Diagnostic urethrocystoscopy: A five-year review of indications and findings in a tertiary hospital in Nigeria

Background:Urethrocystoscopy is defined as endoscopic visualization of the urethra and the urinary bladder for the purpose of diagnosis or treatment of diseases of the lower urinary tract.Objective: To study the indications, diagnosis and complications of diagnostic urethrocystoscopy in our hospital.Materials and method:It was a retrospective descriptive study of all patients who had diagnostic urethrocystoscopy in our hospital between January 2016 to December 2021. Institutional ethical clearance was obtained. Particulars of the patients were collected from the operating theatre register and their medical case files were retrieved. Information about the patients'bio-data, presentation, clinical/radiologic diagnosis, urethrocystoscopic findings and its complications were extracted. The generated data was analyzed using statistical package for social sciences (SPSS) version 21 and results presented in tables, text and figures.Results:Atotal of 673 patients had urethrocystoscopy/cystoscopy during the period out of which we recovered full medical records of 592 patients whose data were analyzed.The patient's age ranges between 9 to 86years with mean age of 43.7±9.3SD years and M: F = 3.9:1. The indications for diagnostic urethrocystoscopy were lower urinary tract symptoms [LUTS] (48.8%), bladder tumour (29.2%) and haematuria (11.1%) among others. The urethrocystoscopic diagnoses were bladder tumour (37.8%), prostate enlargement (19.1%) and urethral stricture (6.9%) among others. The complications recorded were urethral/bladder bleeding (2.4%), urosepsis (1.4%) and urethral/bladder injury (0.3%).Keywords: Urethrocystoscopy, diagnosis, indicationsConclusion: Urethrocystoscopy is a necessary tool for comprehensive practice of urology owing to its vital role in the diagnosis and treatment of different kinds of lower urinary tract diseases and it is generally a safe procedure

Surgical antibiotic prophylaxis: is the clinical practice based on evidence? / Antibioticoprofilaxia cirúrgica: sua prática clínica está baseada em evidências?

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.

RESUMO Objetivo: Avaliar a utilização de antibioticoprofilaxia cirúrgica. Métodos: Foi realizado um estudo descritivo em um hospital universitário de cuidado terciário por meio de coleta de dados de prescrição, sociodemográficos e de hospitalização sobre todos os pacientes internados em 2014 que utilizaram pelo menos um medicamento antimicrobiano. Esses dados foram coletados da base de dados eletrônica do hospital. O consumo de antimicrobianos foi analisado de acordo com a classificação anatômica terapêutica e química/dose diária definida por mil pacientes-dia. Realizou-se uma análise exploratória por meio da análise de componentes principais. Resultados: Um total de 5.182 pacientes internados receberam prescrição de antibioticoprofilaxia cirúrgica, que corresponde a 11,7% do total de antibióticos utilizados no hospital. As unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular e terapia intensiva pós-operatória foram responsáveis pela utilização de mais da metade (56,3%) da antibioticoprofilaxia cirúrgica. A duração de uso desses antimicrobianos nessas unidades foi 2,2, 2,0 e 2,4 dias, respectivamente. Cefalosporinas de terceira geração e fluoroquinolonas foram as classes de antimicrobianos com tempo de utilização mais longo. Conclusão: A utilização de antibioticoprofilaxia cirúrgica foi inadequada nas unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular, terapia intensiva pós-operatória, ginecologia e obstetrícia e otorrinolarigonlogia. Portanto, são importantes o desenvolvimento e a implantação de estratégias que promovam o uso racional de antibioticoprofilaxia cirúrgica nos hospitais.

The Effects after Implementing a Drug Utilization Review System on Contraindicated Drug use: A Systematic Review

OBJECTIVE: The objective of the present study was to evaluate the effects of implementing a systematic Drug Utilization Review (DUR) system on contraindicated drug use and pharmaceutical expenditures in Korea. METHODS: A literature search was conducted using search engines such as PubMed, EMBASE, NDSL, and RISS for relevant systematic studies. The database search was performed and updated in April 2018. Two independent reviewers evaluated the abstracts to find potentially eligible articles. RESULTS: In total, 1433 potentially eligible studies were selected, and 11 articles were eventually shortlisted for inclusion in the present review system. The outcome showed that contraindicated drug use decreased after implementation of the DUR system in Korea. The analysis also showed that the DUR system contributed to a reduction in pharmaceutical expenditures. CONCLUSION: Our study showed that implementing the DUR system reduced both contraindicated drug use and pharmaceutical expenditures in Korea.

