1
|
Ito Y, Mitsufuji T, Okada M, Fujita S, Yokoyama R, Kawasaki H, Yamamoto T. Early Effect of Calcitonin Gene-related Peptide Monoclonal Antibodies in Migraine with Medication Overuse: A Single-center Retrospective Study. Intern Med 2023; 62:3455-3460. [PMID: 37062749 PMCID: PMC10749820 DOI: 10.2169/internalmedicine.1471-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Calcitonin gene-related peptide (CGRP)-(receptor) monoclonal antibody (mAb) has been reported to reduce the frequency of medication overuse in patients with migraine. The present study investigated whether or not CGRP-mAb treatment shows early effectiveness for medication overuse headache (MOH) in Japan. Methods We retrospectively reviewed 34 patients with MOH who received preventive treatment with CGRP-mAb from June 2021 to October 2022. The International Classification of Headache Disorders, 3rd edition was used to diagnose MOH. This study was conducted at the Department of Neurology, Saitama Medical University. Patients were recruited from this specialized headache outpatient center. Results In total, 69 patients with migraine had newly introduced CGRP-mAb, and 34 patients had MOH (49.3%). The mean±standard deviation patient age was 44±15.5 years old. The study population included 24 women (70.6%). The types of CGRP-mAb used were galcanezumab in 16 patients (47.0%), fremanezumab in 10 (29.4%), and erenumab in 8 (23.5%). The mean disease duration was 19.6±13.1 years. The types of migraine diagnosis were chronic migraine in 28 patients (82.4%) and migraine with aura in 11 patients (32.4%). The mean number of headache days in the month before administration of CGRP-mAb was 22±7.7 days; 1 month after administration, the MHD was 16.9±9.1 days. The change in MHD was -5.7 days (22.7%), indicating significant improvement (p<0.05). Conclusion CGRP-mAb has been suggested as a preventive treatment for patients with MOH. Further investigation of the long-term efficacy of CGRP-mAb for MOH is needed.
Collapse
Affiliation(s)
- Yasuo Ito
- Department of Neurology, Saitama Medical University, Japan
| | | | - Mariko Okada
- Department of Neurology, Saitama Medical University, Japan
| | - Shugo Fujita
- Department of Neurology, Saitama Medical University, Japan
| | - Ryu Yokoyama
- Department of Neurology, Saitama Medical University, Japan
| | | | | |
Collapse
|
2
|
Feinstein JA, Feudtner C, Blackmer AB, Valuck RJ, Fairclough DL, Holstein J, Gregoire L, Samay S, Kempe A. Parent-Reported Symptoms and Medications Used Among Children With Severe Neurological Impairment. JAMA Netw Open 2020; 3:e2029082. [PMID: 33306117 PMCID: PMC7733159 DOI: 10.1001/jamanetworkopen.2020.29082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Children with severe neurological impairment (SNI) often take multiple medications to treat problematic symptoms. However, for children who cannot self-report symptoms, no system exists to assess multiple symptoms and their association with medication use. OBJECTIVES To assess the prevalence of 28 distinct symptoms, test whether higher global symptom scores (GSS) were associated with use of more medications, and assess the associations between specific symptoms and medications. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between April 1, 2019, and December 31, 2019, using structured parent-reported symptom data paired with clinical and pharmacy data, at a single-center, large, hospital-based special health care needs clinic. Participants included children aged 1 to 18 years with SNI and 5 or more prescribed medications. Data analysis was performed from April to June 2020. EXPOSURE During routine clinical visits, parent-reported symptoms were collected using the validated 28-symptom Memorial Symptom Assessment Scale (MSAS) and merged with clinical and pharmacy data. MAIN OUTCOMES AND MEASURES Symptom prevalence, counts, and GSS (scored 0-100, with 100 being the worst) were calculated, and the association of GSS with medications was examined. To evaluate associations between symptom-medication pairs, the proportion of patients with a symptom who used a medication class or specific medication was calculated. RESULTS Of 100 patients, 55.0% were boys, the median (interquartile range [IQR]) age was 9 (5-12) years, 62.0% had 3 or more complex chronic conditions, 76.0% took 10 or more medications, and none were able to complete the MSAS themselves. Parents reported a median (IQR) of 7 (4-10) concurrent active symptoms. The median (IQR) GSS was 12.1 (5.4-20.8) (range, 0.0-41.2) and the GSS was 9.8 points (95% CI, 5.5-14.1 points) higher for those with worse recent health than usual. Irritability (65.0%), insomnia (55.0%), and pain (54.0%) were the most prevalent symptoms. Each 10-point GSS increase was associated with 12% (95% CI, 4%-19%) higher medication counts, adjusted for age and complex chronic condition count. Among the 54.0% of children with reported pain, 61.0% were prescribed an analgesic. CONCLUSIONS AND RELEVANCE These findings suggest that children with SNI reportedly experience substantial symptom burdens and that higher symptom scores are associated with increased medication use. Paired symptom-medication data may help clinicians identify targets for personalized symptom management, including underrecognized or undertreated symptoms.
