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[PMID]:29462143
[Au] Autor:Bucholc M; O'Kane M; Ashe S; Wong-Lin K
[Ad] Endereço:Intelligent Systems Research Centre, University of Ulster, Magee Campus, Londonderry, Northern Ireland, United Kingdom.
[Ti] Título:Prescriptive variability of drugs by general practitioners.
[So] Source:PLoS One;13(2):e0189599, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Prescription drug spending is growing faster than any other sector of healthcare. However, very little is known about patterns of prescribing and cost of prescribing between general practices. In this study, we examined variation in prescription rates and prescription costs through time for 55 GP surgeries in Northern Ireland Western Health and Social Care Trust. Temporal changes in variability of prescribing rates and costs were assessed using the Mann-Kendall test. Outlier practices contributing to between practice variation in prescribing rates were identified with the interquartile range outlier detection method. The relationship between rates and cost of prescribing was explored with Spearman's statistics. The differences in variability and mean number of prescribing rates associated with the practice setting and socioeconomic deprivation were tested using t-test and F-test respectively. The largest between-practice difference in prescribing rates was observed for Apr-Jun 2015, with the number of prescriptions ranging from 3.34 to 8.36 per patient. We showed that practices with outlier prescribing rates greatly contributed to between-practice variability. The largest difference in prescribing costs was reported for Apr-Jun 2014, with the prescription cost per patient ranging from £26.4 to £64.5. In addition, the temporal changes in variability of prescribing rates and costs were shown to undergo an upward trend. We demonstrated that practice setting and socio-economic deprivation accounted for some of the between-practice variation in prescribing. Rural practices had higher between practice variability than urban practices at all time points. Practices situated in more deprived areas had higher prescribing rates but lower variability than those located in less deprived areas. Further analysis is recommended to assess if variation in prescribing can be explained by demographic characteristics of patient population and practice features. Identification of other factors contributing to prescribing variability can help us better address potential inappropriateness of prescribing.
[Mh] Termos MeSH primário: Prescrições de Medicamentos
Clínicos Gerais
[Mh] Termos MeSH secundário: Medicina Estatal
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189599


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[PMID]:29441974
[Au] Autor:Gudienè V
[Ti] Título:The medical treatment of Maria, Dowager Empress of the Russian Empire: an analysis of her prescription book from 1807 and 1808.
[So] Source:Pharmazie;71(11):670-679, 2016 Nov 02.
[Is] ISSN:0031-7144
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:This study analyzes the medicines that were used to treat the Dowager Russian Empress Maria, widow of Tsar Paul I, and describes the doctors who cared for her health in 1807 and 1808. The source for this research was the imperial court pharmacy prescription book 1807-1811. Hypotheses about the diseases and medical problems of the Empress and how treatment for her differed according to circumstances, particularly after the loss of her granddaughter Princess Elizabeth, have been made based on the prescriptions recorded in the book. The content of the prescriptions suggests that the Empress suffered from gastrointestinal tract disorders, skin and eye diseases, neuralgic pains and insomnia. Foreign physicians educated in European universities worked at the imperial court and implemented European medical traditions. They took high positions in the administration and the medical education system, and gradually spread their experience and modern knowledge to Tsarist Russian society.
[Mh] Termos MeSH primário: Prescrições de Medicamentos/história
Tratamento Farmacológico/história
[Mh] Termos MeSH secundário: Livros
Quimioterapia Combinada
História do Século XIX
Farmácias
Médicos
Federação Russa
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1691/ph.2016.6067


