin embargo, existen reportes de efectos adversos serios por polimorfismos hepáticos, interacciones farmacológicas, intoxicaciones, adicción y muerte. La dosis óptima de tramadol es paciente dependiente. Por esto, es necesario contar con orientaciones específicas para prescribir tramadol de manera segura y eficaz según las características de cada paciente. Materiales y métodos: se revisaron guías actualizadas, revisiones sistemáticas y guías de sociedades internacionales sobre el uso de opioides en DCNO y el uso de tramadol en patologías de DCNO como artrosis, lumbago crónico, dolor neuropático y fibromialgia. Resultados: tramadol no está indicado en el tratamiento de cuadros de dolor primario como fibromialgia y en DCNO secundario es un fármaco de segunda línea o no está recomendado. En dolor crónico neuropático (DCN) es segunda línea de tratamiento. En osteoartritis de cadera, rodilla y mano, se reporta efecto analgésico modesto. Sopesar riesgos versus beneficios en estos pacientes. En artritis reumatoide y lumbago crónico se desaconseja su uso. Conclusiones: tramadol es un medicamento seguro y efectivo si se indica, administra, supervisa y descontinúa adecuadamente. Sin embargo, puede asociarse a interacciones farmacológicas, efectos secundarios serios, conductas de abuso y usos ilícitos, por lo que es necesario conocer y manejar adecuadamente su farmacología e indicaciones.

Introduction: Tramadol is an opioid pain medicine commonly used for chronic non-cancer pain (CNCP) management. In Chile, it is part of the pharmacological arsenal available in primary care centers for treating specific CNCP pathologies, such as hip and knee arthrosis. Tramadol is considered a safe and effective drug. Nevertheless, there are reports of serious adverse effects of tramadol, such as poisoning, addiction, and death, probably caused by liver polymorphisms and drug interaction. The optimal dose of tramadol is patient-specific. Specific knowledge is needed to prescribe tramadol in a safe and effective way according to the patient's medical backward. Methods: We review updated guidelines, systematic reviews, and guidelines from international societies about the use of opioids and tramadol in CNCP pathologies such as osteoarthritis, chronic low back pain, neuropathic pain, and fibromyalgia. Results: Tramadol has no role in primary pain treatment, such as fibromyalgia, but is a second-line drug for chronic neuropathic pain (CNP) and some secondary pain syndromes. Tramadol has a modest analgesic effect in osteoarthritis patients. Clinicians should always weigh the risks and benefits before prescribing tramadol. Tramadol use is discouraged in rheumatoid arthritis and chronic lumbago. Conclusions: Tramadol is a safe and effective drug if correctly indicated, administered, supervised, and discontinued. However, it may be associated with pharmacological interactions, serious side effects, abuse behaviors, and illicit uses, and it is necessary that clinicians know and manage its pharmacology and indications appropriately.

Applications and consideration for metformin in pregnancy / 中华围产医学杂志

Metformin is recognized for its dual action in lowering blood glucose levels and enhancing insulin sensitivity, positioning it as the primary oral drug for managing type 2 diabetes mellitus (T2DM). Despite its ability to cross the placenta and expose the fetus, extensive clinical application has not revealed significant adverse effects. Metformin finds widespread application during pregnancy in conditions such as obesity, polycystic ovary syndrome, T2DM, and gestational diabetes mellitus. This article aims to establish an evidence-based perspective on the impact of metformin administered during pregnancy on maternal and fetal outcomes, as well as the long-term health of offspring. Generally deemed safe and effective, metformin is viewed as a means to control hyperglycemia and manage gestational weight gain without conspicuous adverse effects on maternal and fetal pregnancy outcomes. However, metformin alone may not suffice for achieving glycemic control, necessitating the addition of insulin. Besides, the long-term offspring risks of metformin exposure are controversial, long-term follow-up study is urgent to bring certainty into this field. Thus, tight control over indications for metformin use during pregnancy is crucial to ensure optimal maternal and fetal health outcomes. Although not suggested as a first-line agent for glycemic control in pregnancy, it may be considered as an adjunctive option in cases of severe insulin resistance or in low-resource areas where access to insulin is challenging.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: History and scenario of patient blood management in the world and in Brazil

Abstract Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient

Abstract The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

Consumo de medicamentos não padronizados na saúde indígena: uso racional? / Consumption of non-standard medication in indigenous health: rational usage?

