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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]: 28459929 [Au] Autor: Sikkens JJ; van Agtmael MA; Peters EJG; Lettinga KD; van der Kuip M; Vandenbroucke-Grauls CMJE; Wagner C; Kramer MHH [Ad] Endereço: Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands. [Ti] Título: Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study. [So] Source: JAMA Intern Med;177(8):1130-1138, 2017 Aug 01. [Is] ISSN: 2168-6114 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. Design, Setting, and Participants: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. Interventions: We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Main Outcomes and Measures: Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. Results: A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found. Conclusions and Relevance: Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments. [Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico Atitude do Pessoal de Saúde Infecções Bacterianas Resistência Microbiana a Medicamentos/efeitos dos fármacos Prescrição Inadequada Melhoria de Qualidade/organização & administração [Mh] Termos MeSH secundário: Infecções Bacterianas/tratamento farmacológico Infecções Bacterianas/epidemiologia Comportamento de Escolha Fidelidade a Diretrizes Hospitais/estatística & dados numéricos Seres Humanos Prescrição Inadequada/efeitos adversos Prescrição Inadequada/prevenção & controle Prescrição Inadequada/psicologia Prescrição Inadequada/estatística & dados numéricos Conduta do Tratamento Medicamentoso/organização & administração Países Baixos/epidemiologia Padrões de Prática Médica/estatística & dados numéricos Estudos Prospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Infective Agents) [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE [do] DOI: 10.1001/jamainternmed.2017.0946

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[PMID]: 29361660 [Au] Autor: Steiner DJ; Thomson Reuters Accelus. [Ti] Título: Pharmaceuticals and Medical Devices: Business Practices. [So] Source: Issue Brief Health Policy Track Serv;2017:1-38, 2017 Dec 26. [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Indústria Farmacêutica/organização & administração Farmacoeconomia Legislação de Medicamentos Medicamentos sob Prescrição/economia [Mh] Termos MeSH secundário: Analgésicos Opioides Leis Antitruste Suplementos Nutricionais Custos de Medicamentos Controle de Medicamentos e Entorpecentes/legislação & jurisprudência Medicamentos Genéricos Epinefrina/economia Epinefrina/uso terapêutico Fraude Seres Humanos Prescrição Inadequada Marketing de Serviços de Saúde Medicaid Medicare Uso Off-Label Patentes como Assunto Desvio de Medicamentos sob Prescrição Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Analgesics, Opioid); 0 (Drugs, Generic); 0 (Prescription Drugs); YKH834O4BH (Epinephrine) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180219 [Lr] Data última revisão: 180219 [Sb] Subgrupo de revista: T [Da] Data de entrada para processamento: 180124 [St] Status: MEDLINE

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[PMID]: 29360296 [Au] Autor: Berry MD; Thomson Reuters Accelus. [Ti] Título: Healthcare Reform: Enforcement And Compliance. [So] Source: Issue Brief Health Policy Track Serv;2017:1-34, 2017 Dec 26. [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Fraude/prevenção & controle Reforma dos Serviços de Saúde/organização & administração [Mh] Termos MeSH secundário: Ambulâncias Analgésicos Opioides Custos de Medicamentos Epinefrina Serviços de Assistência Domiciliar Seres Humanos Prescrição Inadequada Reembolso de Seguro de Saúde Marketing de Serviços de Saúde Medicaid Medicare Medicare Part C Transtornos Relacionados ao Uso de Opioides Desvio de Medicamentos sob Prescrição Diálise Renal/economia Delitos Sexuais Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Analgesics, Opioid); YKH834O4BH (Epinephrine) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180219 [Lr] Data última revisão: 180219 [Sb] Subgrupo de revista: T [Da] Data de entrada para processamento: 180124 [St] Status: MEDLINE