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[PMID]:28466547
[Au] Autor:Inch J; Notman F; Watson M; Green D; Baird R; Ferguson J; Hind C; McKinstry B; Strath A; Bond C; Telepharmacy Research Team
[Ad] Endereço:Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
[Ti] Título:Tele-pharmacy in rural Scotland: a proof of concept study.
[So] Source:Int J Pharm Pract;25(3):210-219, 2017 Jun.
[Is] ISSN:2042-7174
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Technology enables medical services to be provided to rural communities. This proof of concept study assessed the feasibility and acceptability of delivering community pharmacy services (CPS; including advice, sale of over-the-counter products and dispensing of prescriptions) by tele-technology (the Telepharmacy Robotic Supply Service (TPRSS)) to a rural population in Scotland. METHODS: Data collection included the following: postal surveys to local residents; focus groups/ interviews with pharmacists, other healthcare professionals (HCPs) and service users, at baseline and follow-up; TPRSS logs. Interviews/focus groups were audio-recorded, transcribed and thematically analysed. Descriptive statistics were reported for survey data. RESULTS: Qualitative results: Pre-installation: residents expressed satisfaction with current pharmacy access. HCPs believed the TPRSS would improve pharmacy access and reduce pressure on GPs. Concerns included costs, confidentiality, patient safety and 'fear' of technology. Post-installation: residents and pharmacy staff were positive, finding the service easy to use. Quantitative results: Pre-installation: almost half the respondents received regular prescription medicines and a third used an over-the-counter (OTC) medicine at least monthly. More than 80% (124/156) reported they would use the TPRSS. There was low awareness of the minor ailment service (MAS; 38%; 59/156). Post-installation: prescription ordering and OTC medicine purchase were used most frequently; the video link was used infrequently. Reasons for non-use were lack of need (36%; 40/112) and linkage to only one pharmacy (31%; 35/112). DISCUSSION: Community pharmacy services delivered remotely using tele-technology are feasible and acceptable. A larger study should be undertaken to confirm the potential of the TPRSS to reduce health inequalities in rural areas.
[Mh] Termos MeSH primário: Farmácia/tendências
Serviços de Saúde Rural/tendências
Telemedicina/tendências
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Serviços Comunitários de Farmácia
Prescrições de Medicamentos/estatística & dados numéricos
Estudos de Viabilidade
Feminino
Acesso aos Serviços de Saúde
Seres Humanos
Masculino
Meia-Idade
Medicamentos sem Prescrição
Farmacêuticos
População Rural
Escócia
Fatores Socioeconômicos
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Nonprescription Drugs)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1111/ijpp.12376


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[PMID]:28742291
[Au] Autor:Sultan RS; Olfson M; Correll CU; Duncan EJ
[Ad] Endereço:New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr, New York, NY 10032. rs3511@cumc.columbia.edu.
[Ti] Título:Evaluating the Effect of the Changes in FDA Guidelines for Clozapine Monitoring.
[So] Source:J Clin Psychiatry;78(8):e933-e939, 2017 Sep/Oct.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/µL to 1,000/µL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation. We evaluated results of complete blood count monitoring to compare percentages of patients who developed or would have developed ≥ 1 hematologic event under the previous and current FDA guidelines in the first year following initiation of clozapine. RESULTS: From a cohort of 14,620 patients with schizophrenia (ICD-9-295.x), 246 patients received clozapine treatment (1.7%). No agranulocytosis was observed during the study period. Under the former recommendations, 5 patients in the clozapine initiation cohort (n = 160, 3.1%; 95% CI, 0.43-5.83) qualified for treatment interruption during the first year of clozapine treatment, while only 1 patient (0.6%) qualified under the current recommendations. Under the former recommendations, hematologic events occurred at a similar rate for individuals taking and not taking clozapine. CONCLUSIONS: While clozapine remains an underused medication, the new FDA monitoring guidelines are likely to substantially reduce the percentage of patients who meet criteria for clozapine-associated hematologic events requiring treatment interruption. This decrease may reduce the clinical burden of managing patients on clozapine and therefore increase the number of individuals treated with this uniquely effective medication. However, prospective studies of individuals treated under the new guidelines are needed to fully assess safety of the FDA's change.
[Mh] Termos MeSH primário: Clozapina
Monitoramento de Medicamentos
Neutropenia
Esquizofrenia/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Clozapina/administração & dosagem
Clozapina/efeitos adversos
Monitoramento de Medicamentos/métodos
Monitoramento de Medicamentos/estatística & dados numéricos
Prescrições de Medicamentos/estatística & dados numéricos
Feminino
Seres Humanos
Contagem de Leucócitos
Masculino
Conduta do Tratamento Medicamentoso/organização & administração
Conduta do Tratamento Medicamentoso/normas
Meia-Idade
Neutropenia/induzido quimicamente
Neutropenia/diagnóstico
Neutropenia/epidemiologia
Neutropenia/prevenção & controle
Farmacovigilância
Guias de Prática Clínica como Assunto
Escalas de Graduação Psiquiátrica
Melhoria de Qualidade
Esquizofrenia/diagnóstico
Esquizofrenia/epidemiologia
Estados Unidos/epidemiologia
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); J60AR2IKIC (Clozapine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:29419379
[Au] Autor:Yeung EYH
[Ad] Endereço:Royal Lancaster Infirmary, Lancaster LA1 4RP, UK.
[Ti] Título:GPs to judge which patients deserve an NHS prescription.
[So] Source:BMJ;360:k404, 2018 02 01.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Prescrições de Medicamentos/economia
Médicos/legislação & jurisprudência
Medicina Estatal/economia
[Mh] Termos MeSH secundário: Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Cobertura do Seguro/normas
Farmacêuticos/ética
Qualidade da Assistência à Saúde/normas
Medicina Estatal/legislação & jurisprudência
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k404