Resumo O estudo analisou o consumo de medicamentos não padronizados na saúde indígena, enfatizando a racionalidade da farmacoterapia, por meio de um estudo transversal dos dados secundários, de 2018 e 2019, no Distrito Especial Sanitário de Saúde Indígena Minas Gerais/Espírito Santo. Esses medicamentos foram classificados pela Anatomical Therapeutic Chemical Classification. Para a comparação da origem de prescrição e da forma de aquisição, empregaram-se testes não paramétricos, avaliando o acesso a medicamentos. Verificou-se a racionalidade por meio do perfil de consumo e da opção terapêutica na lista de medicamentos padronizados. Foram consumidas 104.928 apresentações farmacêuticas, 66.967 (66%) eram para o trato alimentar e o metabolismo; 17.705 (17%) para o sistema nervoso; 12.961 (12%) para o sistema cardiovascular. Quanto aos medicamentos mais consumidos por regiões, 171 (90%) dos 190 apresentavam opção terapêutica. As prescrições foram mais provenientes do SUS. Encontraram-se diferenças na forma de aquisição dos medicamentos. O estudo apontou importante consumo de medicamentos não padronizados, podendo existir falhas na racionalidade terapêutica. Na saúde indígena, questões etnoculturais e sociais constituem desafios para o acesso aos medicamentos com uso racional.

Abstract The study analyzed the consumption of non-standard medication in the health of indigenous peoples, emphasizing the rationality of pharmacotherapy, by conducting a cross-sectional study of secondary data from 2018 and 2019 in the Minas Gerais/Espírito Santo Special Sanitary Indigenous Health Districts. These medicines were classified by Anatomical Therapeutic Chemical Classification. Non-parametric tests were applied to compare the origin of prescription and the form of acquisition, assessing access to medication. Rationality was verified through the consumption profile and the therapeutic option in the list of standardized medicines. A total of 104,928 pharmaceutical presentations were consumed, 66,967 (66%) for the alimentary tract and metabolism, 17,705 (17%) for the nervous system, and 12,961 (12%) for the cardiovascular system. With respect to medicines consumed per region, 171 (90%) out of 190 had a therapeutic option. Prescriptions were more from the SUS. Differences were found in the way the medicines were acquired. The study pointed to significant consumption of non-standard medicines, and there may be failings in therapeutic rationality. In indigenous health, ethnocultural and social issues are challenges to access to medicines with rational use.

Pattern of antiepileptic drug utilization in epilepsy patients in outpatient departments of a tertiary care hospital

Background: Epilepsy is one of the common neurological disorders diagnosed early in life. Availability of many antiepileptic drugs (AEDs) makes it difficult to choose the appropriate pharmacotherapy. Aim and Objective: Understanding the pattern of AED prescription to evaluate the rationality of AED prescriptions in epileptic patients. Materials and Methods: This was a retrospective, observational study carried out at new civil hospital, Surat for a duration of 6 months. The study involved collecting data from the case files of all the patients irrespective of age or gender diagnosed with epilepsy and undergoing treatment from any of the outpatient departments of the hospital. Demographic details, clinical diagnosis, and detailed data about the prescribed pharmacotherapy were recorded in a pre-approved data sheet. The WHO prescribing indicators were evaluated for each prescription. Descriptive statistics was used. Results: The average age of the patients was 21.64 ± 10.46 years. A total of 1565 drugs were prescribed in the 331 epilepsy patients’ prescriptions. Out of this, 551 drugs (35.21%) were antiepileptics. Most of the patients received monotherapy (75.53%). The most commonly prescribed drug was sodium valproate (46.10%) followed by phenytoin (30.13%) and carbamazepine (10%). The average AED per prescription was 1.70. Majority of the prescriptions (94.63%) used generic names. There were no injectable used and no fixed dose combinations were prescribed in any of the patients. Conclusion: The prescriptions followed the rational prescribing pattern. Treatment of epilepsy is usually by monotherapy with valproate being the most commonly used AED. Prospective studies to evaluate adverse effects and patient compliance will help in efficient policy-making decisions.