5 / 1937

MEDLINE

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[PMID]: 29258401 [Au] Autor: Schmiedl S; Rottenkolber M; Szymanski J; Drewelow B; Siegmund W; Hippius M; Farker K; Guenther IR; Hasford J; Thuermann PA; German Net of Regional Pharmacovigilance Centers (NRPC) [Ad] Endereço: a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany. [Ti] Título: Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. [So] Source: Expert Opin Drug Saf;17(2):125-137, 2018 Feb. [Is] ISSN: 1744-764X [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Studies evaluating the impact of age and potentially inappropriate medication (PIM) on avoidable adverse drug reactions (ADRs) are scarce. METHODS: In this prospective, multi-center, long-term (8.5 years) observational study, we analysed ADRs leading to hospitalization in departments of internal medicine. ADRs causality and preventability were assessed using standardised algorithms. PIM was defined based on the PRISCUS-list. Multivariate analyses and estimation of ADR incidence rates were conducted. RESULTS: Of all 6,427 ADR patients, a preventable ADR was present in 1,253 (19.5%) patients (elderly patients ≥70 years: 828). Risk factors for preventable ADRs in elderly patients were multimorbidity, two to four ADR-causative drugs, and intake of particular compounds (e.g. spironolactone) but not sex, PIM usage, or the total number of drugs. Regarding particular compounds associated with preventable ADRs, highest incidence rates for preventable ADRs were found for patients aged ≥70 years for spironolactone (3.3 per 1,000 exposed persons (95% CI: 1.4-6.6)) and intermediate-acting insulin (3.3 per 1,000 exposed persons (95% CI: 1.6-6.1)). CONCLUSION: Avoiding PIM usage seems to be of limited value in increasing safety in elderly patients whereas our results underline the importance of an individualized medication review of the most commonly implicated drugs in preventable ADRs (supported by BfArM FoNr: V-11337/68605/2008-2010). [Mh] Termos MeSH primário: Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia Hospitalização/estatística & dados numéricos Prescrição Inadequada/estatística & dados numéricos Lista de Medicamentos Potencialmente Inapropriados [Mh] Termos MeSH secundário: Fatores Etários Idoso Idoso de 80 Anos ou mais Algoritmos Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle Feminino Seres Humanos Incidência Estudos Longitudinais Masculino Meia-Idade Análise Multivariada Estudos Prospectivos Fatores de Risco [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180215 [Lr] Data última revisão: 180215 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171221 [St] Status: MEDLINE [do] DOI: 10.1080/14740338.2018.1415322

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[PMID]: 28448783 [Au] Autor: Caffiero N; Delate T; Ehizuelen MD; Vogel K [Ad] Endereço: 1 Pharmacy Department, Kaiser Permanente Colorado, Aurora. [Ti] Título: Effectiveness of a Clinical Pharmacist Medication Therapy Management Program in Discontinuation of Drugs to Avoid in the Elderly. [So] Source: J Manag Care Spec Pharm;23(5):525-531, 2017 May. [Is] ISSN: 2376-1032 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them. OBJECTIVE: To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs. METHODS: This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group. Medicare beneficiaries who were not eligible for MTM but had a targeted DAE dispensing during the same time period were included in the control group. The percentage of patients with another DAE dispensing of the same specified medication (no matter the strength) during the 100 days following index DAE dispensing was assessed. Univariate and multivariable logistic regression analyses were conducted. RESULTS: A total of 9,059 Medicare beneficiaries were included, with 226 beneficiaries in the MTM group and 8,833 beneficiaries in the non-MTM group. Beneficiaries were primarily female and white and had a high burden of chronic disease. The percentages of patients with another dispensing of the specified DAE were 7.1% (95% CI = 3.7%-10.4%) for the MTM beneficiaries and 35.3% (95% CI 34.2%-36.2%) for the non-MTM beneficiaries (P < 0.001). The OR for the MTM group to have received another dispensing of the specified DAE was 0.12 (95% CI = 0.08-0.22) with adjustment for potential confounders. CONCLUSIONS: A clinical pharmacist-provided MTM intervention was associated with decreased DAE dispensing in Medicare beneficiaries. Future studies should evaluate means to further decrease DAE use in the aged. DISCLOSURES: This study was funded by the Kaiser Permanente Colorado Pharmacy Department. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication. Delate has received grant funding from Janssen Pharmaceutical Companies of Johnson & Johnson outside of this study. The authors report no other disclosures. Delate supervised the study and had complete access to the data and takes responsibility for the data integrity. Study concept and design were contributed by Caffiero, Delate, Ehizuelen, and Vogel. Delate collected the data, assisted by the other authors, and analysis and interpretation of the data were provided by Ehizuelen and Vogel, along with Caffiero and Delate. The manuscript was written by Caffiero and Delate, with assistance from Ehizuelen and Vogel, and revised by all the authors. Preliminary findings from this study were presented at the Mountain States Conference for Pharmacy Residents, Fellows, and Preceptors on May 13, 2016, in Salt Lake City, Utah. [Mh] Termos MeSH primário: Prescrição Inadequada/prevenção & controle Conduta do Tratamento Medicamentoso Assistência Farmacêutica/organização & administração Farmacêuticos/organização & administração [Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle Idoso Idoso de 80 Anos ou mais Estudos de Coortes Colorado Prestação Integrada de Cuidados de Saúde/organização & administração Feminino Seres Humanos Modelos Logísticos Masculino Medicare Lista de Medicamentos Potencialmente Inapropriados Estudos Retrospectivos Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180111 [Lr] Data última revisão: 180111 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170428 [St] Status: MEDLINE [do] DOI: 10.18553/jmcp.2017.23.5.525

