Artículos de revistas: "Buy oxycodone without prescription"

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Cunningham, Daniel J., Colleen Wixted, Nicholas B. Allen, Andrew Hanselman y Samuel B. Adams. "How Has Opioid Prescribing in Total Ankle Arthroplasty Changed with Time and State Legislation? A National and State-Level Analysis". Foot & Ankle Orthopaedics 7, n.º 1 (enero de 2022): 2473011421S0015. http://dx.doi.org/10.1177/2473011421s00159.

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Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an increasingly-utilized treatment for ankle arthritis, and opioids are commonly used as part of perioperative pain control. However, many states have enacted opioid-limiting legislation to reduce perioperative opioid prescribing. The aim of this study was to evaluate the impact of time and state legislation on perioperative opioid prescribing in TAA. Methods: This study is a retrospective, observational review of 90-day perioperative opioid prescribing in 1,829 patients undergoing TAA throughout the United States using a large insurance database. Initial and cumulative volumes and rates of opioid prescription filling were recorded along with baseline patient and operative characteristics. Dates of state legislation enactment were also recorded. Student t-tests, analysis of variance (ANOVA), and multivariable linear and logistic regression were utilized to analyze the impact of time and state legislation on opioid prescription filling. Results: In the 90-day perioperative time period, initial and cumulative opioid prescription filling in oxycodone 5-mg equivalents has decreased significantly from 2010 (63.8 initial and 163.3 cumulative oxycodone 5-mg equivalents filled) to 2019 (41.1 initial and 67.2 cumulative oxycodone 5-mg equivalents filled). States with opioid-limiting legislation saw larger and more significant reductions in initial and cumulative opioid prescription filling pre-act to post-act (63.3 to 50.6 oxycodone 5-mg equivalents filled with legislation vs 61.4 to 51.9 oxycodone 5-mg equivalents filled without legislation initial and 146.4 to 93.3 oxycodone 5-mg equivalents filled with legislation vs 125.1 to 108.6 oxycodone 5-mg equivalents filled without legislation cumulative). Conclusion: This study demonstrates that orthopaedic surgeons in states with opioid-limiting legislation have responded by significantly reducing 90-day perioperative opioid prescribing in TAA. These results encourage states without legislation to enact opioid-specific laws to reduce opioid prescribing.

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Cunningham, Daniel J., Nicholas Kwon, Nicholas B. Allen, Andrew Hanselman y Samuel B. Adams. "Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States". Foot & Ankle Orthopaedics 7, n.º 1 (enero de 2022): 2473011421S0016. http://dx.doi.org/10.1177/2473011421s00162.

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Category: Other; Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports Introduction/Purpose: The opioid epidemic has focused attention on opioid overprescribing. State legislation has been enacted to reduce acute opioid prescribing. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods: 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients ages 18 and older undergoing non-trauma, non-arthroplasty foot and ankle surgery from 2010 - 2019 using a commercial database. States with and without legislation were identified and opioid prescription filling before and after legislation was tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results: Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative oxycodone 5-mg equivalents, p<0.001). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared to states without legislation over similar timeframes (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial oxycodone 5-mg equivalents prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative oxycodone 5-mg equivalents prescription filling volume, p<0.001). The figure shows state-level changes in opioid prescription filling from pre-act to post-act. Conclusion: State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the impact of the opioid epidemic.

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Reisman, Richard M., Pareen J. Shenoy, Adam J. Atherly y Christopher R. Flowers. "Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy". Substance Abuse: Research and Treatment 3 (enero de 2009): SART.S2345. http://dx.doi.org/10.4137/sart.s2345.

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Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785). Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

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Cunningham, Daniel J., Michael Blatter, Samuel B. Adams y Mark Gage. "State Regulation Positively Impacts Opioid Prescribing Patterns in Ankle Fracture Surgery: A National and State-Level Analysis". Foot & Ankle Orthopaedics 7, n.º 1 (enero de 2022): 2473011421S0016. http://dx.doi.org/10.1177/2473011421s00161.