The Evaluation of Drug Utilization Review on Potentially Inappropriate Medications for Elderly Patients in a Tertiary Hospital

OBJECTIVE: South Korea made a list of potentially inappropriate medications (PIMs) for elderly patients in 2015 and has prompted medical professionals to prescribe proper medication by using the drug utilization review (DUR) system. It has been three years since the system was introduced, but related studies have rarely been conducted. This study aimed to evaluate the effect of the DUR system on the prescription of PIMs for elderly patients. METHODS: The data on the prescription of PIMs for elderly patients (≥ 65 years) who received medical treatment between March 1st and May 31st in 2015 (before introduction of the DUR system) and who received medical treatment between March 1st and May 31st in 2018 (after introduction of the DUR system) were retrospectively collected from electronic medical records. RESULTS: The prescriptions of PIMs decreased from 3,716 (7.7%) to 3,857 (6.9%) (p < 0.001). The prescription of escitalopram and paroxetine, among selective serotonin reuptake inhibitors, increased significantly, and that of short-acting benzodiazepines also increased significantly from 454 (0.93%) to 624 (1.2%). CONCLUSION: Prescription of PIMs for elderly patients significantly decreased (p < 0.001) after the DUR system was introduced. Further expanded studies of PIMs need to be conducted for the safety of elderly patients.

Conocimiento de protocolos de terapia antibiótica por estudiantes de Odontología de universidades costarricenses / Knowledge of Antibiotic Therapy Protocols by the Students of Costa Rican Dental Schools

RESUMEN El conocimiento de protocolos antibióticos es escencial para garantizar su correcto uso en nuestros pacientes. Una mala selección de terapia antibiótica, puede estar asociada con el desarrollo de efectos adversos, inefectividad terapéutica o desarrollo de resistencia bacteriana entre otros. El objetivo de este estudio fue evaluar el nivel de conocimiento sobre el uso de los protocolos de antibioticoterapia, por parte de los estudiantes que se encontraban realizando la práctica clínica de su Universidad. El estudio se realizó en tres universidades costarricenses que imparten la carrera de Odontología. Se realizó un estudio descriptivo de tipo transversal, donde se aplicó un cuestionario a los estudiantes. Dicho instrumento constó de treinta preguntas cerradas, dividido en cinco segmentos, donde se evaluaron generalidades de los antibióticos, indicaciones y condiciones clínicas de su uso, protocolos especiales del uso de los antibióticos, datos demográficos y generalidades académicas de cada uno de los participantes. Se observó que los estudiantes de Odontología obtuvieron un 40% de respuestas correctas relacionadas al conocimiento de generalidades de los antibióticos, un 40% de respuestas acertadas en las preguntas sobre indicaciones clínicas y un 32.8% de las preguntas sobre protocolos especiales fue correcta. El conocimiento de los estudiantes de las universidades participantes es bajo, por lo que se recomienda reforzar los programas de estudio, la implementación de seminarios que refuercen esta área, así como la constante revisión de literatura que actualice los conocimientos adquiridos en la disciplina de la Farmacología, especialmente en el uso y manejo de antibióticos.

ABSTRACT The knowledge of antibiotic protocols is essential to guarantee its correct use in our patients. A poor selection of antibiotic therapy may be associated with the development of adverse effects, therapeutic ineffectiveness or development of bacterial resistance among others. The aim of this study was to assess the level of knowledge of antibiotic therapy protocols in students of the last year of Dentistry during their clinical practice in different costa rican universities. The study was performed at three of the costa rican universities that offer the career of Dentistry. A descriptive transversal study was performed by applying a questionnaire in different dental schools, to the students undergoing clinical practice. The questionnaire consisted in thirty closed questions and was divided in five segments, assessing the knowledge of general aspects of antibiotics, indications and clinical conditions for antibiotic therapy, and the special protocols in this field. Demographic data and certain academic of the students interviewed were also recorded. From the students who participated in the study, 40% answer correctly the segment concerning general knowledge of antibiotics, 40% to the segment of clinical indications for antibiotic protocols and only the 32,8% of the answers of special antibiotic protocols was correct. The general knowledge of antibiotic protocols of the students surveyed was low. It is recommended to reinforce the study programs and the implementation of seminars to strengthen this area, as well to reinforce the discipline of constant revision of literature in order to update their acquired knowledge in Pharmacology.

