Screening Tool of Older Persons' Prescriptions version 2-update 2014 / 中华老年医学杂志

Screening Tool of Older Persons' Prescriptions (STOPP criteria) version 1 was first launched by geriatricians from Cork University Hospital (Ireland) in 2008.The criteria played a positive role in identifying potentially inappropriate prescriptions.It could also enhance the supervision of drug abuse and reduce adverse drug reactions in the elderly.Recently,a new version of STOPP was published,with updated,more practical and evidence-based guidance.Here we translated and edited the new version of STOPP,in order to provide a valuable reference for physicians and pharmacists and promote rational drug use in elderly patients.

Preparation optimization of palonosetron hydrochloride oral disintegrating tablets by orthogonal test / 重庆医学

Objective To prepare optimization of palonosetron hydrochloride oral disintegrating tablets by orthogonal test. Methods Palonosetron hydrochloride oral disintegrating tablets were prepared with direct compression process.The content of pal-onosetron hydrochloride was determined by HPLC.The formulation was optimized with disintegration time as evaluation indices. Results The optimal formulation(60 mg/tablet)was as follows:L-HPC 12%,mannitol∶SMCC= 2∶1,magnesium stearate 2%, stevia glycosides 3%.The oral disintegrating tablets showed dine appearance and tested better;the disintegration time was 12 sec-onds;the tablets featured a hardness of 3 kg;4 min dissolution rate was 99%.Conclusion The preparation method is simple and reasonable,and the tablets can disintegrate rapidly.

Analysis of Prescribing Patterns in Outpatients based on the Latest Chinese Guideline for the Management of Hypertension / 天津医药

Objective To investigate the pattern of antihypertensive medication prescribing in outpatients from the Second Hospital of Tianjin Medical University, and analyze the shortcoming and deficiency compared with 2010 Chinese guidelines for the management of hypertension. Methods A total of 154 262 electronic prescribing for outpatients with hy-pertension, from January-December 2012 in a Grade 3A hospital in Tianjin, were enrolled in this retrospective survey. Data of commonly used antihypertensive medication and combination therapy in patients were analyzed. The patient data collected were divided into different groups according to age, gender, high blood pressure level and the onset of the season. Results (1)The list of the drugs commonly used for treating hypertension in outpatients were calcium antagonist (52.3%), angiotensin receptor blockers (34.0%),βblockers (25.9%), angiotensin-converting enzyme inhibitors (12.1%), fixed-dose combination (11.0%) and diuretics (1.4%).(2)The fewer combination therapy was found in outpatients than that of monotherapy (43.9%vs 56.1%). Some prescriptions were not routinely recommended by the Guideline (4.6%).(3)The combination therapy used in patients with stage 3 hypertension was higher than that of patients with stage 1or stage 2 hypertension (44.5%vs 37.7%vs 37.7%, P<0.01). The rate of combination therapy was significantly higher in cardiology department than that of other clini-cal departments (P<0.01). The combination therapy tended to be used in the elderly patients than that of non-elderly pa-tients (P<0.01). The number of prescriptions was lower in summer than that of other seasons,but the rate of combination therapy was higher in summer than that of spring, autumn and winter (P<0.01). Conclusion The prescriptions of combina-tion therapy and diuretic were inadequate in outpatients with hypertension. These findings indicate the difference between clinical prescription and the guideline for the management of hypertension.

Analysis of the applications of antibacterial agents to outpatients in primary hospitals in Hefei City of Anhui Province / 中国基层医药

Objective To investigate the applications of antibacterial agents to outpatients in primary hos -pitals in Hefei City of Anhui Province,and to provide reference for rational use of antibacterial agents.Methods In 2011, fourty-five primary hospitals in Hefei City were selected randomly ,including urban community health service centers (Group A) and township hospitals(Group B),and thirty or fourty outpatient prescriptions were analyzed monthly . Results In Group A, the percentage and intensity of antimicrobial usage , the proportion of the combination and injectable formulation were ( 45.36 ±20.02 )%, ( 89.73 ±25.50 ) DDDs · ( 100 cases ) -1 · d-1 , 13.34%, 23.16%,respectively,and the data in Group B were (61.36 ±17.18)%,(108.46 ±32.27)DDDs· (100 cases) -1 · d-1,29.13%,46.39%,respectively,which the former were significantly lower than the latter.Conclusion In primary hospitals,the applications of antibacterial agents to outpatiants are not rataional ,including high percentages of usage and unreasonable selection of species ,and more supervision and training need to be given to the medical staff , especially in township hospitals .