Collapse
Affiliation(s)
- James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison B. Blackmer
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora
| | - Robert J. Valuck
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora
| | - Diane L. Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora
- Colorado School of Public Health, Aurora
| | | | | | - Sadaf Samay
- Research Informatics, Analytics Resource Center, Children’s Hospital Colorado, Aurora
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| |
Collapse
|
3
|
Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Richard A Polin
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NY, USA
| | - Thomas A Hooven
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Wang X, Tang Y, Liu C, Liu J, Cui Y, Zhang X. Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012-2017. Antimicrob Resist Infect Control 2020; 9:159. [PMID: 32977855 PMCID: PMC7519519 DOI: 10.1186/s13756-020-00821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. METHODS Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. RESULTS Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = - 2.4518, P = 0.005) and showed a downward trend (coefficient = - 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = - 0.0553, P = 0.035; coefficient = - 0.0294, P = 0.037; coefficient = - 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = - 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = - 0.0423, P = 0.017; coefficient = - 0.0223, P = 0.006, respectively). An immediate decline (coefficient = - 1.9292, P = 0.002) and a downward trend (coefficient = - 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. CONCLUSIONS Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.
Collapse
Affiliation(s)
- Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Youwen Cui
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| |
Collapse
|
5
|
Abbasi J. Antibiotic-Sparing Gonorrhea Diagnostic Wins Federal Funding. JAMA 2020; 324:928. [PMID: 32897327 DOI: 10.1001/jama.2020.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
6
|
Maillard JY, Bloomfield SF, Courvalin P, Essack SY, Gandra S, Gerba CP, Rubino JR, Scott EA. Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A position paper. Am J Infect Control 2020; 48:1090-1099. [PMID: 32311380 PMCID: PMC7165117 DOI: 10.1016/j.ajic.2020.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of health care facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in health care settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies, and health care professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.
Collapse
Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; International Scientific Forum on Home Hygiene, Somerset, UK.
| | | | | | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles P Gerba
- Departments of Soil, Water and Environmental Science and Environmental Health, University of Arizona, Tucson, AZ, USA
| | - Joseph R Rubino
- Research & Development, Home Hygiene, Lysol/Harpic, Reckitt Benckiser LLC., One Philips Parkway, Montvale, NJ, USA
| | - Elizabeth A Scott
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, MA, USA
| |
Collapse
|
7
|
Abstract
Antibiotic overuse for respiratory tract infections (RTIs) in primary care (PC) is a known important contributor to the serious health threat of antibiotic resistance, yet remains a difficult problem to improve. The purpose of the study was to assess the effects of a combination patient and provider education program on antibiotic prescribing in RTIs in a rural primary care clinic. Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical record review was conducted to determine if a patient and provider education program changed the rates of antibiotics being prescribed (immediate or delayed) during a visit for RTI for 207 randomly selected patients during the established evaluation time periods. The antibiotic prescription rate for the preintervention group was 56.3% compared to 28.8% for the postintervention group (p < .01). Immediate antibiotics were ordered in the preintervention group 31.1% of the time compared to 13.5% for the postintervention group (p < .05). The results of this study demonstrate that educational interventions can be effective in rural settings and that changes in antibiotic prescribing are possible.
Collapse
|
8
|
Abstract
INTRODUCTION Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%-85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions. METHODS AND ANALYSIS The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10-12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP. ETHICS AND DISSEMINATION Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported by training manual and slides.
Collapse
Affiliation(s)
- Shoumitro Deb
- Division of Psychiatry, Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Bharati Limbu
- Division of Psychiatry, Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Mike Crawford
- Division of Psychiatry, Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Tim Weaver
- Department of Mental Health Research, School of Health and Education, Middlesex University, London, UK
| |
Collapse
|
9
|
Famularo D, Kuzmanoski A, Pawasauskas J. Proposed Healthcare Initiatives to Mitigate Opioid Risk and Advance Safety of Pain Management. R I Med J (2013) 2020; 103:40-44. [PMID: 32122100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
10
|
Kashtan M, Dawson M, Anandalwar S, Hills-Dunlap J, Graham DA, Rangel S. Implementation of a Plan-Do-Study-Act framework to reduce unindicated surgical antimicrobial prophylaxis. J Pediatr Surg 2020; 55:86-89. [PMID: 31679771 DOI: 10.1016/j.jpedsurg.2019.09.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/29/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The goal of this study was to use a Plan-Do-Study-Act (PDSA) framework to reduce utilization of unindicated surgical antibiotic prophylaxis (SAP) for clean cases without foreign body implantation. METHODS This was a pre-post intervention study conducted at a single children's hospital comparing 6 months of retrospective preintervention data to 10 months of prospectively collected postintervention data. Interventions to reduce unindicated SAP included faculty meetings to review guidelines and establish consensus around inclusion criteria, publicizing guidelines with regular email reminders, and conducting ongoing compliance audits to root cause noncompliance. Early unanticipated noncompliant cases were associated with rotating trainees who prescribed SAP routinely without attending knowledge. A second PDSA cycle then included education-based emails targeting residents with mandatory feedback loop closure. RESULTS Preintervention, 40.4% (107/265) of patients received unindicated SAP. Postintervention, the rate of unindicated SAP decreased to 15.4% (6/39) after the first month and 6.2% (20/323) after 10 months, reflecting an 85% reduction across periods (p < 0.01). There was no difference in the rate of surgical site infections between the pre and postintervention cohorts (0.36% vs. 0.67%, p = 1.00). CONCLUSIONS Unindicated surgical antibiotic prophylaxis was significantly reduced by implementing a Plan-Do-Study-Act intervention targeting both faculty and trainees. LEVEL OF EVIDENCE Prospective comparative treatment study, level II.