Construction and application of rational drug use database for children in our hospital / 中国药房

OBJECTIVE To establish a database of rational drug use for children in our hospital， and to provide reference for ensuring the safety of drug use in children. METHODS The construction and filling of the knowledge base of rational drug use for children were performed by establishing the basic structure of the knowledge base， formulating reference standards for the quality level of pediatric medication evidence， and refining evidence-based evidence of pediatric medication. The rule base of rational drug use for children was designed and built from four aspects： preliminary determination rules for patient information， basic drug information rules， prescription suitability review rules， result labeling and post-processing rules. The database was embedded into prescription review system of our hospital and was applied online to test its effectiveness. RESULTS A set of database containing 672 commonly used pediatric medicines and more than 15 000 rules for rational drug use for children was initially constructed. The average interception rate of unreasonable medical orders for hospitalized children after database application（from December 2021 to May 2022）was 2.03%， and was higher than 0.80% before database application（from June 2021 to November 2021）（χ 2＝5 784.389， P＜0.001）； after post-sampling and prescription review， the average qualified rate of medication orders in discharged medical records for children after the application of the database was 99.10%， and was higher than 94.58% before the application of the database （χ 2＝301.237， P＜0.001）. CONCLUSIONS Self-constructed evidence-based rational drug use database for children is close to the actual clinical needs of pediatrics in medical institutions， which can effectively reduce clinical irrational drug use behaviors in pediatrics， improve the pass rate of prescriptions， and ensure the safety of children’s drug use.

Establishment and application of DUE criteria of Dolasetron / 药学实践与服务

Objective To establish the drug use evaluation ( DUE) of Dolasetron, evaluate the rationality of the clinical use of Dolasetron and provide a reference for the rationally clinical use of Dolasetron．Methods On the basis of Dolasetron DUE criteria, a retrospective analysis was made in 794 hospitalized patients from January 2021 to June 2021. Results The drug use evaluation criterion on Dolasetron consisted of drug indications, drug use process, the result of drug use and indication management. Conclusion There are some inappropriate medication problems in Dolasetron utilization in the hospital. The DUE criterion is very practical which could be used to standardize the clinical utilization of Dolasetron.

Discussion on importance of reasonable range of sugar-to-fat ratio in parenteral nutrition prescriptions / 肠外与肠内营养

Objective:To explore the medication safety issues caused by unreasonable sugar-to-fat ratio in clinical practice of parenteral nutrition,providing a basis for the rational use of clinical nutritional drugs.Methods:From the beginning of the database construction until February 28,2023,relevant databases at home and abroad were searched to summarize and analyze the clinical adverse outcomes caused by unreasonable sugar-to-fat ratio prescriptions encountered in the included literature and clinical practice.Results:Eleven articles were included,and 1 case of patient discomfort was improved by adjusting the unreasonable sugar-to-fat ratio.A total of 86 patients were involved,including 51 males and 35 females,with an age range of 18 to 89 years.Among the 86 patients,there were 79 clinical adverse outcomes,including 8 deaths.The incidence rates of clinical adverse outcomes were as follows:abnormal liver function 46.8％(37/79),bile stasis 22.8％(18/79),fat overload syndrome 13.9％(11/79),liver steatosis 11.4％(9/79),platelet reduction 3.8％(3/79),and other 1.3％(1/79).Among the 86 patients,2 cases were clearly recorded to have improved clinical adverse outcomes after adjusting the sugar-to-fat ratio,and the others were not detailed.Conclusions:Inappropriate sugar-to-fat ratio may lead to safety issues related to parenteral nutrition medication and should be given clinical attention.

