A comparative study to assess prescription pattern, cost, and appropriateness of antimicrobial usage in a rural government tertiary care hospital and rural private practitioners

Background: Antimicrobial resistance is defined as the ability of microorganism (bacteria, fungus, virus, or parasite) to resist the effects of a drug to inhibit microorganism growth, which is becoming a major concern worldwide particularly in developing country like India. Aim and Objectives: The aim of this study was to identify, compare, and assess the appropriateness of antimicrobials prescribed in a rural tertiary care hospital and those prescribed by rural private practitioners and to assess the average cost of antimicrobials per prescription. Materials and Methods: A cross-sectional study was conducted, in which a total of 2003 prescriptions were analyzed from outpatient department (OPD) of rural tertiary and prescriptions from nearby chemist shops for prescription pattern, cost, and appropriateness. Results: It was identified that most of the antimicrobial containing prescriptions in both private and public health sector were prescribed by MBBS doctors (56.33%). In Government Medical College (GMC) OPDs, antimicrobials were prescribed mostly for gastrointestinal infection (25.75%) and beta lactams (45.23%) followed by fluoroquinolones (27.10%) were the most commonly prescribed. While among rural private practitioners, gastrointestinal infections (33.50%) followed by fever (27.70%) were the most common clinical conditions, for which antimicrobials were prescribed and 13.40% prescriptions contained more than one antimicrobial. About 43.37% of antimicrobials prescribed in OPDs of GMC and 56.20% antimicrobials prescribed by private practitioners were found to be inappropriate which was statistically significant. Conclusion: The study concluded that around half of the prescriptions analyzed were inappropriate and so there is a strict need of supervising the antimicrobials prescribing patterns, consumption, and it’s dispensing from the pharmacy shops.

Adecuación de la terapia hidrocinética en el paciente ortopédico-traumatológico: un estudio transversal / Appropriateness of hydrokinesitherapy in the orthopedic-traumatological patient: a cross sectional surve

ABSTRACT Introduction: Hydrokinesitherapy is a rehabilitation method used for the treatment of different types of orthopedic, neurological, respiratory problems, etc. However, the existing literature presents not so much evidence regarding the greater efficacy of water treatment compared to dry treatment in patients with post-traumatic outcomes. Objective: Through the administration of a questionnaire, we tried to investigate the rehabilitation experience of hydrokinetic therapists (trained with the so-called Sequential and Preparatory Approach) in order to understand hydrokinesitherapy areas and methods of proper application based on experts' opinion. Methods: A cross-sectional study was carried out in 2020 by administering a questionnaire to physiotherapists trained in hydrokinesitherapy according to the Sequential and Preparatory Approach method, with the aim to investigate their opinion on the use of hydrokinesitherapy in patients with various orthopedic-traumatological problems. Microsoft FORMS® platform was used for the administration of the questionnaire. Results: Sixty-two users participated in the study. From their answers emerged that the use of hydrokinesitherapy is not recommended for the treatment of post-traumatic hypersensitization of peri-lesional tissues (hypersensitive scars; general hypersensitization) and neuropathic syndromes (of the upper and lower limbs). Conclusions: The data obtained from administering the questionnaire were not sufficient to create a specific path to define the appropriateness of hydrokinesitherapy for some orthopedic-traumatological problems but could be considered a good starting point on which to build future developments through further studies.

RESUMEN Introducción: La terapia hidrocinética es un método rehabilitador utilizado para el tratamiento de diferentes tipos de problemas ortopédicos, neurológicos, respiratorios, entre otros. Sin embargo, en la literatura existente no abundan evidencias en cuanto a la mayor eficacia del tratamiento con agua en comparación con el tratamiento seco en pacientes con resultados traumáticos. Objetivo: A través de un cuestionario, se intentó investigar la experiencia de rehabilitación de los terapeutas hidrocinéticos (entrenados con el llamado Enfoque Secuencial y Preparatorio) para comprender las áreas de la terapia hidrocinética y los métodos de aplicación adecuados con base en la opinión de expertos. Métodos: Se realizó un estudio transversal en el año 2020 mediante la administración de un cuestionario a fisioterapeutas formados en la terapia hidrocinética según el método de Abordaje Secuencial y Preparatorio, con el objetivo de averiguar su opinión sobre el uso de la terapia hidrocinética en pacientes con diversos problemas ortopédico-traumatológicos. Se utilizó la plataforma Microsoft FORMS® para la administración del cuestionario. Resultados: Sesenta y dos usuarios participaron en el estudio. De sus respuestas surgió que no se recomienda el uso de la terapia hidrocinética para el tratamiento de la hipersensibilización postraumática de los tejidos perilesionales (cicatrices hipersensibles; hipersensibilización general) y síndromes neuropáticos (de miembros superiores e inferiores). Conclusiones: Los datos obtenidos del cuestionario no fueron suficientes para crear una ruta específica que defina la idoneidad de la terapia hidrocinética para algunos problemas ortopédicos-traumatológicos, pero podría considerarse un buen punto de partida para construir futuros desarrollos a través de estudios adicionales.