Collapse
Affiliation(s)
- Mark Kashtan
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Michele Dawson
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Seema Anandalwar
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jonathan Hills-Dunlap
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Dionne A Graham
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA
| | - Shawn Rangel
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
11
|
Clarke H, Bao J, Weinrib A, Dubin RE, Kahan M. Canada's hidden opioid crisis: the health care system's inability to manage high-dose opioid patients: Fallout from the 2017 Canadian opioid guidelines. Can Fam Physician 2019; 65:612-614. [PMID: 31515308 PMCID: PMC6741787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hance Clarke
- Staff anesthesiologist and Director of Pain Services in the Department of Anesthesia and Pain Management in the Pain Research Unit at Toronto General Hospital in Ontario.
| | - James Bao
- Anesthesiology resident in the Department of Anesthesia and Pain Management at Toronto General Hospital
| | - Aliza Weinrib
- Clinical psychologist in the Transitional Pain Service in the Department of Anesthesia and Pain Management at Toronto General Hospital
| | - Ruth E Dubin
- Family physician with a special interest in pain and addiction practising in Kingston, Ont, Associate Professor in the Department of Family Medicine at Queen's University, and Co-chair of ECHO Ontario Pain and Opioid Stewardship
| | - Meldon Kahan
- Professor in the Department of Family and Community Medicine at the University of Toronto, and Medical Director of Substance Use Service/Addictions Medicine and Project Lead of META:PHI (Mentoring, Education and Clinical Tools for Addiction: Primary Care-Hospital Integration), both at Women's College Hospital
| |
Collapse
|
12
|
Limmathurotsakul D, Sandoe JAT, Barrett DC, Corley M, Hsu LY, Mendelson M, Collignon P, Laxminarayan R, Peacock SJ, Howard P. 'Antibiotic footprint' as a communication tool to aid reduction of antibiotic consumption. J Antimicrob Chemother 2019; 74:2122-2127. [PMID: 31074489 PMCID: PMC6640305 DOI: 10.1093/jac/dkz185] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
'Superbugs', bacteria that have become resistant to antibiotics, have been in numerous media headlines, raising awareness of antibiotic resistance and leading to multiple action plans from policymakers worldwide. However, many commonly used terms, such as 'the war against superbugs', risk misleading people to request 'new' or 'stronger' antibiotics from their doctors, veterinary surgeons or pharmacists, rather than addressing a fundamental issue: the misuse and overuse of antibiotics in humans and animals. Simple measures of antibiotic consumption are needed for mass communication. In this article, we describe the concept of the 'antibiotic footprint' as a tool to communicate to the public the magnitude of antibiotic use in humans, animals and industry, and how it could support the reduction of overuse and misuse of antibiotics worldwide. We propose that people need to make appropriate changes in behaviour that reduce their direct and indirect consumption of antibiotics.
Collapse
Affiliation(s)
- Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK
| | - Jonathan A T Sandoe
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- British Society of Antimicrobial Chemotherapy, Birmingham B1 3NJ, UK
| | - David C Barrett
- Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, UK
| | - Michael Corley
- British Society of Antimicrobial Chemotherapy, Birmingham B1 3NJ, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117649, Singapore
- National Centre for Infectious Diseases, Moulmein Road, Singapore 308433, Singapore
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
- International Society for Infectious Diseases, Brookline, MA 02446, USA
| | - Peter Collignon
- Infectious Diseases and Microbiology, Canberra Hospital, Canberra, 2605, Australia
- Medical School, Australian National University, Acton, 2606, Australia
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, 110024, India
- Princeton Environmental Institute, Princeton, NJ 08544, USA
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- British Society of Antimicrobial Chemotherapy, Birmingham B1 3NJ, UK
| |
Collapse
|
13
|
|
14
|
Vicens C, Leiva A, Bejarano F, Sempere E, Rodríguez-Rincón RM, Fiol F, Mengual M, Ajenjo A, Do Pazo F, Mateu C, Folch S, Alegret S, Coll JM, Martín-Rabadán M, Socias I. Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study. BMJ Open 2019; 9:e022046. [PMID: 30705235 PMCID: PMC6359733 DOI: 10.1136/bmjopen-2018-022046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Benzodiazepines (BZDs) are mainly used to treat anxiety and sleep disorders, and are often prescribed for long durations, even though prescription guidelines recommend short-term use due to the risk of dependence, cognitive impairment, and falls and fractures. Education of general practitioners (GPs) regarding the prescription of BZDs may reduce the overuse and of these drugs.The aims of this study are to analyse the effectiveness of an intervention targeted to GPs to reduce BZD prescription and evaluate the implementation process. METHODS AND ANALYSIS The healthcare centres in three regions of Spain (Balearic Islands, Catalonia and Community of Valencia) will be randomly allocated to receive a multifactorial intervention or usual care (control). GPs in the intervention group will receive a 2-hour workshop about best-practice regarding BZD prescription and BZD deprescribing, monthly feedback about their BZD prescribing practices and access to a support web page. Outcome measures for each GP are the defined daily dosage per 1000 inhabitants per day and the proportion of long-term BZD users at 12 months. Data will be collected from the electronic prescription database of the public health system, and will be subjected to intention-to-treat analysis. Implementation will be evaluated by mixed methods following the five domains of the Consolidated Framework For Implementation Research. ETHICS AND DISSEMINATION This study was approved by the Balearic Islands Ethical Committee of Clinical Research (IB3065/15), l'IDIAP Jordi Gol Ethical Committee of Clinical Research (PI 15/0148) and Valencia Primary Care Ethical Committee of Clinical Research (P16/024). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN28272199.