Use of Paroxetine in Outpatients of a Tertiary Psychiatric Hospital in Jiangsu Province / 昆明医科大学学报

Objective To evaluate the clinical application of paroxetine in outpatients.Methods A retrospective analysis was used to collect the prescription information of all outpatients who used paroxetine in the hospital from January 1,2020 to June 30,2023.The structural characteristics of patients and information on medication dosage,frequency,and cost were analyzed to evaluate the rationality of prescriptions.Results A total of 28,106 valid prescriptions for paroxetine were included,of which 9257 were male and 18849 were female.The use of paroxetine hydrochloride tablets decreased annually while the use of enteric-coated paroxetine hydrochloride sustained-release tablets increased annually.The annual use of paroxetine hydrochloride tablets decreased,while the annual use of enteric-coated paroxetine hydrochloride sustained-release tablets increased.The average cost of the drug per patient unit dose increased each year.Non-compliant prescriptions included off-label use,improper dosage,excessive treatment duration,and off-label use in children and adolescents.Conclusion The clinical application of paroxetine is not standardized,and there are unreasonable situations such as overuse.It is necessary to further strengthen the medication management of paroxetine in outpatient patients.

Analysis of clinical use of antibiotics in pediatric gastroenterology department of a single center from 2015 to 2021 / 中国小儿急救医学

Objective:To analyze the use of antibiotics in the department of pediatric gastroenterology, and improve the standardization and rationality of drug use.Methods:The relevant indicators of antibiotics use in hospitalized children from 2015 to 2021 in the Department of Pediatric Gastroenterology at Shengjing Hospital of China Medical University were collected with statistical analysis, including the proportion of drugs, the proportion of antibiotics expenses, the utilization rate of antibiotics expenses, and the intensity of antibiotics use (AUD).Results:From 2015 to 2021, the proportion of drugs, the proportion of antibiotics expenses and the average annual utilization rate of antibiotics for hospitalized children showed a fluctuating decline.The proportion of drugs decreased from 32.01 % in 2015 to 26.29 % in 2021.The proportion of antibiotics expenses decreased from 15.28 % in 2015 to 2.55 % in 2021.The average annual utilization rate of antibiotics decreased from 51.21 % in 2015 to 34.26 % in 2021.From 2018 to 2021, the AUD showed a fluctuating decline, from 16.15 in 2018 to 15.73 in 2021.The average utilization rate and average AUD in different seasons did not fluctuate significantly.Conclusion:The proportion of drugs, the proportion of antibiotics expenses, the annual average utilization rate of antibiotics, and the annual average AUD in the department of pediatric gastroenterology in a single center show a fluctuating decline.There is no significant difference in the utilization rate and AUD in different seasons.

The role of drug utilization evaluation in medical sciences / 《全球健康杂志（英文）》

Background:Drug utilization evaluation(DUE)is defined by the World Health Organization(WHO)and focuses on the medical,social,and economic consequences of pharmaceutical marketing,distribution,prescribing,and usage in society.The WHO recommends a physician to every 1 000 people.According to the recent data from the Health Ministry in 2019,in which 1.16 million doctors are of active population with just 80％,or 0.9 million,practicing.As a result,a ratio of 0.68 doctors for every 1 000 people,which is much below as per the WHO reports.This article describes history,types,WHO guidelines,need and purpose of DUE.Objective:The main aim of this paper is to provide information about the rational use of medication in outpa-tient and inpatient department with special emphasis of DUEs.It also provides awareness directly to healthcare professionals,researchers,academicians,pharmacist and nurses to reduce the irrationality of medicines.Methods:The method used to compile this review information gathered from websites,Google scholar,PubMed,Research gate,and studies published on DUE from July 20 to Oct 22 were included as source of information.Results:We studied more than 35 published study on DUE,that reveals most of the physicians prescribed branded drugs not generic drugs,but WHO prescribing indicator allows to prescribe generic drugs in the hospital pharmacy to maintain better inventory control.It may also help to prevent pharmacist misunderstanding during dispensing.Conclusion:The use of generic prescription names avoids the possibility of medication product duplication and lowers patient costs.It is important to remember that incorrect medication prescriptions have impact on both patients and their family members.WHO indicators identify irrational prescribing behaviours to make therapy more rational and cost-effective.