Appropriateness of Hospital Admissions in a University Hospital in Egypt: Analyzing a Preintervention Phase

Background: Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work: To measures the rate of inappropriate admissions at the Ain Shams University Hospital. Methods: This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients’ medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. Results: The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am–2:00 pm). The remaining other factors that were studied also proved insignificant. Conclusion: It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient’s gender, shifts during which admission occurred, and the affected body systems. Recommendations: Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.

Role of Prescription Practice in Ensuring Patient Safety in the Primary Health-Care Settings in India

“Completeness (a measure of adequacy)” and the “appropriateness (a measure of the quality of care)” are two dimensions of good prescription practice. The study assessed the prescription practices at the primary health centers (PHCs); to demonstrate the effect of individual and system‑level factors, on adequacy and appropriateness of prescription practices, with special reference to e‑prescription over manual prescription given the rising acceptance of teleconsultation in health care. A total of 600 manual and 1000 e‑prescriptions were randomized using a probability‑proportional‑to‑size sampling method to distribute/allocate samples across manual and e‑prescriptions. Findings revealed that while adequacy and appropriateness of prescriptions depend on individual training and clinical practice; adequacy of prescription, especially the manual was compromised by systemic factors, such as nonavailability of space in a prescription, forcing doctors to prioritize documentation of diagnosis, advising tests, and prescribing medicines, over other details (chief complaints and examination findings).

Study on the inpatient care use since China′s new healthcare reform / 中华医院管理杂志

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.

Study on the feasibility of pharmaceutical intervention to improve medication appropriateness in elderly inpatients / 中国药房

OBJECTIVE To evaluate the effects of pharmaceutical interventio n led by clinical pharmacists on medication appropriateness of elderly inpatients. METHODS A non-randomized concurrent controlled trial was carried out. Elderly patients admitted to two treatment groups in the geriatric department of Yancheng First People ’s Hospital since June 2021 were selected as the research objects. According to the inclusion and exclusion criteria ，the first 40 patients were selected from each of the two treatment groups （according to the order of admission time ）and set as the control group or the intervention group. The control group received routine treatment and nursing services ，and the intervention group additionally received pharmaceutical intervention led by clinical pharmacists on the basis control group. Clinical pharmacists found potential inappropriate medication （PIM）and put forward suggestions on optimization of medication regimen. American Geriatrics Society 2019 Updated AGS Beers Criteria ® for PIM Use in Older Adults （hereinafter referred to as “Beers criteria ”）and the Criteria of PIMs for Older Adults in China 2017 Edition （hereinafter referred to as “Chinese criteria ”）were used as reference tools for drug use review. The medication appropriateness index （MAI）total scores （main evaluation indicator ），the number of PIMs ，the number of drugs used ，the length of hospital stay ，the number of drug-related adverse events during hospital stay ，the number of drug regimen optimization suggestions by pharmacists ， and implementation rate of E-mail：zhihuadou@163.com optimization suggestions adopted by clinicians were compared between 2 groups at admission and at discharge. RESULTS At admission ，there were no statistically differences in MAI total scores，the number of PIMs based on Beers criteria ，the number of PIMs based on Chinese criteria or the number of drugs used between 2 groups（P＞0.05）. At discharge ，there were no statistically differences in the number of PIMs based on Chinese criteria and the length of hospital stay between 2 groups（P＞0.05），but the MAI total scores ，the number of PIMs based on Beers criteria and the number of drugs used in the intervention group were lower than those in the control group （P＜0.05）. In the intervention group，the proportion of drugs recorded as “inappropriate medication ”at admission （34.5％）was significantly higher than that at discharge（19.5％）（P＜0.05）. The difference between the number of drugs discharged from hospital and the number of drugs admitted to hospital in the control group [ 3（1-4.8)] was significantly higher than that in the intervention group [ 1（0-2.8)]（P＝ 0.012）. Compared with admission ，the proportion of drugs recorded as “inappropriate medication ”in the intervention group at discharge was significantly decreased on the basis of “effectiveness”dimension and “course”dimension （P＜0.05）. During hospitalization，clinical pharmacists put forward 70 optimization suggestions of drug regimen for the intervention group ，among which 39 suggestions were adopted and implemented by clinicians ，with an implementation rate of 55.7％. CONCLUSIONS The pharmaceutical intervention led by clinical pharmacists can improve overall appropriateness of drug use in the elderly inpatients using MAI as main evaluation indicator.