Collapse
Affiliation(s)
- Caterina Vicens
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service Ib-Salut, Palma, Spain
- Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
| | - Alfonso Leiva
- Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
- Primary Care Reseach Unit, Balearic Health Service Ib-Salut, Palma, Spain
| | - Ferran Bejarano
- DAP Camp de Tarragona, Catalunya Health Services-CatSalut, Tarragona, Spain
| | - Ermengol Sempere
- Paterna Healthcare Centre, Conselleria de Sanitat Universal, Agència Valenciana de Salut, Valencia, Spain
| | | | - Francisca Fiol
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service Ib-Salut, Palma, Spain
| | - Marta Mengual
- DAP Camp de Tarragona, Catalunya Health Services-CatSalut, Tarragona, Spain
| | - Asunción Ajenjo
- Paterna Healthcare Centre, Conselleria de Sanitat Universal, Agència Valenciana de Salut, Valencia, Spain
| | - Fernando Do Pazo
- Pharmacy Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Catalina Mateu
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service Ib-Salut, Palma, Spain
- Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
| | - Silvia Folch
- DAP Camp de Tarragona, Catalunya Health Services-CatSalut, Tarragona, Spain
| | - Santiago Alegret
- Son Serra-La Vileta Healthcare Centre, Balearic Health Service Ib-Salut, Palma, Spain
| | - Jose Maria Coll
- Menorca Primary Care Management, Balearic Health Service Ib-Salut, Mahón, Spain
| | | | - Isabel Socias
- Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
- Manacor Healthcare Centre, Balearic Health Service Ib-Salut, Manacor, Spain
| |
Collapse
|
15
|
Cousins S. Proposed regulation of oxytocin in India causes concern. Lancet 2018; 392:108. [PMID: 30017119 DOI: 10.1016/s0140-6736(18)31605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
16
|
Cataldo D, Derom E, Liistro G, Marchand E, Ninane V, Peché R, Slabbynck H, Vincken W, Janssens W. Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice. Int J Chron Obstruct Pulmon Dis 2018; 13:2089-2099. [PMID: 30013336 PMCID: PMC6039066 DOI: 10.2147/copd.s164259] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Evidence and guidelines are becoming increasingly clear about imbalance between the risks and benefits of inhaled corticosteroids (ICSs) in patients with COPD. While selected patients may benefit from ICS-containing regimens, ICSs are often inappropriately prescribed with - according to Belgian market research data - up to 70% of patients in current practice receiving ICSs, usually as a fixed combination with a long-acting β2-adrenoreceptor agonist. Studies and recommendations support withdrawal of ICSs in a large group of patients with COPD. However, historical habits appear difficult to change even in the light of recent scientific evidence. We have built a collaborative educational platform with chest physicians and primary care physicians to increase awareness and provide guidance and support in this matter.
Collapse
Affiliation(s)
- Didier Cataldo
- Department of Respiratory Medicine, Centre Hospitalier Universitaire de Liège (CHU) and University of Liège, Liège, Belgium,
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Belgium
| | - Giuseppe Liistro
- Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, Belgium
| | - Eric Marchand
- Department of Respiratory Medicine, University Hospital UCL Namur, Yvoir, Belgium
- URPhyM, University of Namur, Namur, Belgium
| | - Vincent Ninane
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Rudi Peché
- Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - Wim Janssens
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
17
|
Waldman SA, Schottenfeld JR, Gluck AR. Treatment Innovation in Orthopedic Surgery: A Case Study from Hospital for Special Surgery. J Law Med Ethics 2018; 46:238-240. [PMID: 30146982 DOI: 10.1177/1073110518782924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.
Collapse
Affiliation(s)
- Seth A Waldman
- Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School
| | - Joseph R Schottenfeld
- Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School
| | - Abbe R Gluck
- Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School
| |
Collapse
|
18
|
Pomerleau AC, Nelson LS, Hoppe JA, Salzman M, Weiss PS, Perrone J. The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey. Pain Med 2018; 18:889-897. [PMID: 26995800 DOI: 10.1093/pm/pnw032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Emergency department (ED) providers are high volume but low quantity prescribers of opioid analgesics (OA). Few studies have examined differences in opioid prescribing decisions specifically among ED providers. The aim of this study was to describe OA prescribing decisions of ED providers at geographically diverse centers, including utilization of prescribing guidelines and prescription drug monitoring programs (PDMP). Methods This was a multi-center cross-sectional Web-based survey of ED providers who prescribe OA. Respondents were asked about their OA prescribing decisions, their use of PDMPs, and their use of prescribing guidelines. Data was analyzed using descriptive statistics and chi-square tests of association were used to assess the relationship between providers' opioid prescribing decisions and independent covariates. Results The total survey population was 957 individuals and 515 responded to the survey for an overall response rate of 54%. The frequency respondents prescribed different types of pain medication was variable between centers. of respondents were registered to access a PDMP, and were not aware whether their state had a PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines, while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing guidelines. No significant differences in OA prescribing decisions were found between groups either by use of PDMP or by guideline adherence. Conclusions In this multi-center survey study of ED clinicians, OA prescribing varied between centers The utilization of prescribing guidelines and PDMPs was not associated with differences in OA prescribing decisions.