Treatment advice of small molecule antiviral drugs for elderly COVID-19 / 中国药理学通报

COVID-19 has been prevalent for three years. The virulence of SARS-CoV-2 is weaken as it mutates continuously. However, elderly patients, especially those with underlying diseases, are still at high risk of developing severe infections. With the continuous study of the molecular structure and pathogenic mechanism of SARS-CoV-2, antiviral drugs for COVID-19 have been successively marketed, and these anti-SARS-CoV-2 drugs can effectively reduce the severe rate and mortality of elderly patients. This article reviews the mechanism, clinical medication regimens, drug interactions and adverse reactions of five small molecule antiviral drugs currently approved for marketing in China, so as to provide advice for the clinical rational use of anti-SARS-CoV-2 in the elderly.

Systematic Review on Safety of Chinese Medicines Combined with Tripterygium wilfordii Preparations in Treatment of Rheumatoid Arthritis and Exploration on Underlying Network Regulatory Mechanisms of Enhancing Efficacy and Reducing Toxicity / 中国实验方剂学杂志

ObjectiveTo systematically evaluate the safety of Chinese medicines combined with Tripterygium wilfordii polyglycoside tablets/Tripterygium wilfordii tablets （TWPT/TWT） in the treatment of rheumatoid arthritis （RA）， and to explore the network regulatory mechanisms of enhancing efficacy and reducing toxicity of commonly used combination regimes. MethodThe literature involving the adverse reactions of TWPT/TWT in treating RA was searched and collected from three Chinese databases （CNKI， Wanfang Data， VIP） and three English databases （PubMed， Cochrane Library， Embase） from the inception of the databases to July 2021. All studies were assessed by the Cochrane risk of bias tool， and the data were extracted and analyzed by Stata 15.0. Furthermore， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine 2.0 （TCMIP v2.0，http：//www.tcmip.cn/） was used to construct a "drug target-symptom gene of efficacy and toxicity" interaction network， to explore the underlying network regulatory mechanisms of enhancing efficacy and reducing toxicity of common T. wilfordii preparation combinations. ResultA total of 2 132 articles on Chinese medicines combined with TWPT/TWT in the treatment of RA were retrieved， and 18 of them were finally included. The systematic review showed that the adverse reactions of TWPT/TWT against RA mainly occurred in the digestive system， blood system， and reproductive system， of which digestive system had the highest incidence of damages. However， the combination with Chinese medicines effectively alleviated the adverse reactions caused by TWPT/TWT ［RR （95% CI）=0.45 （0.30， 0.66）， P<0.01］. In addition， the subgroup analysis indicated that the age of RA patients， course of disease， combination regimen， medication dosage and duration of treatment all affected the occurrence of adverse reactions of TWPT/TWT. It was found in clinical studies that total glucosides of paeony （TGP） and TWPT/TWT was most widely combined， and the effect of TGP in reducing TWPT/TWT-induced hepatotoxicity was also more significant than that of other Chinese medicines. Moreover， taking this combination regime as an example， this paper explored the "efficacy-toxicity" association mechanisms of TGP-TWPT/TWT against RA. The "drug target-symptom gene of efficacy and toxicity" interaction network revealed that the core network targets of TGP-TWPT/TWT enhanced efficacy and reduced toxicity mainly through regulating immunity-inflammation-related pathways， metabolic pathways and cell signal transduction. Especially， interleukin-4 （IL-4） and interleukin-13 （IL-13）， which were involved in the "immunity-inflammation" module， were the common targets of TGP-TWPT/TWT to enhance efficacy and reduce toxicity. The endogenous sterols， bile acids and bile salts， insulin secretion and other metabolic pathways in the "body metabolism" module were closely associated with the mechanisms of TWPT/TWT inducing hepatotoxicity and TGP reducing hepatotoxicity. While cell function regulation pathways， such as stem cell factor （SCF）/tyrosine kinase receptor （KIT） signaling pathway and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）signaling pathway were involved in both anti-RA effects and hepatotoxicity of TWPT/TWT. ConclusionClinical application of suitable Chinese medicines combined with TWPT/TWT in the treatment of RA can effectively improve the rheumatism and reduce the adverse reactions of TWPT/TWT， and TGP-TWPT/TWT has the most significant toxicity-reducing effect. Further biological network-based investigation indicates that the toxicity-reducing mechanism of TGP-TWPT/TWT may be related to the regulation of interleukin signaling pathway and bile acid metabolism pathway， and the synergistic efficacy-enhancing effect of the combination may be achieved by acting on interleukin signaling pathway and cell function regulation pathway.