To do, or not to do, that is the question: Appropriateness of the requested CT and MR imaging studies in the Philippine General Hospital outpatient department based on the American College of Radiology Appropriateness Criteria

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the rate of the appropriateness of the requested CT and MRI procedures in the Outpatient Department of a tertiary hospital in the Philippines from January to June 2018 using the American College of Radiology Appropriateness Criteria (ACR-AC).</p><p style="text-align: justify;"><strong>Methods:</strong> This retrospective research reviewed outpatient CT and MR imaging requests and cross-referenced with the corresponding ACR-AC guideline available for the written clinical diagnosis.</p><p style="text-align: justify;"><strong>Results:</strong> Four hundred thirty-six (436) (56%) of the 774 retrieved requests were CT scan studies, while the remaining 338 (44%) are MR imaging procedures. Cross-referencing with ACR-AC, the rate of appropriateness across all patients is high at 96.6%, with a 95% confidence interval of 95.0% and 97.6%. The rates were not significantly different between MRI and CT (p-value = 0.4502). Likewise, there was no significant difference in rates of appropriateness for the body parts abdomen, cranial, chest, and spine (p-value = 0.6502).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Although the results were high, relative to the few available international studies, the importance and potential of the ACR-AC cannot be disregarded. The ACR-AC serves as a guide in selecting the appropriate imaging test given a clinical situation. This may equate to better patient management, considering all patient-related factors.</p><p style="text-align: justify;"><strong>Key Words:</strong> diagnostic imaging; reviews, appropriateness; practice guideline</p>

Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Appropriateness of Helicobacter pylori eradication therapy in gastroenterology patients of a tertiary care hospital

Recommended and widely used first-line treatment of Helicobacter pylori consists of a proton pump inhibitor, clarithromycin, and amoxicillin/metronidazole. Recent reports suggest an increase in resistance to these antibiotics, especially to clarithromycin which has adversely affected the effectiveness of this standard regimen, hence levofloxacin containing regimens have also been introduced. Our objective was to assess the appropriateness of clarithromycin and levofloxacin containing regimens for H. pylori eradication by considering the factors such as dose, duration of treatment, patient medication adherence, and H. pylori induced symptom relief. In this prospective observational study, 120 patients were enrolled on the basis of H. pylori induced symptoms, positive campylobacter-like organism (CLO) test, or histology proven H. pylori infection. Besides socio-demographic characteristics, endoscopic findings, CLO test results and H. pylori induced symptom eradication were documented. Majority of the patients (85.83%) received an eradication regimen consisting of clarithromycin + amoxicillin + pantoprazole and the remaining patients were prescribed levofloxacin containing regimens. H. pylori eradication regimen containing clarithromycin was more effective in symptom control. Based on both symptom relief and a negative CLO test on treatment completion, only 40% of the patients received benefit from the regimens. Moreover, overall therapy was unsatisfactory due to inappropriate dose, duration, or sub-optimal adherence.

Antibiotic stewardship initiative in a Medicine unit of a tertiary care teaching hospital in India: A pilot study

Background & objectives: The models for implementation of antibiotic stewardship programme (ASP) in the acute care settings of developing countries are lacking. In most of the hospitals, patient turnover is high and a proper system for recording antibiotic-related information and tracking hospital-acquired infections is not in place. This pilot study was conducted in a tertiary care teaching hospital in north India to assess the feasibility of implementation of an ASP in a Medicine unit and to evaluate the effect of implementation as per the criteria applicable in this set up. Methods: A pre-post-quasi-experimental non-randomized study was conducted in two phases. In the first phase, current practices in the Medicine wards were observed. In the second phase, the ASP was implemented in a single Medicine unit, along with prospective audit and feedback, tracking of the process, as well as outcome measures. Patient risk stratification, blood culture on day one, day 3 bundle, dose optimization, de-escalation and intravenous to oral conversion of antibiotics were the key elements focused upon. Results: There was a significant improvement in the appropriateness of antibiotic prescription (66 vs. 86%, P<0.001) and reduction in the mean number of antibiotics used per person (4.41 vs. 3.86, P<0.05) along with decrease in the duration of hospital stay (17 vs. 14 days, P<0.05). There was a significant improvement in sending of blood cultures on day one during the stewardship phase (P<0.001). Interpretation & conclusions: The ASP approach used in our pilot study may be feasible and beneficial. However, it needs further confirmation in other settings and on a large scale.