Collapse
Affiliation(s)
- Adam C Pomerleau
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewis S Nelson
- Department of Emergency Medicine, New York University School of Medicine, New York, USA
| | - Jason A Hoppe
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado; Rocky Mountain Poison and Drug Center, Denver, Colorado, USA
| | - Matthew Salzman
- Department of Emergency Medicine, Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Paul S Weiss
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
19
|
Roehr B. Stigma and silence are key barriers to dealing with addiction, Bill Clinton says. BMJ 2017; 359:j5042. [PMID: 29089305 DOI: 10.1136/bmj.j5042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
20
|
Abstract
Modern prescribing can be very easy. In many cases, we don't even have to write a prescription - just a few clicks can start a chain of events, affecting patients' lives more than we can imagine. Although it is easy to look for a quick pharmacological fix, consider carefully whether the patient really needs the medication you are prescribing.
Collapse
|
21
|
Huttner A, Albrich WC, Bochud PY, Gayet-Ageron A, Rossel A, von Dach E, Harbarth S, Kaiser L. PIRATE project: point-of-care, informatics-based randomised controlled trial for decreasing overuse of antibiotic therapy in Gram-negative bacteraemia. BMJ Open 2017; 7:e017996. [PMID: 28710229 PMCID: PMC5541592 DOI: 10.1136/bmjopen-2017-017996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Antibiotic overuse drives antibiotic resistance. The optimal duration of antibiotic therapy for Gram-negative bacteraemia (GNB), a common community and hospital-associated infection, remains unknown and unstudied via randomised controlled trials (RCTs). METHODS AND ANALYSIS This investigator-initiated, multicentre, non-inferiority, informatics-based point-of-care RCT will randomly assign adult hospitalised patients receiving microbiologically efficacious antibiotic(s) for GNB to (1) 14 days of antibiotic therapy, (2) 7 days of therapy or (3) an individualised duration determined by clinical response and 75% reduction in peak C reactive protein (CRP) values. The randomisation will occur in equal proportions (1:1:1) on day 5 (±1) of efficacious antibiotic therapy as determined by antibiogram; patients, their physicians and study investigators will be blind to treatment duration allocation until the day of antibiotic discontinuation. Immunosuppressed patients and those with GNB due to complicated infections (endocarditis, osteomyelitis, etc) and/or non-fermenting bacilli (Acinetobacter spp, Burkholderia spp, Pseudomonas spp) Brucella spp, Fusobacterium spp or polymicrobial growth with Gram-positive organisms will be ineligible. The primary outcome is incidence of clinical failure at day 30; secondary outcomes include clinical failure, all-cause mortality and incidence of Clostridiumdifficile infection in the 90-day study period. An interim safety analysis will be performed after the first 150 patients have been followed for ≤30 days. Given a chosen margin of 10%, the required sample size to determine non-inferiority is roughly 500 patients. Analyses will be performed on both intention-to-treat and per-protocol populations. ETHICS AND DISSEMINATION Ethics approval was obtained from the cantonal ethics committees of all three participating sites. Results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER This trial is registered at www.clinicaltrials.gov (NCT03101072; pre-results).
Collapse
Affiliation(s)
- Angela Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Pierre-Yves Bochud
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Angèle Gayet-Ageron
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Anne Rossel
- Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Elodie von Dach
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Harbarth
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
22
|
Affiliation(s)
- Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester2Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Alice Bonner
- Massachusetts Executive Office of Elder Affairs, Boston
| | | |
Collapse
|
23
|
Burchett HED, Leurent B, Baiden F, Baltzell K, Björkman A, Bruxvoort K, Clarke S, DiLiberto D, Elfving K, Goodman C, Hopkins H, Lal S, Liverani M, Magnussen P, Mårtensson A, Mbacham W, Mbonye A, Onwujekwe O, Roth Allen D, Shakely D, Staedke S, Vestergaard LS, Whitty CJM, Wiseman V, Chandler CIR. Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence. BMJ Open 2017; 7:e012973. [PMID: 28274962 PMCID: PMC5353269 DOI: 10.1136/bmjopen-2016-012973] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts. DESIGN A comparative case study approach, analysing variation in outcomes across different settings. SETTING Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. PARTICIPANTS 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. INTERVENTIONS The interventions included different mRDT training packages, supervision, supplies and community sensitisation. OUTCOME MEASURES Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial). RESULTS Outcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs. CONCLUSIONS Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.