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Category: Ankle; Trauma Introduction/Purpose: The impact of time and state regulation on opioid prescribing in orthopaedic trauma is not well known. The purpose of this study is to evaluate the impact of time and state-level opioid legislation on 90-day perioperative opioid prescribing in ankle fracture surgery from 2010 - 2019. Methods: This is a retrospective, cohort study using a national insurance database including commercial insurance, Medicare, Medicaid, and cash pay patients to evaluate 90-day perioperative opioid prescription filling in 40,286 patients ages 18 and older undergoing Current Procedural Terminology codes 27766, 27769, 27792, 27814, 27822, and/or 27823 between 2010 and 2019 in all 50 United States. The primary study outcome was initial and cumulative 90-day perioperative opioid prescription filling and rates of filling and refills. Results: Mean first prescription volume has not changed dramatically from 2010 (37 oxycodone 5-mg pills) to 2019 (33.3 oxycodone 5-mg pills). However, cumulative prescriptions within the 90-day perioperative timeframe have decreased considerably from 2010 (128.5 oxycodone 5-mg pills) to 2019 (70.4 oxycodone 5-mg pills, p<0.001), and cumulative prescription filling in years 2018 and 2019 was significantly less than in 2010. Legislation targeting duration or duration and volume had the largest impacts on initial and cumulative opioid prescribing (approximately 14-22 fewer oxycodone 5-mg pills filled in states with legislation compared to states without legislation, p<0.001). The figure shows state-level pre-act and post-act cumulative 90-day opioid prescribing in ankle fracture surgery. Conclusion: In ankle fracture surgery, cumulative opioid prescribing has decreased dramatically over time. In addition, states with opioid prescribing legislation had larger reductions in perioperative opioid prescribing compared to states without opioid legislation. Legislation targeting duration or duration and volume had the largest impacts on opioid prescribing.

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Regueras, PhD, MBA, Esperanza y José López Guzmán, PhD. "Quantification of opioid dependence and abuse prevalence in the United States between 2017 and 2018". Journal of Opioid Management 18, n.º 3 (5 de mayo de 2022): 205–21. http://dx.doi.org/10.5055/jom.2022.0712.

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Objectives: To quantify the prevalence of opioid drug dependence and abuse in United States between 2017 and 2018 and identify which opioid molecules are associated with a higher level of dependence and abuse.Design: National Survey on Drug Use and Health (NSDUH) data for 2017 and 2018 have been extracted. The variables related to painkillers were studied, the most important ones were selected, and several variable crosses were made. After the data were extracted, they were analyzed using Microsoft Excel and PivotTables, calculating the relative prevalence and percentages of patients with abuse and dependence.Results: In total, 1.4 million people had dependence on pain relievers (PRs) in 2018. The last PR used was mostly hydrocodone (33 percent) and oxycodone (24 percent). The main reasons for using a PR without a doctor's prescription were relieving pain (48 percent), feel good (16 percent), and relax or relieve tension (15 percent). Among patients who used a PR with a medical prescription, 1.5 million used it more frequently than prescribed, 1.2 million used it longer than prescribed, and 1.9 million used it in higher amounts than prescribed.Conclusions: Abuse and dependence to PRs is lower than expected with over 1.4 million people in the United States having dependence in 2018 (0.6 percent point prevalence). Most cases of dependence are associated with misuse or abuse of prescriptions without medical supervision or the use of medications without a prescription of their own. Oxycodone and hydrocodone are the molecules most associated with dependence, misuse, abuse, and use without prescription. The age of onset of oxycodone misuse is very early (14 years old). Fentanyl does not seem relevant in any of the variables studied.