I've got toothache, i need antibiotics: a uk perspective on rational antibiotic prescribing by dentists

Abstract Antibiotics do not cure toothache. This headline message of the United Kingdom's (UK) Dental Antimicrobial Stewardship (AMS) toolkit's posters and leaflets is aimed at patients; clinicians are expected to know this already. Evidence based clinical guidelines exist to set clear standards for good clinical practice yet there are barriers to compliance. The national AMS audit tool is designed for clinicians to review their management of acute dental conditions, including but not limited to the prescription of antibiotics. In this article we aim to help dental teams protect their patients and themselves from adverse events related to antibiotic prescription. It explores the emergent problem of Clostridium difficile, antibiotic resistance and severe sepsis, and considers some of the barriers, which clinicians have suggested, contribute to the unjustified prescription of antibiotics. Dentists must weigh the risks against the benefits before prescribing any antibiotic.

Resumo Antibióticos não curam dor de dente. Tal mensagem, encontrada no título dos panfletos e cartazes da caixa de ferramentas Gerenciamento Antimicrobiano Odontológico (AMS) do Reino Unido, é direcionada aos pacientes; os clínicos já deveriam saber disso. Diretrizes clínicas baseadas em evidência existem para estabelecer padrões claros à boa prática clínica, ainda que existam barreiras para sua observância. A ferramenta AMS para monitoramento nacional é voltada para clínicos revisarem sua conduta frente às condições dentais agudas, inclusive mas não limitada à prescrição de antibióticos. Neste artigo, visa-se colaborar com equipes odontológicas a fim de protegerem a si e a seus pacientes contra situações adversas relacionadas ao uso de antibióticos. Explora-se o problema emergente do Clostridium difficile, resistência bacteriana a antimicrobianos e sepsis severa, além de considerar algumas das barreiras que clínicos têm sugerido como geradoras de prescrições inapropriadas de antibióticos. Os dentistas devem pesar riscos e benefícios antes de prescrever qualquer antibiótico.

Impact of the Health Insurance Coverage Policy on Oral Anticoagulant Prescription among Patients with Atrial Fibrillation in Korea from 2014 to 2016

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.

Assessing Seasonality of Acute Febrile Respiratory Tract Infections and Medication Use / 보건행정학회지

BACKGROUND: Monitoring appropriate medication categories can provide early warning of certain disease outbreaks. This study aimed to present a methodology for selecting and monitoring medications relevant to the surveillance of acute respiratory tract infections, such as influenza. METHODS: To estimate correlations between acute febrile respiratory tract infection and some medication categories, the cross-correlation coefficient (CCC) was used and established. Two databases were used: real-time prescription trend of antivirals, anti-inflammatory drugs, antibiotics using Drug Utilization Review Program between 2012 and 2015 and physicians' number of encounters with acute febrile respiratory tract infections such as influenza outbreaks using the national level health insurance claims data. The seasonality was also evaluated using the CCC. RESULTS: After selecting six candidate diseases that require extensive monitoring, influenza with highly specific medical treatment according to the health insurance claims data and its medications were chosen as final candidates based on a data-driven approach. Antiviral medications and influenza were significantly correlated. CONCLUSION: An annual correlation was observed between influenza and antiviral medications, anti-inflammatory drugs. Suitable models should be established for syndromic surveillance of influenza.