Collapse
Affiliation(s)
- Helen E D Burchett
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Baptiste Leurent
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Baiden
- Epidemiology Unit, Ensign College of Public Health, Kpong, Ghana
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, and Global Health Science, University of California, Berkeley, California, USA
| | - Anders Björkman
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Katia Bruxvoort
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Siân Clarke
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Deborah DiLiberto
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristina Elfving
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Hopkins
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Sham Lal
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Mårtensson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Wilfred Mbacham
- Laboratory for Public Health Research Biotechnologies, The Biotechnology Center, University of Yaoundé, Yaoundé, Cameroon
| | - Anthony Mbonye
- School of Public Health- Makerere University and Commissioner Health Services, Ministry of Health, Uganda
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Enugu-Campus, Nigeria
| | | | - Delér Shakely
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Department of Medicine, Kungälv Hospital, Sweden
| | - Sarah Staedke
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Lasse S Vestergaard
- Centre for Medical Parasitology, University of Copenhagen and Copenhagen University Hospital Rigshospitalet, Denmark
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Denmark
| | - Christopher J M Whitty
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health and Community Medicine, Australia
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
24
|
Abstract
As older adults age, it is imperative to constantly reevaluate medications. Deprescribing, the process of identifying and discontinuing drugs that could potentially harm rather than benefit a patient, should therefore be considered in all older adults on an individual basis. Nurses are a critical part of the team in addressing this issue. The current article discusses deprescribing, tactics to this approach, and important areas for future development.
Collapse
|
25
|
Fields SA, Johnson WM, Hassig MB. Adult ADHD: Addressing a unique set of challenges. J Fam Pract 2017; 66:68-74. [PMID: 28222452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
ADHD diagnostic criteria are different for adults than they are for children. Plus, prescribing psychostimulants for adults raises the risk of misuse and diversion.
Collapse
Affiliation(s)
- Scott A Fields
- West Virginia University School of Medicine-Charleston Division, USA.
| | | | | |
Collapse
|
26
|
Affiliation(s)
| | - B Sonny Bal
- BalBrenner/Orthopaedic Law Center, Chapel Hill, NC, USA.
- University of Missouri, Columbia, 1100 Virginia Ave., Columbia, MO, 65212, USA.
| |
Collapse
|
27
|
Abstract
PURPOSE Best practices and guidance are provided for improved electronic detection and alerting of inadvertent supratherapeutic cumulative doses of acetaminophen and other medications with narrow therapeutic ranges in inpatient settings. SUMMARY Despite the use of medication safety technologies, overdosage and associated sentinel events continue to be serious problems in many inpatient settings. The tools needed to monitor and employ dose alerts, accumulators, and warning systems are available to reduce inadvertent overdose. Required are staff training and the implementation of processes that provide guidance and documentation of the drug reconciliation process from admittance to discharge for safe patient passage through the various transitions of care. Recommendations to achieve optimal patient safety outcomes include the adoption and integration of available technologies with full functionality configured to meet the institution's policies and processes, initial training and retraining of all staff who use these systems, continuing education of the patient care staff on the dosing safety requirements, and assigning a prominent role to the clinical pharmacist in the entire drug-use and reconciliation process. CONCLUSION The key factors contributing to inadvertent overdosage in inpatient settings include a lack of recognition of recommended maximum daily dosages; failure to optimally communicate medication information at transitions of care; failure to optimally implement medication safety technologies, particularly dose accumulator calculation features and associated alerts; and alert fatigue and override.
Collapse
|
28
|
Gulla C, Selbaek G, Flo E, Kjome R, Kirkevold Ø, Husebo BS. Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatr 2016; 16:115. [PMID: 27245665 PMCID: PMC4888256 DOI: 10.1186/s12877-016-0287-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms, such as affective symptoms, psychosis, agitation, and apathy are common among nursing home patients with and without dementia. Treatment with one or more psychotropic drug is often without explicit clinical indication, despite low treatment efficacy, and potential side effects. We aim to investigate the multi-psychotropic drug use to identify factors and patient characteristics associated with multi-use. METHODS We analysed three cohorts from 129 Norwegian nursing homes, collected between 2004 and 2011. Patients (N = 4739) were assessed with the Neuropsychiatric Inventory - Nursing Home version (NPI-NH), Clinical Dementia Rating scale, and Physical Self Maintenance Scale. We used ordinal logistic regression to analyse associations between psychotropics (antidepressants, antipsychotics, anxiolytics, hypnotics, and anti-dementia drugs), patient characteristics, and neuropsychiatric symptoms. RESULTS Patients used on average 6.6 drugs; 27 % used no psychotropics, 32 % one, and 41 % multiple psychotropic drugs (24 % two, 17 % ≥3). Thirty-nine percent were prescribed antidepressants, 30 % sedatives, 24 % anxiolytics, and 20 % antipsychotics. The total NPI-NH score was associated with multi-use (OR 1.02, 95 % CI 1.02-1.03), and increased from a mean of 13.5 (SD 16.3) for patients using none, to 25.5 (21.8) for patients using ≥3 psychotropics. Affective symptoms (depression and anxiety) were most strongly associated with multi-psychotropic drug use (OR 1.10, 95 % CI: 1.09-1.12). Female gender, independency in daily living, younger age, dementia, and many regular drugs were also associated with multi-use. CONCLUSION Forty-one percent were exposed to multi-psychotropic drug prescriptions. Contrary to current evidence and guidelines, there is an extensive use of multiple psychotropic drugs in patients with severe NPS and dementia.