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[PMID]:29425084
[Au] Autor:Sponsler KC; Mixon AS
[Ad] Endereço:Assistant Professor, Department of Medicine, Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. kelly.sponsler@vanderbilt.edu.
[Ti] Título:Finding balance: Optimizing medication prescribing in older patients.
[So] Source:Cleve Clin J Med;85(2):136-137, 2018 02.
[Is] ISSN:1939-2869
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Prescrições de Medicamentos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
[Mh] Termos MeSH secundário: Seres Humanos
Erros de Medicação
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180210
[St] Status:MEDLINE
[do] DOI:10.3949/ccjm.85a.17087


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[PMID]:28459898
[Au] Autor:Pek EA; Remfry A; Pendrith C; Fan-Lun C; Bhatia RS; Soong C
[Ad] Endereço:Department of Medicine, University of Toronto, Ontario.
[Ti] Título:High Prevalence of Inappropriate Benzodiazepine and Sedative Hypnotic Prescriptions among Hospitalized Older Adults.
[So] Source:J Hosp Med;12(5):310-316, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Benzodiazepines and sedative hypnotics are commonly used to treat insomnia and agitation in older adults despite significant risk. A clear understanding of the extent of the problem and its contributors is required to implement effective interventions. OBJECTIVE: To determine the proportion of hospitalized older adults who are inappropriately prescribed benzodiazepines or sedative hypnotics, and to identify patient and prescriber factors associated with increased prescriptions. DESIGN: Single-center retrospective observational study. SETTING: Urban academic medical center. PARTICIPANTS: Medical-surgical inpatients aged 65 or older who were newly prescribed a benzodiazepine or zopiclone. MEASUREMENTS: Our primary outcome was the proportion of patients who were prescribed a potentially inappropriate benzodiazepine or sedative hypnotic. Potentially inappropriate indications included new prescriptions for insomnia or agitation/anxiety. We used a multivariable random-intercept logistic regression model to identify patient- and prescriber-level variables that were associated with potentially inappropriate prescriptions. RESULTS: Of 1308 patients, 208 (15.9%) received a potentially inappropriate prescription. The majority of prescriptions, 254 (77.4%), were potentially inappropriate. Of these, most were prescribed for insomnia (222; 87.4%) and during overnight hours (159; 62.3%). Admission to a surgical or specialty service was associated with significantly increased odds of potentially inappropriate prescription compared to the general internal medicine service (odds ratio [OR], 6.61; 95% confidence interval [CI], 2.70-16.17). Prescription by an attending physician or fellow was associated with significantly fewer prescriptions compared to first-year trainees (OR, 0.28; 95% CI, 0.08-0.93). Nighttime prescriptions did not reach significance in initial bivariate analyses but were associated with increased odds of potentially inappropriate prescription in our regression model (OR, 4.48; 95% CI, 2.21-9.06). CONCLUSIONS: The majority of newly prescribed benzodiazepines and sedative hypnotics were potentially inappropriate and were primarily prescribed as sleep aids. Future interventions should focus on the development of safe sleep protocols and education targeted at first-year trainees.Journal of Hospital Medicine 2017;12:310-316.
[Mh] Termos MeSH primário: Benzodiazepinas/uso terapêutico
Hospitalização/tendências
Hipnóticos e Sedativos/uso terapêutico
Prescrição Inadequada/tendências
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Benzodiazepinas/efeitos adversos
Prescrições de Medicamentos
Feminino
Seres Humanos
Hipnóticos e Sedativos/efeitos adversos
Masculino
Prevalência
Estudos Retrospectivos
Transtornos do Sono-Vigília/tratamento farmacológico
Transtornos do Sono-Vigília/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 12794-10-4 (Benzodiazepines)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2739