Comparison of two analysis methods of opioid consumption sum in medical institutions / 中国药房

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

Exploring the safe and rational use of Epimedii Folium based on the evolution of efficacy/toxicity records in ancient and modern literature / 药学学报

Epimedii Folium is a traditional non-toxic Chinese herbal medicine. However, liver injury caused by Chinese herb preparations, including Epimedii Folium, is frequently reported over the years. Based on ancient and modern literature, this paper systematically summarized and analyzed the safe application of Epimedii Folium from the perspectives of varieties, processing methods, clinical adverse reactions, pharmacological effects and toxic mechanism. Combined with our team work, we build the comprehensive prevention and control system "human-drug-application", for the safe and rational application of Epimedii Folium. This study is expected to provide support for scientific evaluation and precise prevention and control of the safety risk of Epimedii Folium.

Framework design of WHO and typical national essential medicine lists and its implications for China / 中国药房

OBJECTIVE To sort out the common presentation forms and components of the framework of domestic and foreign essential medicine lists （EMLs）， in order to provide reference for optimizing the framework of the Chinese EML. METHODS The latest edition of the EMLs of WHO， China， South Africa， India， Malaysia and other typical countries were compared， and the similarities and differences of the presentation form and constituent elements of the list framework were analyzed. RESULTS & CONCLUSIONS The common presentation forms of WHO and typical countries’ EMLs included version， classifications and symbols， of which management ideas， functions， and implementation difficulties varied； common framework elements included target population， hospital levels， drug use conditions， core and supplementary lists and procurement priority. Through comparison， it was found that the information covered by the Chinese EML was relatively thin， and the framework design had not yet fully played the ideal role in guiding clinical rational drug use and optimizing the allocation of health resources， and there was still some room for improvement. It is recommended that China clarify the characteristics and roles of different presentation forms of the EML， and reasonably set the EML framework based on national conditions and development needs； the multi-dimensional drug information should be supplemented， such as clinical use， economy， and policy attributes of drugs in the EML， to ensure the rational use of essential drugs； it is also necessary to add “the level of hospitals” in the framework of the EML， refine the management requirements for the allocation and use of essential medicine， and optimize the resource allocation of hospitals.

Antibiotic safety among neonates and paediatrics in a public hospital: KwaZulu-Natal

Background: The World Health Organization (WHO) guidelines recommend the empiric treatment of infections before definitive treatment begins. However, ethical concerns limit the availability of clinical trials in neonates and paediatrics to fully ascertain the safety profile of antibiotics in these populations. Aim: This study aimed to quantify the use of antibiotics among neonates and paediatrics and commented on the use, rationale and appropriateness of antibiotics prescribed. Setting: A secondary level public sector hospital located in Durban, KwaZulu-Natal. Methods: Demographic and treatment information of neonates and paediatrics were collected retrospectively from January 2022 to June 2022. Data were obtained from patient files and extracted for analysis using Microsoft Excel®. Analytical and descriptive statistics were used to analyse patient demographics and treatment variables. Results: A total of 568 antibiotics, issued to 389 patients, were reviewed. Penicillins (40.1%), aminoglycosides (24.3%) and combination penicillin-beta-lactam inhibitors (23.3%) were identified as the most frequently prescribed antibiotics for inpatients. Most antibiotics prescribed to inpatients were for complications associated with pre-term birth (66.9%). Combination penicillin-beta-lactam inhibitors (34.7%), penicillins (29.5%) and cephalosporins (29.5%) were the most frequently prescribed antibiotics to outpatients. A correlation was found between the route of administration and the duration of therapy; the intravenous route (63.6%) was preferred over the oral route (36.4%) for administration. Conclusion: Many broad-spectrum antibiotics were prescribed, thus increasing the risk of resistance. Antibiotics were being prescribed according to the guidelines; however, there is still a need for therapeutic drug monitoring to ensure the continuation of rational drug use. Contribution: There was evidence of rational use of antibiotics in the public hospital (KwaZulu-Natal), in keeping with economic and availability factors.