Collapse
Affiliation(s)
- Christine Gulla
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway.
| | - Geir Selbaek
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, PO Box 2136, N-3103, Tonsberg, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabeth Flo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway
| | - Reidun Kjome
- Research group in Social Pharmacy, Department of Global Public Health and Primary Care, and Centre for Pharmacy, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway
| | - Øyvind Kirkevold
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, PO Box 2136, N-3103, Tonsberg, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Faculty of Health, Care and Nursing, Gjovik University College, Gjovik, Norway
- Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU) in Gjøvik, N-2821, Gjøvik, Norway
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| |
Collapse
|
29
|
Nordland WP. The Pendulum Has Swung Too Far. J Calif Dent Assoc 2016; 44:267. [PMID: 27290820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
30
|
Fee L. The path of least resistance in oral surgery. J Ir Dent Assoc 2016; 62:114-120. [PMID: 27197372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
STATEMENT OF THE PROBLEM Antibiotic resistance is an imminent threat to worldwide public health. Dental professionals must demonstrate judicious use of antibiotics and educate their patients about the risks associated with their overuse. PURPOSE OF THE PAPER: To encourage the dental profession to prescribe responsibly in order to optimise the use of antibiotics in oral surgery. Antibiotic stewardship programmes are recommended to help reduce the emergence of infections that are multidrug-resistant. Clinical practice audits are encouraged to help dentists ensure conservative prescribing patterns. CONCLUSIONS The dental profession has a duty of care to prescribe antibiotics in adherence with current best practice oral surgery guidelines. The dental profession must show leadership in slowing antibiotic resistance by pledgina to safeguard their appropriate use.
Collapse
|
31
|
Abstract
OBJECTIVES There is a need to develop and validate new metrics to access the appropriateness of laboratory test requests. METHODS The mean abnormal result rate (MARR) is a proposed measure of ordering selectivity, the premise being that higher mean abnormal rates represent more selective test ordering. As a validation of this metric, we compared the abnormal rate of lab tests with the number of tests ordered on the same requisition. We hypothesized that requisitions with larger numbers of requested tests represent less selective test ordering and therefore would have a lower overall abnormal rate. RESULTS We examined 3,864,083 tests ordered on 451,895 requisitions and found that the MARR decreased from about 25% if one test was ordered to about 7% if nine or more tests were ordered, consistent with less selectivity when more tests were ordered. We then examined the MARR for community-based testing for 1,340 family physicians and found both a wide variation in MARR as well as an inverse relationship between the total tests ordered per year per physician and the physician-specific MARR. CONCLUSIONS The proposed metric represents a new utilization metric for benchmarking relative selectivity of test orders among physicians.
Collapse
Affiliation(s)
- Christopher T Naugler
- From the Calgary Laboratory Services, Calgary, Canada; and Department of Pathology and Laboratory Medicine and Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Maggie Guo
- From the Calgary Laboratory Services, Calgary, Canada; and
| |
Collapse
|
32
|
Pecher S, Grätzel P. ["Parents want that their child does not suffer"]. MMW Fortschr Med 2016; 158:34. [PMID: 27084145 DOI: 10.1007/s15006-016-7983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
33
|
Krumme AA, Isaman DL, Stolpe SF, Dougherty S, Choudhry NK. Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs. Am J Manag Care 2016; 22:179-186. [PMID: 27023023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The burden of visiting pharmacies to fill medications is a central contributor to nonadherence to maintenance medications. Recently, pharmacies have begun offering services that align prescription fill dates to allow patients to pick up all medications on a single visit. We evaluated the prevalence and structure of synchronization programs and evidence of their impact on adherence and clinical outcomes. STUDY DESIGN Mixed-methods approach consisting of semi-structured interviews, data from surveillance activities, and a systematic literature review. METHODS We conducted interviews with opinion leaders from nonprofit advocacy organizations and exemplary synchronization programs. Program prevalence was determined using data from regular surveillance efforts. A literature review included Medline, EMBASE, Google Scholar, and general Internet searches. RESULTS Synchronization programs exist in approximately 10% of independent, 6% of stand-alone chain, and 11% of retail store pharmacies. The majority of programs include a monthly pharmacist appointment and reminder communication. Programs reported the importance of pharmacist buy-in, technology to track and recruit patients, links to other healthcare services, and flexible solutions for managing costs and communication preferences. Although existing peer-reviewed literature suggests that synchronization improves adherence, more evidence is needed to evaluate its impact on patient-centered outcomes. CONCLUSIONS As medication synchronization programs shift directions and compete for patients and payer resources, it will be more important than ever to rigorously evaluate their ability to improve clinical outcomes while also providing the growing number of patients managing multiple chronic conditions with the highest level of patient engagement and consumer choice.