Reasons of Non-Guideline-Concordant Treatment in Patients with Multivessel Coronary Artery Disease Regret -One Trial

Objective: We aimed to find the prevalence and the reasons for receiving non-guideline-concordant treatment in patients with multivessel coronary artery disease (mv-CAD), at a single centre. Methods: All consecutive patients who underwent coronary angiography, due to stable angina pectoris or non-ST-elevation acute coronary syndrome (NSTE-ACS), and were diagnosed with mv-CAD at our hospital between August 2017 and February 2018 were included in this study. Stand-alone medical treatment, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or hybrid revascularization is recommended treatment methods by The European Society of Cardiology (ESC) and The European Association for Cardio-Thoracic Surgery Guidelines (EACTS) on Myocardial Revascularisation. Stabilised NSTE-ACS patients were assessed as stable angina pectoris patient Results: A total of 140 patients (96 male, 68.6% and 111 NSTE-ACS, 79.3%) were included in this study, of which 65 (46.4%) received non-guideline-concordant treatment and 75 patients (53.6%) received guideline-concordant treatment. Sociodemographic and clinical characteristics did not differ statistically between patients who received guideline-concordant treatment and non-guideline-concordant treatment. Patients that received non-guideline-concordant treatment did so for the following reasons: patient’s preference and/or cardiologist’s decision of PCI over CABG (42, 64.6%), patient’s refusal of the revascularization method (14, 21.5 %), refusal by the surgery team to perform surgery due to advanced patient age or low left ventricular ejection fraction (5, 7.7%),unavailability of the surgery team (1, 1.5%) and developing ischaemia/myocardial infarction during the waiting period (3, 4.6 %). There was no inappropriate CABG decision. Conclusions: In our study, the prevalence of non-guideline-concordant treatment was high and associated primarily with the preferences of the interventional cardiologists and patients.

Prospective observational study for appropriateness of blood and blood components therapy in children up to 16 years of age admitted in a tertiary care hospital

Background: Blood component therapy is a rational replacement therapy of proven clinical value and efficacy, but it is a double-edged sword as it is associated with many hazards of transfusion reaction. Because of ease of availability and gap in the knowledge of medical professional's blood products are being used very liberally leading to huge mismatch in the demand and supply of life saving blood product.Methods: Prospective cross-sectional observational study was done over a period of 1 year in a tertiary hospital, in western part of India. 225 events of blood component therapy were studied in neonates (<1month) and pediatric (1month-16years) age groups. Indications and reactions to blood components therapy were studied in both the groups. Each component therapy was considered as one event and its indication was compared with standard guidelines for terming it as appropriate or inappropriate.Results: Out of total 225 events of transfusions, most commonly used was PRBC (48.9%) followed by FFP (24.9%), platelet (16.0%), IVIG (9.8%) and whole blood (0.4%).' Authors found that overall 17.3% of the component therapy' were inappropriate( neonates 10.2%' and 7.1% in the rest). Most commonly misused blood product was FFP (37.5%) followed by IVIG (22.7%), platelets (16.7%) and PRBC (6.4%).Conclusions: Regular audit of blood and its component usage is essential to assess the blood utilization pattern and set ideal policies in all the medical specialties to make it appropriate, ensure availability and save patients from its hazards.

Appropriateness of Proton Pump Inhibitors Prescription in Patients Admitted to a Malaysian Tertiary Hospital