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Hernández-Vásquez, Akram, Christoper A. Alarcon-Ruiz, Deysi Díaz-Seijas, Luisa Magallanes-Quevedo y Diego Rosselli. "Purchase of medications without prescription in Peru: a cross-sectional population-based study". F1000Research 7 (3 de septiembre de 2018): 1392. http://dx.doi.org/10.12688/f1000research.15886.1.

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Background: Low availability of medicines in health services, self-medication, inadequate use of medicines, and inadequate dispensing practices in pharmacies are frequent problems in Peru. We aimed to evaluate how frequent the purchase of medications without medical prescription is in Peru, and which factors are associated with this practice. Methods: We conducted a secondary analysis of the 2016 ENSUSALUD national survey data. Purchase of medicines that require a prescription was measured as a dichotomous coded as bought one or more medicines that requires medical prescription or bought medicines that do not require a prescription. Crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using Poisson regressions model with robust variance to assess the association of purchasing of medicines that require prescriptions with sociodemographic factors. Results: There were 3858 participants in the dataset. The prevalence of purchasing medications without prescriptions was 47.2%. History of having previously consumed the same medication (31.6%), and the delay in receiving an appointment at health facilities (26.9%) were the main reasons to buy medications without a prescription. Regarding the recommendation of the medication purchased, the advice of the pharmacy, and remembering a previous old prescription, were the most frequent reasons (38.3%, and 25.9%, respectively). On the multivariable analysis, users that buy medications without prescription were more likely to be of aged 24-45; reside in the Amazon and Highlands regions; and self-consumption of the purchase. Individuals with Seguro Integral de Salud (Comprehensive Health Insurance) were less likely to buy medications without prescription. Conclusions: There is a high prevalence of prescription requiring medication being bought without one from pharmacies in Peru. It is necessary to include the evaluation of consumer patterns to develop strategies with the aim to regulate the consumption of prescription drugs in the Peruvian population.

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Hernández-Vásquez, Akram, Christoper A. Alarcon-Ruiz, Deysi Díaz-Seijas, Luisa Magallanes-Quevedo y Diego Rosselli. "Purchase of medications without prescription in Peru: a cross-sectional population-based study". F1000Research 7 (22 de febrero de 2019): 1392. http://dx.doi.org/10.12688/f1000research.15886.2.

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Background: Low availability of medicines in health services, self-medication, inadequate use of medicines, and inadequate dispensing practices in pharmacies are frequent problems in Peru. We aimed to evaluate how frequent the purchase of medications without medical prescription is in Peru, and which factors are associated with this practice. Methods: We conducted a secondary analysis of the 2016 ENSUSALUD national survey data. Purchase of one or more medicines that require a prescription was measured as a dichotomous variable. Crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using Poisson regressions model with robust variance to assess the association of purchasing of medicines that require prescriptions with sociodemographic factors. Results: There were 3858 participants in the dataset. The prevalence of purchasing medications without prescriptions was 47.2%. History of having previously consumed the same medication (31.6%), and the delay in receiving an appointment at health facilities (26.9%) were the main reasons to buy medications without a prescription. Regarding the recommendation of the medication purchased, the advice of the pharmacy, and remembering a previous old prescription, were the most frequent reasons (38.3%, and 25.9%, respectively). On the multivariable analysis, users that buy medications without prescription were more likely to be of aged 25-44; reside in the Jungle and Highlands regions; and self-consumption of the purchase. Individuals with Seguro Integral de Salud (Comprehensive Health Insurance) were less likely to buy medications without prescription. Conclusions: There is a high prevalence of prescription requiring medication being bought without one from pharmacies in Peru. It is necessary to include the evaluation of consumer patterns to develop strategies with the aim to regulate the consumption of prescription drugs in the Peruvian population.

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Pratama, Septa. "Studi Pembelian Antibiotik Tanpa Resep di Apotek Kita, Kota Jambi". Informasi dan Promosi Kesehatan 1, n.º 1 (15 de junio de 2022): 25–30. http://dx.doi.org/10.58439/ipk.v1i1.20.