Analysis of antibiotics recipe in hospital in the context of special rectification / 重庆医学

Objective To investigate the antibiotics recipe in one third‐grade hospital from January to December 2012 and to pro‐vide reference for clinical rational use and effective management of antibiotics .Methods The defined daily dose(DDD) was treated as analysis unit ,and the total DDDs was calculated .The antibiotics use densities(AUD) were calculated by the value of DDD per 100 days person .Results The average value of AUD in 2012 was 49 .84 ,compared to the first half of the year ,the second half at‐tended to decrease .Qualification rate was 91 .8% for the investigated antibiotics recipe .Conclusion The use density of antibiotics was medium in the investigated hospital in 2012 .The date of usage of antibacterial drugs showed a steady trend and to be more rea‐sonable during the clinical use of antimicrobial agents special rectification activities .

Attaching great importance to polypharmacy in elderly patients / 中华老年医学杂志

Based on the ongoing clinical experiences at our outpatient pharmacy and geriatrics multidisciplinary inpatient and outpatient services,we believe that polypharmacy among elderly patients is serious and pervasive in China.This observation is supported by the findings from literature review.To help address this serious issue in senior care,we recommend to gain better understanding of age-related physiological changes of the elderly as well as those in pharmacokinetics and pharmacodynamics,and to conduct prescription review and medication reconciliation.The multi-and interdisciplinary approach employed by modern geriatrics care model,involving doctors,pharmacists and nurses,should further help address this issue and promote rational use of pharmaceuticals in the elderly patients.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil / Frequência de potenciais interações entre drogas nas prescrições médicas em uma cidade do Sul do Brasil

CONTEXT AND OBJECTIVE: Drug interactions form part of current clinical practice and they affect between 3 and 5 percent of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS: Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS: Most of the patients were female (69.8 percent), married (59.4 percent) and in the age group of 60 years or over (56.3 percent), with an income less than or equal to three minimum monthly salaries (81.3 percent) and less than eight years of schooling (69.8 percent); 90.6 percent of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5 percent). The frequency of drug interactions was 66.6 percent. Among the 154 potential drug interactions, 4.6 percent were classified as major, 65.6 percent as moderate and 20.1 percent as minor. CONCLUSION: The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

CONTEXTO E OBJETIVO: As interações medicamentosas fazem parte da prática corrente na clínica médica e a sua incidência oscila entre 3 por cento e 5 por cento nos pacientes fazendo uso da polifarmácia. O objetivo do estudo foi identificar a frequência de interações droga-droga potenciais em prescrições de pacientes adultos e idosos. TIPO DE ESTUDO E LOCAL: Inquérito farmacoepidemiológico de corte transversal, realizado de 12/2006 a 02/2007 no conjunto habitacional Parque Verde, Cascavel, Paraná, Brasil. MÉTODO: A amostra foi por conglomerado e estratificada, proporcional ao total de residências no conjunto habitacional, constituída de 95 residências, com 96 pacientes de 19 anos ou mais, sexo feminino e masculino, com prescrição de no mínimo duas especialidades farmacêuticas. As interações foram identificadas de acordo com os softwares DrugDigest, Medscape, Micromedex. RESULTADOS: A maioria dos pacientes pertencia ao gênero feminino (69,8 por cento), em situação conjugal casada (59,4 por cento), com renda menor ou igual a três salários mínimos (81,3 por cento), faixa etária 60 anos ou mais (56,3 por cento) e 8 anos ou menos de estudo (69,8 por cento) com 90,6 por cento dos pacientes moravam com mais outra pessoa. O total de especialidades farmacêuticas foi de 406, correspondendo a uma média de 4,2 medicamentos por paciente. Os fármacos mais prescritos foram os anti-hipertensivos (47,5 por cento). A frequência de interações medicamentosas foi de 66,6 por cento. Dentre as 154 interações medicamentosas potenciais, 4,6 por cento foram classificadas como maior e 65,6 por cento como moderada e 20,1 por cento como menor. CONCLUSÃO: A alta frequência de prescrições de drogas com potencial de interações diferenciado indica uma situação ainda pouco explorada, mas real em pesquisa domiciliar.