Revisión con agujas y uso de bevacizumab en bulas de filtración encapsuladas / Needle revision and the use of bevacizumab in encapsulated filtration blebs

Objetivo: determinar la efectividad a mediano plazo de la revisión con aguja asociada a bevacizumab (avastin) en ampollas de filtración encapsuladas postrabeculectomía. Métodos: se realizó un estudio observacional descriptivo-prospectivo, de serie de casos (14 ojos, 14 pacientes), con antecedentes de quiste de Tenon a corto plazo postrabeculectomía (2 meses - 1 año). Se realizó revisión con aguja asociada a inyección subconjuntival de avastin (1 mg) hasta completar 3 dosis en días alternos. Se evaluaron la presión intraocular y el uso de colirios hipotensores preoperatorio y posoperatorio a la semana, 1 mes, 3 meses y 1 año. Se definió el éxito total (si en el posoperatorio la PIO era menor o igual a 21 mmHg sin necesidad de colirios hipotensores); parcial (si la PIO era menor o igual a 21 mmHg con el uso de hasta dos fármacos); y sin éxito (si la PIO era menor o igual a 21 mmHg con 3 colirios hipotensores o mayor que 21 mmHg). Se registraron las complicaciones quirúrgicas. Resultados: la edad media fue de 59,3 ± 8,4 (43-75). Predominó el sexo femenino (57 por ciento) y no existieron diferencias en cuanto al color de piel (7/7). El grado de reducción de la PIO fue regular a la semana y al mes, y malo a los 3 meses y al año, lo que requirió una nueva cirugía en 11 casos (78,6 por ciento). Las complicaciones más frecuentes fueron: hemorragia subconjuntival (71,4 por ciento de casos) y Seidel positivo (21,4 por ciento). Conclusiones: la revisión con aguja asociada al uso de avastin subconjuntival como tratamiento de la ampolla encapsulada no logra una reducción significativa de la presión intraocular(AU)

Objective: determine the medium-term effectiveness of needle revision with bevacizumab (avastin) in encapsulated filtration blebs after trabeculectomy. Methods: an observational descriptive prospective case-series study was conducted of 14 eyes of 14 patients with a history of Tenon cyst shortly (2 months - 1 year) after trabeculectomy. Needle revision was performed by avastin subconjunctival injection (1 mg) until completing 3 doses on alternate days. Evaluation of intraocular pressure and the use of hypotensive collyriums before and after surgery was conducted at 1 week, 1 month, 3 months and 1 year. Definitions were made of total success (IOP minor or equal 21 mmHg in the postoperative period without hypotensive collyriums), partial success (IOP minor or equal 21 mmHg with up to two drugs), and no success (IOP minor or equal 21 mmHg with 3 hypotensive collyriums or greater than 21 mmHg). Surgical complications were recorded. Results: mean age was 59.3 ± 8.4 (43-75) years. Female sex prevailed (57 percent) and no differences were found based on skin color (7/7). The degree of IOP reduction was fair at one week and one month, and bad at 3 months and one year, 11 cases (78.6 percent) requiring new surgery. The most common complications were subconjunctival hemorrhage (71.4 percent of the cases) and positive Seidel (21.4 percent). Conclusions: needle revision with subconjunctival avastin to treat encapsulated blebs does not achieve a significant reduction in intraocular pressure(AU)

Clinical pharmacology profile of care in Hepatology clinic / Perfil clínico farmacológico dos atendimentos no ambulatório de Hepatologia

Summary Since 2010, the Clinical Gastroenterology and Hepatology Division of the Central Institute of Hospital das Clínicas of the University of São Paulo Medical School (HC-FMUSP, in the Portuguese acronym) has been developing specialized electives assistance activities in the Outpatient Specialty Clinic, Secondary Level, in São Paulo NGA-63 Várzea do Carmo. The objective of this study was to analyze the pharmacotherapeutic profile of patients. This is a cross-sectional and retrospective study in which patients were seen at the Hepatology sector and the results were submitted to descriptive statistics. During the study period, 492 patients were treated at the clinic, with a mean age of 58.9 years and frequency of 61.2% female and 74.8% living in São Paulo. This population was served by various other medical specialties (cardiology and endocrine among others) and the major liver diagnoses were: chronic hepatitis B and C and fatty liver. Comorbidities were also identified, such as diabetes, hypertension and dyslipidemia. Most patients took their medication in the Basic Health Units. We found that 30% of patients use of more than five medications and the most prescribed were omeprazole 208 (42.3%), metformin 132 (26.8%) and losartan 80 (16.3%). Because it is an adult/elderly population, with several comorbidities and polymedication, it is important to be aware of the rational use of medication. The multidisciplinary team is important in applying correct conducts for the safe use of medicines, to reduce the burden on health spending and improving the quality of life of patients.