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Background: Antibiotics are prescription drugs that must be obtained from a doctor. However, because it is now available without a doctor's prescription, the potential for resistance is even greater. The purpose of this study is to determine the pattern of antibiotic purchases at Our Pharmacy without a doctor's prescription. Methods: This is a descriptive observational study to see how to buy antibiotics at our pharmacies without a doctor's prescription. The population of this study included all customers who came to our pharmacy to buy drugs, and the sample included customers who purchased antibiotics without a prescription. The samples were collected using the incidental sampling technique. The results: showed that the sex who purchased the most antibiotics was male (61.05%). The majority of the age group is over 40 years old (52.13%). According to the reasons for purchasing antibiotics, the majority of patients (18.75%) purchased antibiotics because they had coughs and colds, while amoxycillin was the most commonly purchased antibiotic (43.75%). Conclusion: Based on the results, it is possible to conclude that free antibiotic purchases continue to occur in our pharmacies, with the majority of patients being male. Those over the age of 40 make up the majority of the age group. Antibiotics are typically purchased without a doctor's prescription due to complaints of cough and cold with the main antibiotic, amoxycillin.

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Leung, Noelle, Zachary D. Stanley, Emily Slade, Feitong Lei, John M. O'Brien y Douglas R. Oyler. "Use-Based Opioid Prescribing Protocol Reduces Opioid Prescriptions After Cesarean Section [ID 2683514]". Obstetrics & Gynecology 143, n.º 5S (mayo de 2024): 56S. http://dx.doi.org/10.1097/01.aog.0001013720.15595.6d.

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INTRODUCTION: Up to 75% of post-cesarean patients report having up to 50% of their discharge opioid prescription left over. We assessed an institutional standardized post-cesarean section pain management and opioid prescribing protocol implemented to decrease unused opioids entering the community while still adequately managing pain. METHODS: This was an IRB-approved single-center retrospective comparative cohort study in patients aged 18 years or older, who underwent cesarean section before or after implementation of standardized pain management and opioid prescribing protocol. The intervention group received scheduled acetaminophen and NSAIDs with oxycodone 5 to 10 mg as needed postoperatively. Opioid consumption during the 24 hours prior to discharge was used with set ranges determine the quantity of opioid to prescribe for discharge. Outcomes included opioid prescription receipt, quantity of opioid prescribed, and supplementary opioid prescription within 30 days of discharge. RESULTS: Four hundred thirty-three patients were included, with 255 in the intervention group and 208 in the control group. The intervention group used less oxycodone postoperatively (75.1%, 17.8%, and 7.1% of patients using 45 mg, respectively, versus 52.4%, 30.3%, and 17.3%; P<.001), received fewer opioid prescriptions (79.1% versus 89.4%; P=.041), and fewer oxycodone tablets if prescribed (median [interquartile range]: 15 [5–20] versus 30 [20–30]; P<.001). There was no significant difference in number of supplemental post-discharge opioid prescriptions received. CONCLUSION: A standardized post-cesarean section pain management and opioid prescribing protocol significantly reduced the number of both opioid prescriptions written and number of tablets prescribed without increasing patients seeking opioid refills in the 30 days following discharge.

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Kim, Sharon, Amanda King, Pavan Parikh, Ajleeta Sangtani, Sherif Shazly, Ellen Brodrick y Angela Thompson. "Optimizing Post-Cesarean Opioid Prescription Practices at Mayo Clinic: A Quality Improvement Initiative". American Journal of Perinatology 39, n.º 04 (28 de noviembre de 2021): 337–41. http://dx.doi.org/10.1055/s-0041-1739491.