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[PMID]: 28458417 [Au] Autor: Rakesh KB; Chowta MN; Shenoy AK; Shastry R; Pai SB [Ad] Endereço: Department of Pharmacology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India. [Ti] Título: Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital. [So] Source: Indian J Pharmacol;49(1):16-20, 2017 Jan-Feb. [Is] ISSN: 1998-3751 [Cp] País de publicação: India [La] Idioma: eng [Ab] Resumo: OBJECTIVES: To assess the polypharmacy and appropriateness of prescriptions in geriatric patients in a tertiary care hospital. METHODS: An observational study was done in geriatric patients (>60 years) of either gender. The data collected from patients included: Socio-demographic data such as age, gender, marital status, educational status, socioeconomic status, occupation, nutritional status, history of alcohol/smoking, exercise history, details of comorbid diseases, medication history, findings of clinical examination etc. In this study, polypharmacy was considered as having 5 or more medications per prescription. Medication appropriateness for each patient was analysed separately based on their medical history and clinical findings by applying medication appropriateness index, screening tool to alert to right treatment (START) and Beers criteria and STOPP criteria. RESULTS: A total of 426 patients, 216 (50.7%) were males and 210 (49.3%) were females. Polypharmacy was present in 282 prescriptions (66.2%). Highest prevalence of polypharmacy was seen in 70-79 years age group compared to the other two groups and it was statistically significant. Out of 426 patients, 36 patients were receiving drugs which were to be avoided as per Beers criteria. Among the total patients, 39 patients were overprescribed as per MAI, 56 patients were under prescribed as per START criteria and 85 out of 426 prescriptions were inappropriate in accordance with beers criteria, stop criteria, start criteria and MAI index. CONCLUSION: Around 66.19% patients were receiving polypharmacy. Significant number of patients were receiving drugs which are to be avoided as well as overprescribed and under prescribed. Inappropriate prescription was seen in a good number of patients. [Mh] Termos MeSH primário: Prescrição Inadequada/estatística & dados numéricos Polimedicação Padrões de Prática Médica/estatística & dados numéricos [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Estudos Transversais Feminino Seres Humanos Masculino Meia-Idade Lista de Medicamentos Potencialmente Inapropriados Padrões de Prática Médica/normas Prevalência Centros de Atenção Terciária [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171229 [Lr] Data última revisão: 171229 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE [do] DOI: 10.4103/0253-7613.201036

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[PMID]: 29202142 [Au] Autor: Fiore DC; Fettic LP; Wright SD; Ferrara BR [Ad] Endereço: Department of Family and Community Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA. Email: dfiore@medicine.nevada.edu. [Ti] Título: Antibiotic overprescribing: Still a major concern. [So] Source: J Fam Pract;66(12):730-736, 2017 Dec. [Is] ISSN: 1533-7294 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Despite universal agreement that antibiotic overprescribing is a problem, the practice continues to vex us. Antibiotic use--whether appropriate or not--has been linked to rising rates of antimicrobial resistance, disruption of the gut microbiome leading to Clostridium difficile infections, allergic reactions, and increased health care costs. And yet, physicians continue to overprescribe this class of medication. A 2016 Centers for Disease Control and Prevention report estimates that at least 30% of antibiotics prescribed in US outpatient settings are unnecessary. Another report cites a slightly higher figure across a variety of health care settings. Pair these findings with the fact that there are currently few new drugs in development to target resistant bacteria, and you have the potential for a post-antibiotic era in which common infections could become lethal. Family practitioners are on the front lines of this battle. Here's what we can do now. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Infecções Bacterianas/tratamento farmacológico Farmacorresistência Bacteriana Medicina de Família e Comunidade Prescrição Inadequada/efeitos adversos Padrões de Prática Médica [Mh] Termos MeSH secundário: Centers for Disease Control and Prevention (U.S.) Tomada de Decisão Clínica Desprescrições Seres Humanos Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171208 [Lr] Data última revisão: 171208 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171205 [St] Status: MEDLINE