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[PMID]:29368495
[Au] Autor:Kempen PM
[Ti] Título:Rationally addressing the opiate drug problem.
[So] Source:W V Med J;112(6):8, 2016 Nov-Dec.
[Is] ISSN:0043-3284
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Prescrições de Medicamentos/estatística & dados numéricos
Medicina de Família e Comunidade
Transtornos Relacionados ao Uso de Opioides/epidemiologia
Dor/tratamento farmacológico
[Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem
Seres Humanos
Transtornos Relacionados ao Uso de Opioides/prevenção & controle
West Virginia/epidemiologia
[Pt] Tipo de publicação:EDITORIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE


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[PMID]:29292933
[Au] Autor:Ringbom T; Salin K; Scholz B; Hillver SE; Ljung R
[Ti] Título:Tonvis med diklofenak i våra vatten ­ regeländring behövs..
[So] Source:Lakartidningen;114, 2017 11 17.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Mh] Termos MeSH primário: Anti-Inflamatórios não Esteroides/análise
Diclofenaco/análise
Legislação de Medicamentos
Qualidade da Água/normas
[Mh] Termos MeSH secundário: Anti-Inflamatórios não Esteroides/metabolismo
Diclofenaco/metabolismo
Prescrições de Medicamentos
Uso de Medicamentos
Seres Humanos
Suécia
Águas Residuais/análise
Poluentes Químicos da Água/análise
Poluentes Químicos da Água/metabolismo
[Pt] Tipo de publicação:LETTER
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Waste Water); 0 (Water Pollutants, Chemical); 144O8QL0L1 (Diclofenac)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


  10 / 24508 MEDLINE  
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[PMID]:29211514
[Au] Autor:Mullins TLK; Zimet G; Lally M; Xu J; Thornton S; Kahn JA
[Ad] Endereço:1 Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
[Ti] Título:HIV Care Providers' Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults.
[So] Source:AIDS Patient Care STDS;31(12):504-516, 2017 Dec.
[Is] ISSN:1557-7449
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pre-exposure prophylaxis (PrEP) is indicated for use in US adults, and little is known about clinician intentions to prescribe and actual prescription of PrEP to adolescents younger than 18. Fifty-six clinicians who care for HIV-infected and at-risk youth completed an anonymous online survey in 2014. Primary outcomes were (1) intentions to prescribe PrEP to adolescents and adults in four risk categories [men who have sex with men (MSM), transgender women, heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners]; and (2) actual prescription of PrEP to adolescents and adults in these risk groups. Independent variables included clinician characteristics, experience prescribing nonoccupational postexposure prophylaxis, familiarity with and knowledge of PrEP and PrEP guidance, attitudes toward PrEP, and facilitating factors for prescribing PrEP and incorporation of PrEP guidance into practice. Variables associated with intention to prescribe ("very likely to prescribe" vs. other responses) and actual prescription of PrEP stratified by age and risk category were identified in logistic regression models. Mean age was 45.9 years (standard deviation 10.7); 64% were physicians. More clinicians reported high intention to prescribe PrEP to adult versus adolescent MSM (p = 0.02) and transgender women (p = 0.001). Variables associated with intention to prescribe and prescription of PrEP differed by age and risk category. In adolescents, those variables included positive beliefs, higher number of facilitating factors, and fewer barriers to PrEP prescription. Designing strategies based on these findings that address both facilitating factors and barriers to PrEP prescription may improve PrEP uptake by at-risk youth.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/administração & dosagem
Atitude do Pessoal de Saúde
Prescrições de Medicamentos/estatística & dados numéricos
Infecções por HIV/prevenção & controle
Intenção
Médicos/psicologia
Padrões de Prática Médica
Profilaxia Pré-Exposição
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fármacos Anti-HIV/economia
Fármacos Anti-HIV/uso terapêutico
Prescrições de Medicamentos/economia
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Heterossexualidade
Seres Humanos
Masculino
Meia-Idade
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1089/apc.2017.0147



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