Estudo das tendências de prescrição de antimicrobianos para pacientes idosos hospitalizados sob a perspectiva do uso racional de medicamentos / Study of antibiotics prescriptions tendencies for elderly inpatients concerning the rational drug use perspective

Estudos de utilização de medicamentos incorporam aspectos relevantes na saúde pública, despertando questionamentos sobre o risco sanitário que, consequentemente, funcionarão como ferramentas de transformações positivas da realidade. Gastos com complicações causadas pelo mau uso de medicamentos em hospitais representam 15 a 20% de seus orçamentos. Este estudo se propos a investigar as prescrições de antimicrobianos em três Hospitais Sentinela, a partir de 210 prontuários de pacientes idosos (60 anos ou mais) hospitalizados e submetidos à antibioticoterapia, quanto ao padrão de prescrição e indicações presentes. O delineamento da pesquisa foi observacional e transversal. Os prontuários foram consultados após a alta ou óbito dos pacientes. Verificou-se o predomínio das infecções respiratórias (67 prontuários) e estes casos passaram a ser a população de estudo. Foram identificadas as tendências de prescrição de antimicrobianos nos hospitais. Predominou o sexo masculino e faixa etária de 80 anos ou mais. Os grupos dos beta-lactâmicos e das quinolonas foram os mais prescritos. Os medicamentos foram classificados como pertencentes ou não à Relação Nacional de Medicamentos Essenciais, como critério de uso racional. O uso empírico correspondeu a 93% das prescrições. Foram estabelecidas as distribuições dos pacientes por número de princípios ativos prescritos, via de administração, dose diária utilizada e tempo de tratamento. Houve associação de até oito princípios ativos, porém o regime de monoterapia foi utilizado em 39% dos pacientes. A via mais utilizada foi a endovenosa (78%). O estudo demonstrou a necessidade de intervenções que assegurem a integração das ações de controle de infecção hospitalar com os serviços de farmácia.

Studies on drug use incorporate relevant public health features, and lead to questions on the sanitary risk and the development of tools for positive transformations. 15 to 20% of hospital budgets are spent on drug misuse. This study investigated antimicrobial prescription (patterns and indications), in 210 medical files of elderly (60-year-old or above) inpatients from three sentinel hospitals. The design was observational and cross-sectional. The files were consulted after patient discharge or death. Because respiratory infections predominated (67 files), these cases made up the study population. Antimicrobial prescription patterns were identified. There was a predominance of males and the age of 80 years or above. Beta-lactams and quinolones were the most frequently prescribed antibiotics. The criterion of rational use was based on the fact whether the drugs belonged to the National List of Essential Drugs or not. Empiric used was found in 93% of the prescriptions. The patients were distributed according to the number of drugs prescribed, administration route, daily dose and treatment duration. Up to 8 drugs were associated for a single patient, although 39% used monotherapy. The intravenous route was the most frequently used one(78%). The study pointed to the need to develop interventions that integrate the control of hospital-acquired infections and pharmacy services.

Avaliação de prescrições medicamentosas de um hospital universitário brasileiro / Evaluation of prescription data of a Brazilian teaching hospital

A prescrição é o ponto de partida para a utilização de medicamentos. O objetivo deste trabalho foi identificar a qualidade das informações presentes nas prescrições das enfermarias de um hospital universitário brasileiro. Foram coletadas 1.785 prescrições medicamentosas de pacientes maiores de 12 anos, de ambos os sexos, internados em enfermaria de 1º de janeiro a 30 de abril de 2004. A amostragem foi feita coletando-se todas as prescrições emitidas em um dia de cada semana durante o período de estudo, observando-se o intervalo de seis dias entre cada coleta. Foram avaliados dados relativos à identificação do paciente, do medicamento e do prescritor. Em 230 (12,9 por cento) prescrições não havia a idade do paciente. Em 224 (12 por cento) prescrições não constava à assinatura do prescritor. Em 16 por cento dos medicamentos prescritos foi detectada afalta de pelo menos uma informação relativa à posologia (dose, forma farmacêutica, via e/ou intervalo entre doses). Afalta destas informações é um obstáculo ao uso seguro de medicamentos, podendo levar ao uso inadequado e a reações adversas. Sugerimos intervenções educativas junto aos profissionais que lidam com o medicamento (desde a prescrição até sua utilização) e a implantação de monitoramento farmacoterapêutico dos pacientes. A participação mais ativa do farmacêutico na equipe de saúde também pode proporcionar tratamentos mais efetivos, seguros e convenientes aos pacientes hospitalizados. A assistência farmacêutica e a utilização de medicamentos em hospitais brasileiros precisam ser mais estudadas.