Resumo Desde 2010, a Divisão de Gastroenterologia e Hepatologia Clínica do Instituto Central do HC-FMUSP tem desenvolvido atividades assistenciais eletivas especializadas em Hepatologia no Ambulatório de Especialidades Nível Secundário de São Paulo no Estado de São Paulo NGA-63 Várzea do Carmo. O objetivo do estudo é analisar o perfil farmacoterapêutico dos pacientes. Trata-se de um estudo transversal e retrospectivo, no qual pacientes foram atendidos pelo setor de Hepatologia e os dados encontrados foram submetidos à estatística descritiva. Os resultados demonstraram que 492 pacientes foram atendidos nesse ambulatório durante o período do estudo com a média de idade de 58,9 anos, frequência de 61,2% do sexo feminino e 74,8% residindo na capital paulista. Essa população foi atendida por outras diferentes especialidades médicas (cardiologia e endócrino, entre outras), e os principais diagnósticos hepáticos foram hepatite crônica B e C e esteatose hepática. Também foram identificadas comorbidades como diabetes, hipertensão arterial e dislipidemia. Boa parte da população tende a retirar a sua medicação nas Unidades Básicas de Saúde. Foi verificado que 30% dos pacientes fazem uso de mais de cinco medicamentos, sendo os mais prescritos o omeprazol (208; 42,3%), metformina (132; 26,8%) e losartana (80; 16,3%). Por se tratar de uma população adulta/idosa, com diversas comorbidades e com polimedicação, é importante estar atento ao uso racional do medicamento. O atendimento da equipe multiprofissional é importante para aplicar tomadas de condutas corretas para a segurança no uso de medicamentos e diminuir a oneração em gastos em saúde, melhorando a qualidade de vida do paciente.

Medication adherence in patients with juvenile idiopathic arthritis / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários

ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28) were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20) patients, “moderate” adherence in 48.8% (n = 21), and “low” adherence in 4.7% (n = 2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11) of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

RESUMO Objetivo: Investigar a adesão ao tratamento farmacológico de pacientes com artrite idiopática juvenil, atendidos na farmácia ambulatorial de hospital terciário do Nordeste do Brasil. Métodos: A análise da adesão foi feita junto aos cuidadores, por meio de questionário estruturado com base no teste de Morisky, Green e Levine, que viabilizou a categorização da adesão em “máxima”, “moderada” ou “baixa”, e da avaliação dos registros de dispensação dos medicamentos, que classificou a retirada de medicamentos na farmácia como “regular” ou “irregular”. Os problemas relacionados com medicamentos (PRM) foram identificados por meio da narrativa dos cuidadores e classificados conforme o Segundo Consenso de Granada. Em seguida, aplicou-se uma tabela de orientação farmacêutica, que contém informações sobre o esquema terapêutico, de forma a esclarecer questões que influenciavam a adesão. Resultados: Participaram 43 pacientes, com média de 11,12 anos, 65,1%, (n = 28) do sexo feminino. Por meio do questionário, verificou-se adesão “máxima” em 46,5% (n = 20) dos pacientes, “moderada” em 48,8% (n = 21) e “baixa” em 4,7% (n = 2). Pelo registro de dispensação, observou-se um nível de adesão menor: apenas 25,6% (n = 11) dos participantes receberam os medicamentos “regularmente”. Identificaram-se 26 PRM, 84,6% (n = 22) classificados como “reais”. Não foram observadas associações significativas entre as variáveis sociodemográficas e a adesão, embora alguns cuidadores tenham relatado dificuldade de acesso ao medicamento e de compreensão do tratamento. Conclusão: Nossos achados demonstraram falhas no processo de adesão, relacionadas ao descuido, esquecimento e à irregularidade para receber os medicamentos, o que reforça a necessidade de estratégias para facilitar a compreensão do tratamento e garantir a adesão

Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: Resultados de un trabajo colaborativo, 2013 / Evaluation of antimicrobial consumption en 15 Chilean hospitals: Results of a collaborative work, 2013

La vigilancia del consumo de antimicrobianos es parte central en los programas de utilización de antimicrobianos. Sin embargo, en Chile no se conocen datos del consumo de antibacterianos por servicios clínicos, que representen un número importante de hospitales. En el año 2013 se envió una encuesta a múltiples hospitales chilenos para evaluar el consumo de antimicrobianos en los servicios clínicos de Medicina (SM), Cirugía (SC) y Unidades de Pacientes Críticos (UPC). Para ello se usó la metodología estandarizada recomendada por la OMS de DDD/100 días camas. En los SM y SC se evaluaron antibacterianos β-lactámicos y no β-lactámicos de uso frecuente. En las UPC se evaluó el consumo de vancomicina, linezolid, imipenem, meropenem, colistín y tigeciclina. Se obtuvo resultados de 15 hospitales, los cuales informaron la densidad de consumo de antimicrobianos de los servicios mencionados. Ceftriaxona y cloxacilina fueron los antimicrobianos más utilizados en servicios generales (promedio cloxacilina 4,9 DDD/100 días cama en SM y 8,0 DDD/100 en SC; ceftriaxona 13,5 DDD/100 en SM y 16,7 DDD/100 en SC). En los SC se agrega además un consumo importante de metronidazol (promedio 14,5 DDD/100 días cama). En las UPC destaca la variabilidad de consumo de antimicrobianos seleccionados. Este estudio reporta el promedio y rangos de consumo de antibacterianos en SM, SC y UPC de un número importante de hospitales del país durante el año 2013. Esta información permite a los hospitales comparar su consumo de antibacterianos con una muestra significativa de hospitales chilenos. El análisis de esta información debe considerar una cuidadosa interpretación de acuerdo a la muestra aquí representada y la realidad de cada uno de los hospitales.

Surveillance of antimicrobial consumption is a central part in programs of antibiotic stewardship. However, in Chile there are no national data on antibiotic consumption representing a significant number of hospitals by clinical services. In 2013 a survey was sent to multiple Chilean hospitals to evaluate antimicrobial consumption in medical services (MS), surgery services (SS) and critical care units (ICU). We used the standardized methodology recommended by the WHO, using the number of DDD/100 days beds. In the MS and SS beta-lactam and no beta-lactam antibiotics commonly used were evaluated. In the ICU consumption vancomycin, linezolid, imipenem, merope-nem, colistin and tigecycline was evaluated. Fifteen hospitals reported the density of antimicrobial consumption. Ceftriaxone and cloxacillin were the most commonly used antibiotics in general services (average cloxacillin 4,9 DDD/100 bed days in MS and 8,0 DDD/100 in SS; ceftriaxone 13,5 DDD/100 in MS and 16,7 DDD/100 in SS). In the SS there was also a significant consumption of metronidazole (average 14,5 DDD/100 bed days). In the ICU there was an important variability of consumption of selected antibiotics. This study reports the average and range of antibiotic consumption in MS, SS, and ICU from a significant number of hospitals in the country, during 2013. This information allows hospitals to compare their consumption of antibiotics with a significant sample of Chilean hospitals. Analysis of this information should consider a careful interpretation according to the sample shown here and the reality of each hospital.

16 month survey of cyclosporine utilization evaluation in allogeneic hematopoietic stem cell transplant recipients

Objectives: Graft versus host disease [GVHD] is a life threatening reaction in the stem cell transplantation process. Nowadays Cyclosporine is the most commonly utilized agent for GVHD prophylaxis and it has a major role in successful transplantation. Cyclosporine has been applied for many years in this field but it could be stated that currently no general consensus is available for its optimal method of administration. Conditions related to cyclosporine administration and possible related adverse reactions observed closely in our patients with the aim of constructing a comprehensive practice guideline in the future

Patients and Methods: Allogeneic stem cell transplant recipients who have been taking cyclosporine were monitored during and after their hospitalization while recording all observations on predefined questionnaires on the basis of periodic clinical and laboratory examinations for a 16 month period