Collapse
Affiliation(s)
| | | | | | | | - Niteesh K Choudhry
- Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120. E-mail:
| |
Collapse
|
34
|
Moriates C, Mourad M. Striving for optimal care: Updates in quality, value, and patient experience. J Hosp Med 2016; 11:145-50. [PMID: 26417871 DOI: 10.1002/jhm.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hospitalists are playing a growing role in quality improvement efforts, and they are increasingly spearheading programs to improve patient experience and healthcare value. We aimed to summarize and critique recent research related to quality, value, and patient experience in the clinical practice of hospital medicine. METHODS We reviewed articles published between January 2014 and February 2015, identified through a hand search of leading journals, continuing medical education collaborative journal reviews, Agency for Healthcare Research and Quality's Patient Safety network, and PubMed. The authors collectively selected 9 articles based on their relevance to hospital practice. We review their findings, strengths, and limitations and make recommendations for practice. This is a summary of an update we presented at the 2015 Hospital Medicine national meeting. RESULTS Key findings include: a comprehensive hand-off program was associated with improved patient safety; successful readmissions interventions were resource-intensive, multifaceted and increased patient capacity to handle illness; patient activation was correlated with lower resource use post-hospitalization; positive associations exist between patient experience and understanding of their hospitalization; hospitals and practitioners can adopt simple low-cost strategies to reduce the trauma of hospitalization; hospitalists frequently order low-value tests, most often to reassure themselves or their patients; broad-spectrum antibiotics are grossly overused in hospitalized patients leading to preventable harms including clostridium difficile colitis, and programs that support "self-stewardship" may help moderate this risk. CONCLUSIONS Recent research provides important insights into readmissions prevention, patient experience and low-value test ordering, as well as introduces interventions that may mitigate the risks of handoffs and the overuse of broad-spectrum antibiotics.
Collapse
Affiliation(s)
- Christopher Moriates
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
- Center for Healthcare Value, University of California, San Francisco, San Francisco, California
| | - Michelle Mourad
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
35
|
Lenhoff A. In the news: antibiotic resistance. MLO Med Lab Obs 2016; 48:26-27. [PMID: 26887096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
36
|
National health program for substance use. Aust Nurs Midwifery J 2015; 23:5. [PMID: 26668870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
37
|
Mort JR. Antipsychotic Medication Use in Nursing Homes: Approaches to Reduce Use and National Trends. S D Med 2015; 68:464-465. [PMID: 26630836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Consensus exists regarding the need to reduce antipsychotic medication use in nursing homes, multiple initiatives have been implemented with the intent to achieve this goal, and progress is being made. While limited high quality research is available documenting the impact of various approaches, resource tool kits and best practice descriptions can help guide efforts.
Collapse
|
38
|
McDermott L, Yardley L, Little P, van Staa T, Dregan A, McCann G, Ashworth M, Gulliford M. Process evaluation of a point-of-care cluster randomised trial using a computer-delivered intervention to reduce antibiotic prescribing in primary care. BMC Health Serv Res 2014; 14:594. [PMID: 25700144 PMCID: PMC4260184 DOI: 10.1186/s12913-014-0594-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to conduct a process evaluation for a cluster randomised trial of a computer-delivered, point-of-care intervention to reduce antibiotic prescribing in primary care. The study aimed to evaluate both the intervention and implementation of the trial. METHODS The intervention comprised a set of electronic educational and decision support tools that were remotely installed and activated during consultations with patients with acute respiratory infections over a 12 month intervention period. A mixed method evaluation was conducted with 103 general practitioners (GPs) who participated in the trial. Semi-structured telephone interviews were conducted with 20 GPs who had been in the intervention group of the trial and 4 members of the implementation staff. Questionnaires, consisting of both intervention evaluation and theory-based measures, were self-administered to 83 GPs (56 control group and 27 intervention group). RESULTS Interviews suggested that a key factor influencing GPs' use of the intervention appeared to be their awareness of the implementation of the system into their practice. GPs who were aware of the implementation of the intervention reported feeling confident in using it if they chose to and understood the purpose of the intervention screens. However, GPs who were unaware that the intervention would be appearing often reported feeling confused when they saw the messages appear on the screen and not fully understanding what they were for or how they could be used. Intervention evaluation questionnaires indicated that GPs were satisfied with the usability of the prompts, and theory-based measures revealed that intervention group GPs reported higher levels of self-efficacy in managing RTI patients according to recommended guidelines compared to GPs in the control group. CONCLUSIONS Remote installation of a computer-delivered intervention for use at the point-of-care was feasible and acceptable. Additional measures to promote awareness of the intervention may be required to promote health care professionals' utilisation of the intervention and these might sometimes compromise the pragmatic intention of a trial. TRIAL REGISTRATION ISRCTN47558792 (registered on 17 March 2010).
Collapse
Affiliation(s)
- Lisa McDermott
- />Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London, UK
| | - Lucy Yardley
- />Department of Psychology, University of Southampton, Shakleton Building, Highfield, Southampton, UK
| | - Paul Little
- />Aldermoor Health Centre, School of Primary Care and Population Sciences, University of Southampton, Aldermoor Close, Southampton, UK
| | - Tjeerd van Staa
- />The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 5th Floor, 151 Buckingham Palace Road, London, Victoria UK
| | - Alex Dregan
- />Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London, UK
| | - Gerard McCann
- />The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 5th Floor, 151 Buckingham Palace Road, London, Victoria UK
| | - Mark Ashworth
- />Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London, UK
| | - Martin Gulliford
- />Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London, UK
| | - The eCRT research team
- />Department of Primary Care and Public Health Sciences, King’s College London, Capital House, 42 Weston Street, London, UK
- />Department of Psychology, University of Southampton, Shakleton Building, Highfield, Southampton, UK
- />Aldermoor Health Centre, School of Primary Care and Population Sciences, University of Southampton, Aldermoor Close, Southampton, UK
- />The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 5th Floor, 151 Buckingham Palace Road, London, Victoria UK
| |
Collapse
|