Prescription is the starting point for medicine use. The objective of this work was to identify the quality of the information contained in the prescriptions of a Brazilian university hospital. During the period January 1 to April 30,2004,1.785 drug prescriptions for inpatients older than 12 years were collected. The sample consisted of the total of prescriptions emitted on one day of each week during the study period, observing an interval of 6 days between each collection. Characteristics of the patient, the drug and the prescriber were evaluated. In 230 (12.9 percent) prescriptions the age of the patient was no mentioned. In 224 (12 percent) cases the prescriber had not signed the prescription. In 16 percent of prescriptions at least one item of the information regarding dosage (dosage, pharmaceutical form, route and/or time interval between doses) was missing. The lack of such information represents an obstacle for safe use of medicines and can lead to misuse and adverse reactions. We suggest educative interventions for the professionals who deal with medicines and pharmacotherapeutic monitoring of patients. The participation of the pharmacist in the health team can also contribute to more effective, safe and convenient therapies for the hospitalized patients. Pharmaceutical care and medicine use in Brazilian hospitals need further studies.

A prescrição médica eletrônica em um hospital universitário: falhas de redação e opiniões de usuários / Computerized physician order entry in a university hospital: writing failure and users´ opinions / La prescripción médica electrónica en un hospital universitario: fallas en la redacción y opinión de los usuarios

Este estudo analisou as falhas de redação da prescrição médica eletrônica e opiniões dos usuários acerca das suas vantagens e desvantagens. Foram analisadas 1.351 prescrições médicas de um hospital universitário e entrevistados 84 profissionais da área da enfermagem e medicina. Os resultados indicaram que 17,7% das prescrições apresentavam rasuras, em 16,8% havia medicamentos suspensos, em 28,2% havia informações que podiam deixar os profissionais em dúvida e em 25% havia medicamentos prescritos manualmente. Os profissionais indicaram as seguintes vantagens: facilidade de leitura dos dados e rapidez com que a prescrição é feita e liberada e como desvantagens: repetição de prescrições de dias anteriores sem revisão e informações digitadas de forma incorreta. Conclui-se que apesar de ser uma estratégia importante na redução de erros, é preciso revisão desse sistema e educação dos profissionais na sua utilização.

This study analyzed the writing failure of the computerized physician order entry system and its advantages and disadvantages according to users. At a university hospital 1,351 physician orders were analyzed and 84 nursing and medical professionals were interviewed. The results showed that 17.7% of the orders presented erasures, medication had been suspended in 16.8%, in 28.2% there was dubious or misleading information and in 25% medication had been prescribed manually. The professionals indicated advantages such as: ease of data reading and the quickness with which the order is entered and released, among others. They also reported disadvantages such as the repetition of orders from previous days without a review and incorrectly typed information. Therefore, it is concluded that, despite representing an important strategy for error reduction, this system must be overhauled and professionals must be trained to use it.

Este estudio tuvo por objetivo identificar las fallas en la redacción de la prescripción médica electrónica y las opiniones de los usuarios sobre sus ventajas y desventajas. Fueron analizadas 1351 prescripciones médicas de un hospital universitario y entrevistados 84 profesionales de las áreas de enfermería y medicina. Los resultados indicaron que el 17,7% de las prescripciones presentaban rasgaduras, en el 16,8% habían medicamentos suspendidos, en el 28,2% habían informaciones que podían dejar a los profesionales en duda y en el 25% habían medicamentos prescriptos manualmente. Los profesionales indicaron algunas ventajas como: facilidad para leer los datos y rapidez con que la prescripción es realizada y liberada, entre otras, y como desventajas: repetición de prescripciones de días anteriores sin revisión e informaciones digitadas incorrectamente. Se concluye que a pesar de ser una estrategia importante para la reducción de errores, es necesario una revisión de ese sistema y educación de los profesionales en su utilización.

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients / 예방의학회지

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients / 예방의학회지

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.