@#Introduction Proton pump inhibitors (PPIs) are one of the commonest drug prescribed, however it is not without risk of adverse effects especially if the usage is inappropriate. We aimed to evaluate the frequency, indications and appropriateness of PPIs prescription among the medical inpatients, Serdang Hospital, which is a tertiary hospital in Malaysia. Methods This is a cross sectional study consisting of 1184 patients admitted to medical ward and received PPI from 1st July 2016 to 31st March 2017, and their database were further analysed by SPSS Statistics 17.0. Unpaired t-test was performed to analyze the data collected. P < 0.05 (two-tailed) is considered significant. Their indications were cross-referenced against the indications adapted from the United States Food and Drug Administration (FDA). Results About 23.9% (1184/4953) of inpatients were using PPIs, and 63.0% (746/1184) of them recently started on PPI in the ward, with mean age of 59.7 years. More male patients were commenced on PPIs during hospitalization (P value < 0.05). Based on the FDA guideline, only 21.8% patients were indicated, 32.2% were borderline indicated, and 46.0% patients were not indicated in prescribing PPIs. Stress ulcer prophylaxis was the commonest indication, while anaemia with no evidence of gastrointestinal bleed was the main non-indication in starting PPIs. Only 11% of patients had performed the oesophago-gastro-duodenoscopy (OGDS) during the hospital stay. Conclusions 46.0% of inpatients were inappropriately prescribed PPIs according to FDA guideline. More efforts should be initiated to improve the current situation of PPIs overutilization in Malaysia.

Assessment and analysis for deployment appropriateness of medical linear accelerator at hospitals in China / 中华医院管理杂志

Objective To analyze the deployment of medical linear accelerators at 26 hospitals in China, and suggest on the deployment of such accelerators. Methods From June 2017 to November 2018, a total of 26 hospitals were surveyed by stratified random sampling. Descriptive analysis of the deployment and staffing of medical linear accelerators at 26 hospitals, and the deployment appropriateness of the medical linear accelerator was evaluated using the TOPSIS method. Results The number of medical linear accelerators in different types of hospitals was significantly different. The proportion of imported equipment at tertiary hospitals was 80% (12/15) and the proportion of imported equipment at secondary hospitals was 9% (1/11). The professional staff was deployed basically reasonable, and there was a shortage of physicists at some hospitals. The suitability of medical linear accelerators at tertiary hospitals was better than that of secondary hospitals, 80% (12/15) of tertiary hospitals received " good" and above ratings, while 91% (10/11) of the secondary hospitals received " general" and below ratings. Conclusions Hospitals should carry out the allocation of large-scale medical equipment based on their own situations and requirements. Efforts should be paid on training of professional technicians for radiotherapy. It is important to strengthen the management of planning, access and supervision of medical equipment.

Appropriateness of deep vein thrombosis (DVT) prophylaxis use among medical inpatients: a DVT risk alert tool (DRAT) study

@#Increasing incidence of Venous Thromboembolism (VTE) has complicated treatment courses for hospitalised patients. Despite recommendation to support deep vein thrombosis (DVT) risk assessment and appropriate use of prophylaxis in medical inpatients, it is either neglected or prescribed unnecessarily by the clinicians. This study aimed to assess and compare the appropriateness of DVT prophylaxis prescribing between usual care versus a pharmacist-driven DVT Risk Alert Tool (DRAT) intervention among hospitalised medical patients.

RAM study on general standard of maximum residue limits for pollution-free traditional Chinese medicine based on Chinese Pharmacopoeia formula / 中国中药杂志

The excessive pesticide residues and heavy metals in traditional Chinese medicine seriously endanger human health and the sustainable development of Chinese medicine industry. In order to improve the quality of traditional Chinese medicine and establish a general standard for maximum residue limits(MRL) of pesticides in pollution-free traditional Chinese medicine and decoction pieces, and to ensure the safety of clinical medication from its origin, MRLs were calculated based on the formula(MRL=A×W/100M) from Chinese Pharmacopeia, comparing it with the current Chinese and international standards as well as literature review, the RAND/UCLA appropriateness method(RAM) was applied to determine the categories and MRLs of pesticides in pollution-free traditional Chinese medicine and decoction pieces. Two questionnaires were drafted for expert panel and appropriateness analysis was carried out with the 9-point Likert scale to determine the general standard for MRLs of pollution-free traditional Chinese medicine and decoction pieces. The results showed that a total of nine experts from different fields scored the necessity of standard-setting and 206 pesticide residue limits respectively. The appropriateness scores of 206 pesticides were greater than 7, and appropriateness rate was 100%, which signifies that the expert panel has reached consensus. In summary, based on the RAM, the general standard for maximum residue limits of pesticides in pollution-free Chinese medicines and decoction pieces has reached an expert consensus. Comparing with the MRLs of medicinal plants and plant-sourced food from CAC, Europe Union, the United States, South Korea, Japan, Australia, New Zealand and Canada, 206 MRLs from this general standard share 88.8% in common, 4.4% of which is higher and 6.8% lower than those international standards. This has provided a basis for standardizing the use of pesticides in pollution-free traditional Chinese medicine.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea / 예방의학회지

OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Contemplation of Legal Status of the Committee for the Appropriateness of Hospitalization Related to Involuntary Admission / 신경정신의학

The revised Mental Health Act, in which the legal status and role of “the committee for the appropriateness of hospitalization” as an administrative committee, which has been launched since June 2017, is discussed. The German and British laws were reviewed in comparison with the Korean laws, focusing on the similarities and differences among the laws and which parts require revision. This study reported that patient care should be considered not only from a constitutional point of view, but also from a health care point of view. Self-determination and medical paternalism are both important but generally incompatible values. In recent days, objective and fair diagnosis from medical experts have been challenging. The current Mental Health Act was inevitably revised to actively accept the decisions of the Constitutional Court and apparently guarantee the basic rights of people in the future. The pros and cons of “the committee for the appropriateness of hospitalization” and which parts need to be revised to perform its role properly as a guardian of the admission procedure are assessed. This should reflect the current reality of the mental health medical community. In addition, a face-to-face examination should be made in principle. Nevertheless, the basic rights of the mentally ill are not guaranteed based on current law because of the shortage of budget and human resources. The final option maybe the introduction of a judicial system on involuntary admission. Legitimacy and professionalism are engagements that should be adhered to when treating psychiatric patients.

Evaluation of Hemoglobin Trigger and Appropriateness of Perioperative Red Cell Transfusion in Surgical Departments / 대한수혈학회지

BACKGROUND: Red blood cell (RBC) transfusion is an essential practice during surgery to accommodate for bleeding. As such, there are efforts being made to allow for a safe and appropriate transfusion due to shortages of blood components and to minimize transfusion-related adverse reactions. However, a conventional transfusion decision with relatively high hemoglobin (Hb) threshold is still performed in clinical setting. In this study, we investigated the threshold of Hblevel and appropriateness of RBC transfusion in patients receiving perioperative RBC transfusion in surgical departments. METHODS: We investigated the pre-transfusion Hb level of 1,379 patients (2,170 episodes) receiving perioperative RBC transfusion in five surgical departments, including cardiothoracic surgery (CS), general surgery (GS), neurosurgery (NS), obstetrics and gynecology (OBGY), and orthopedics (OS), between June 2017 and March 2018. The appropriateness of transfusion was evaluated with two criteria: 1) pretransfusion Hb level ≤10 g/dL and 2) posttransfusion Hb level ≤10 g/dL. RESULTS: The median pretransfusion Hb level was 8.5 g/dL (interquartile range 7.7~9.4); that of each department was as follows: 8.6 g/dL (7.9~9.2) in CS, 7.9 g/dL (7.3~8.6) in GS, 9.1 g/dL (8.5~9.8) in NS, 8.5 g/dL (7.7~9.8) in OBGY, and 8.7 g/dL (7.9~9.7) in OS. With a criteria of pretransfusion of Hb level ≤10 g/dL, 85.4% of total episodes were appropriate. With criteria of post-transfusion of Hb level ≤10 g/dL, 44.7% were appropriate. CONCLUSION: This study presents a fundamental data observing the trend of RBC transfusion in a single institution. A significant proportion of inappropriate RBC transfusion are still being conducted in surgical setting. Continuous and effective education of clinicians and implementation of monitoring systems to assess the appropriateness of RBC transfusion may be necessary.

Analysis on the Rationality of Aspirin in Inpatients with Diabetes / 中国药学杂志

OBJECTIVE: To investigate the use of aspirin in patients hospitalized in department of endocrinology from October 1st, 2015 to March 31th, 2016 and analyze the rationality use of aspirin to promote the proper use. METHODS: The appropriateness of aspirin use was analyzed according to relevant guidelines, literature etc. And the safety was analyzed through observing the incidence of adverse drug reaction(ADR). RESULTS: The 204 patients were included. For patients with cardiovascular disease or with high cardiovascular risk, aspirin should be used according to guidelines. But the actual utilization rate of aspirin was 62.50% in these two kinds of patients. About 23% of patients used aspirin after a meal which should be used on an empty stomach based on instruction. Although these patients used some drugs that could interact with aspirin, no adverse events observed during hospitalization. For inpatients who used aspirin, the proportion of ADR was only 1.83%. CONCLUSION: Rational use of aspirin need to be further improved, the safety of 100 mg aspirin is good.