Atuação de um centro regional de informação sobre medicamentos na baixada fluminense de 2020 a 2022 / Performance of a regional drug information center in the baixada fluminense from 2020 to 2022 / Acción de un centro regional de información médica en la baja fluminencia de 2020 a 2022

No ano de 2020 observou-se um aumento da divulgação de informações parciais e sem embasamento científico sobre COVID-19. Nesse contexto, o Centro Regional de Informação sobre Medicamentos (CRIM) em uma Universidade Pública, torna-se um importante disseminador de informações referenciadas. Este trabalho foi realizado para identificar, por meio dos dados obtidos nos canais de comunicação em que essas ações virtuais foram desenvolvidas, o alcance atingido por cada publicação e evento. Dentre os materiais produzidos, 38,5% foram relacionados à COVID-19; 26,9% ao uso de medicamentos; 21,1% às datas representativas da área da saúde; e 13,5% às informações sobre doenças. Destacaram-se temas como: "Qual a diferença entre medicamento referência e genérico?"; "A importância de tomar o medicamento com água"; "CAFEÍNA: Uso indiscriminado"; "Interações fármacos x alimentos"; e "Imunização Infantil: Devo vacinar meu filho contra a COVID-19?". As ações de educação continuada, somadas às visualizações dos eventos produzidos totalizaram 5.160 visualizações. Destaca-se o IV Simpósio sobre Uso Racional de Medicamentos (URM) e o I Simpósio de Direitos Humanos e Saúde Mental que, em sua totalidade, somaram 3.459 visualizações. As ações reforçam a necessidade de promover práticas voltadas à informação para garantia do uso eficaz, seguro e racional de medicamentos.

In 2020, there was an increase in the dissemination of partial and scientifically unsupported information about COVID-19. In this context, the Regional Drug Information Center (RDIC) in a Public University becomes an important disseminator of referenced information. This work was carried out to identify, through the data obtained from the communication channels in which these virtual actions were developed, the reach atteined by each publication and event. Amongst the materials produced, 38.5% were related to COVID-19; 26.9% to the use of medication; 21.1% to representative dates in the health area; and 13.5% to information about diseases. Topics such as: "What is the difference between reference and generic medicine?"; "The importance of taking the medicine with water"; "CAFFEINE: Indiscriminate use"; "Drug x food interactions"; and "Childhood Immunization: Should I vaccinate my child against COVID-19?". Continuing education actions, added to the views of the events produced, totaled 5,160 views. We highlight the IV Symposium on Rational Use of Drugs (RUD) and the I Symposium on Human Rights and Mental Health which, in their entirety, totaled 3,459 views. The actions reinforces the need to promote information-oriented practices to ensure the effective, safe and rational use of medicines.

En el año 2020 se produjo un aumento en la difusión de información parcial y no se obtuvo ninguna base científica sobre el COVID-19. En este contexto, el Centro Regional de Información sobre Medicinas (CRM) de una Universidad Pública se convierte en un importante difusor de información referenciada. Este trabajo se llevó a cabo para identificar, mediante los datos obtenidos en los canales de comunicación en los que se desarrollaron estas acciones virtuales, el alcance alcanzado por cada publicación y evento. De los materiales producidos, el 38,5% estaban relacionados con el COVID-19; el 26,9% con el uso de medicamentos; el 21,1% con las fechas representativas del área de salud; y el 13,5% con información sobre enfermedades. Temas como: "¿Cuál es la diferencia entre la medicina de referencia y la genérica?"; "La importancia de tomar el medicamento con agua"; "CAFEÍNA: uso indiscriminado"; "Interacciones medicamentosas versus alimentos"; e "Inmunización infantil: ¿debo vacunar a mi hijo contra COVID-19?". Las acciones de la educación continua, sumadas a las visualizaciones de los eventos producidos, alcanzaron un total de 5.160 visitas. Se destacan el cuarto simposio sobre el uso racional de los medicamentos (UDA) y el primer simposio sobre derechos humanos y salud mental, que en su totalidad sumaron hasta 3.459 visualizaciones. Las medidas adoptadas refuerzan la necesidad de promover prácticas orientadas a la información para garantizar el uso eficaz, seguro y racional de los medicamentos.