Results: Mean recorded duration of infusions was 1.44 +/- 0.68 h and by twice daily administration, means intravenous and oral dose was 101.85 +/- 22.03 mg and 219.28 +/- 63.9 mg, respectively. A mean CsA trough level after about 12 h of specified unique doses was 223 +/- 65 ng/mL. We found hypertension, nephrotoxicity, neurotoxicity, hypertension, and dyslipidemia in about 14, 20, 48, and 94 percent of patients

Conclusions: This study proposed that permanent guidance of healthcare team according to a fixed and standard method of cyclosporine administration routine with using efficient facilities and protocols would be helpful considerably for an optimal pharmacotherapy

Adherence to Guidelines for Antithrombotic Therapy in Patients with Atrial Fibrillation According to CHADS2 Score before and after Stroke: A Multicenter Observational Study from Korea

BACKGROUND AND PURPOSE: A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. METHODS: AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score > or =2. RESULTS: Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. CONCLUSIONS: This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.

National Rules for Drug–Drug Interactions: Are They Appropriate for Tertiary Hospitals?

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed.

Constructing a Real-Time Prescription Drug Monitoring System / 대한의료정보학회지

OBJECTIVES: The objective of this investigation was to demonstrate the possibility of the construction of a real-time prescription drug monitoring system (PDMOS) using data from the nationwide Drug Utilization Review (DUR) system in Korea. METHODS: The DUR system collects information on drug prescriptions issued by healthcare practitioners and on drugs dispensed by pharmacies. PDMOS was constructed using this data. The screen of PDMOS is designed to exhibit the number of drug prescriptions, the number of prescriptions dispensed by pharmacies, and the dispensed prescription drug costs on a daily and weekly basis. Data was sourced from the DUR system between June 1, 2016 and July 18, 2016. The TOGA solution developed by the EYEQMC Co. Ltd. of Seoul, Korea was used to produce the screen shots. RESULTS: Prescription numbers by medical facilities were more numerous than the number of prescriptions dispensed by pharmacies, as expected. The number of prescriptions per day was between 2 to 3 million. The prescriptions issued by primary care clinics were most numerous, at 75% of the total number of prescriptions. Daily prescription drug costs were found to be approximately US $50 million. The prescription drug costs were highest on Mondays and were reduced towards the end of the week. Prescriptions and dispensed prescriptions numbered approximately 1,200 and 1,000 million, respectively. CONCLUSIONS: The construction of a real-time PDMOS has been successful to provide daily and weekly information. There was a lag time of only one day at the national level in terms of information extraction, and scarcely any time was required to load the data. Therefore, this study highlights the potential of constructing a PDMOS to monitor the estimate the number of prescriptions and the resulting expenditures from prescriptions.

New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea / 대한의료정보학회지

OBJECTIVES: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. METHODS: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. RESULTS: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. CONCLUSIONS: These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.

Antibiotic Control Policies in South Korea, 2000-2013 / 감염과화학요법

Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.

Comprehensive evaluation on the prescription behavior for outpatients in primary health care institutions of Yiyang / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the prescription behavior for outpatients in primary health care institutions of Yiyang and to provide scientific basis for promoting the rational use of drugs.
@*METHODS@#A multi-stage random sampling method was conducted in 21 primary health care institutions from Yiyang. Fifteen prescriptions were randomly selected in every month from each institution and a total of 3780 prescriptions were eventually collected in a year.
@*RESULTS@#Both the number of drugs and percentage of injection in a prescription were greater than the international standards. Children were more likely to be prescribed by multiple prescriptions, antibiotics prescriptions, hormones and injections prescriptions. The utilization of essential drug was more frequent in female. Antibiotics and hormones were more frequently used in summer and autumn season. Polypharmacy, antibiotics, injections and essential drugs were more frequently used in hospitals of small town. The skin and subcutaneous tissue diseases were often treated with multiple prescriptions, while the respiratory diseases were often treated with antibiotics, hormones and injections. Most primary health care institutions were at the upper limit of rational drug use.
@*CONCLUSION@#The usage of prescription drug in most primary health care is rational, but some still surpass international standards. Thus, primary health care physicians should strictly control their prescriptions behavior.