9 / 1937

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[PMID]: 29197313 [Au] Autor: Wu E; Langsjoen J; Pruszynski J; Kuehl TJ; Larsen WI [Ad] Endereço: From the Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, and the Office of Biostatistics, Baylor Scott and White Health, Temple, Texas. [Ti] Título: Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention. [So] Source: South Med J;110(12):782-784, 2017 Dec. [Is] ISSN: 1541-8243 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVES: Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012-2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time. This study aimed to examine variations in the use of prophylactic antibiotics in patients undergoing gynecologic surgery at Scott and White Memorial Hospital and determine whether an educational intervention to gynecology physicians was associated with a significant decrease in unindicated prophylactic antibiotics. METHODS: A retrospective chart review was performed for all women undergoing gynecologic surgery at Scott and White Memorial Hospital in Temple, Texas for 1 year. An educational intervention regarding prophylactic antibiotic usage was held for obstetricians and gynecologists in the middle of that year. Subjects were included if they had procedures with a Current Procedural Terminology code corresponding to a procedure that does not require prophylactic antibiotics. Subjects were excluded if they had concurrent procedures for which antibiotics are recommended. RESULTS: A total of 500 subjects met inclusion and exclusion criteria, with 243 before the educational intervention and 257 after the intervention. In our study, a significant decrease ( < 0.0001) in unindicated prophylactic antibiotic use was demonstrated: from 45.7% (111/243) preintervention to 24.9% (64/257) postintervention. Before the educational intervention, both the gynecology oncology and reproductive endocrinology and infertility divisions had the highest rates of unindicated antibiotic use-91.7% (44/48) and 91.7% (33/36), respectively. The generalist and urogynecology divisions had the lowest rates for specialists before the intervention: 20.6% (30/146) and 30.8% (4/13), respectively. After the intervention, all of the divisions demonstrated an improvement in their rates of unindicated prophylactic antibiotic use. The urogynecology division demonstrated an improvement that can be considered clinically significant while not meeting statistical significance. The adverse event rates were not different between subjects who received preoperative prophylactic antibiotics (2.9%) and subjects who did not (2.8%). CONCLUSIONS: A simple educational intervention was associated with a significant decrease in unindicated prophylactic antibiotics in gynecologic procedures. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Antibioticoprofilaxia/utilização Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos Ginecologia/educação Prescrição Inadequada/estatística & dados numéricos [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Antibioticoprofilaxia/métodos Feminino Procedimentos Cirúrgicos em Ginecologia/educação Seres Humanos Meia-Idade Estudos Retrospectivos Texas Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171207 [Lr] Data última revisão: 171207 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171203 [St] Status: MEDLINE [do] DOI: 10.14423/SMJ.0000000000000737

10 / 1937

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[PMID]: 29092694 [Au] Autor: Del Mar CB; Scott AM; Glasziou PP; Hoffmann T; van Driel ML; Beller E; Phillips SM; Dartnell J [Ad] Endereço: Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD CDelMar@bond.edu.au. [Ti] Título: Reducing antibiotic prescribing in Australian general practice: time for a national strategy. [So] Source: Med J Aust;207(9):401-406, 2017 Nov 06. [Is] ISSN: 1326-5377 [Cp] País de publicação: Australia [La] Idioma: eng [Ab] Resumo: In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates - antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits. Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult. Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to "no repeats" in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs' access to near-patient diagnostic testing, and public awareness campaigns. Many unanswered clinical research questions remain, including research into optimal implementation methods. Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support. [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Resistência Microbiana a Medicamentos Prescrição Inadequada/estatística & dados numéricos Padrões de Prática Médica/normas Infecções Respiratórias/tratamento farmacológico [Mh] Termos MeSH secundário: Austrália Tomada de Decisões Medicina Geral/normas Educação em Saúde Seres Humanos Ensaios Clínicos Controlados Aleatórios como Assunto Infecções Respiratórias/epidemiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171107 [Lr] Data última revisão: 171107 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171103 [St] Status: MEDLINE

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2	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2
3	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2

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