Atenção farmacêutica e farmacoterapia do idoso: uma revisão integrativa / Pharmaceutical care and pharmacotherapy for the elderly: an integrative review / Atención farmacéutica y farmacoterapia de las personas mayores: una revisión integradora

Este trabalho tem como objetivo selecionar e sintetizar as evidências da literatura sobre o contexto atual da atenção farmacêutica e farmacoterapia do idoso, considerando os aspectos clínicos e sociais envolvidos. A revisão foi conduzida de acordo com as diretrizes do protocolo PRISMA, que consiste na busca, seleção, avaliação e síntese de estudos relevantes sobre o tema. Foram selecionados 15 artigos que atenderam aos critérios de inclusão e exclusão estabelecidos. A análise dos artigos permitiu identificar que a atenção farmacêutica é um serviço que visa otimizar o uso racional de medicamentos e melhorar a qualidade de vida dos pacientes, especialmente dos idosos, que apresentam maior risco de polifarmácia, interações medicamentosas e reações adversas. A farmacoterapia do idoso envolve aspectos fisiológicos, psicológicos, sociais e econômicos que devem ser considerados na prescrição, dispensação e acompanhamento dos medicamentos. No entanto, ainda há precariedade na integração do farmacêutico nas equipes de saúde. Conclui-se que a atenção farmacêutica é uma estratégia importante a ser implementada em todas as equipes de saúde públicas e privadas, para promover o uso seguro e efetivo dos medicamentos pelos idosos, contribuindo para um envelhecimento saudável e digno.

This paper aims to select and synthesize evidence from the literature on the current context of pharmaceutical care and pharmacotherapy of the elderly, considering the clinical and social aspects involved. The review was conducted according to the guidelines of the PRISMA protocol, which consists of the search, selection, evaluation and synthesis of relevant studies on the topic. Fifteen articles that have met the established inclusion and exclusion criteria were selected. The analysis of the articles allowed the identification that pharmaceutical care is a service that aims to optimize the rational use of medicines and improve the quality of life of patients, especially the elderly, who present a higher risk of polypharmacy, drug interactions, and adverse reactions. The pharmacotherapy of the elderly involves physiological, psychological, social, and economic aspects that must be considered when prescribing, dispensing, and monitoring medications. However, there is still a precariousness in the integration of the pharmacist in health teams. It is concluded that pharmaceutical care is an important strategy to be implemented in all public and private health teams, to promote the safe and effective use of medicines by the elderly, contributing to a healthy and dignified aging.

Este trabajo tiene como objetivo seleccionar y sintetizar la evidencia de la literatura sobre el contexto actual de la atención farmacéutica y la farmacoterapia de las personas mayores, considerando los aspectos clínicos y sociales implicados. La revisión se ha realizado siguiendo las directrices del protocolo PRISMA, que consiste en la búsqueda, selección, evaluación y síntesis de estudios relevantes sobre el tema. Se seleccionaron 15 artículos que cumplieron los criterios de inclusión y exclusión establecidos. El análisis de los artículos permitió identificar que la atención farmacéutica es un servicio que tiene como objetivo optimizar el uso racional de los medicamentos y mejorar la calidad de vida de los pacientes, especialmente de los ancianos, que presentan un mayor riesgo de polifarmacia, interacciones medicamentosas y reacciones adversas. La farmacoterapia del anciano implica aspectos fisiológicos, psicológicos, sociales y económicos que deben ser considerados a la hora de prescribir, dispensar y monitorizar los medicamentos. Sin embargo, todavía existe una precariedad en la integración del farmacéutico en los equipos de salud. Se concluye que la atención farmacéutica es una estrategia importante a ser implementada en todos los equipos de salud públicos y privados, para promover el uso seguro y eficaz de los medicamentos por los ancianos, contribuyendo para un envejecimiento saludable y digno.