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Objective Optimal prescriptions practices of opioids in the post-cesarean period remain controversial. The primary aim of this initiative was to minimize unused prescription narcotic medication, with a goal of ≤4 leftover pills of 5-mg oxycodone at postoperative day (POD) 14 without affecting pain or satisfaction measures. Study Design This was a prospective longitudinal quality improvement (QI) initiative starting in 2017 utilizing the DMAIC methodology. The measurement phase consisted of validated surveys over 3 months, along with chart review to determine current institutional prescription practices and predictors of outpatient opioid use. Resulting recommendations were adopted, and 1 year later, all patients undergoing cesarean were surveyed for 3 months to determine the effectiveness of the intervention. The study was approved by the Department's QI Committee. Results The response rate was 48%, with 50 of 101 patients completing surveys pre-intervention and 52 of 111 post-intervention. Pre-intervention, surplus medication was predicted (p <0.05) only by the quantity of the opioid prescription. In addition, patients who required ≤37.5 morphine milligram equivalents (MMEs) during the inpatient postoperative stay did not require outpatient narcotic prescriptions. Thereafter, a strategy of matching inpatient use to outpatient prescription 1:1 in a linear regression model (p <0.001, R 2 0.55) optimally matched patient needs up to 200 MME. In the post-intervention survey, mean (SD) prescription decreased from 17.6 (13.7) MME to 8.4 (8.3) MME (p <0.01); 39% compared with 16% of women were discharged without a prescription (p <0.01); and amongst all patients 82.7% compared with 59.6% (p <0.01) had ≤4 pills remaining without differences in patient satisfaction or pain perception. Conclusion This initiative highlights a practical approach to QI utilizing industry techniques in health care. This approach resulted in significant reductions in over-prescription and unused medication, without impacting pain or satisfaction scores. Key Points

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Garcia, Juan F., M. Jose Diez, Ana M. Sahagun, Raquel Diez, Matilde Sierra, Juan J. Garcia y M. Nelida Fernandez. "The Online Sale of Antibiotics for Veterinary Use". Animals 10, n.º 3 (17 de marzo de 2020): 503. http://dx.doi.org/10.3390/ani10030503.

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Antibiotics are essential medicines against infectious diseases in both humans and animals. An inappropriate use of antibiotics can impair animal health and enhance the risk of bacterial resistance, as well as its transfer from animals to humans. The objective of this study was to assess the possibility of purchasing antibiotics for veterinary use on the internet, to evaluate if a prescription is required, and to determine the availability of drugs classified as the highest priority critically important antimicrobials (HP-CIA). The Google and Bing search engines and both simple and complex search strings in Spanish and in English were used. The simple search string was “buy veterinary antibiotics”. Complex searches used wildcards and specific syntax. The searches carried out in Spanish revealed that 50% of websites operated in South America, and 65% of websites did not require a valid prescription. Fluoroquinolones were offered in 84% of these websites (45% without prescription), macrolides were offered in 63% of these websites (43% without prescription), and 3rd– and 4th–generation cephalosporins in 54% of these websites (38% without prescription). For the searches in English, 57% of these websites operated in the United States of America (USA), and 55% of them did not require a prescription. Fluoroquinolones were offered in 79% of these websites (49% without prescription), macrolides were offered in 72% of these websites (45% without prescription), and 3rd– and 4th–generation cephalosporins were offered in 49% of these websites (27% without prescription). Therefore, it is easy to illegally access antibiotics via the internet.

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Nayak, Rajesh, David Brushwood y Carole Kimberlin. "Should Oral Contraceptives Be Sold Without a Prescription? An Analysis of Women’s Risk and Benefit Perceptions Regarding Nonprescription Birth Control Pills". Journal of Pharmacy Practice 18, n.º 6 (diciembre de 2005): 479–85. http://dx.doi.org/10.1177/0897190005280522.

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Despite expert opinions favoring a switch of oral contracepwho were surveyed, 37% favored the acquisition of OCs with-tives (OCs) from prescription to over-the-counter (OTC) staout a prescription. Women associated the OTC system for obtus, limited empirical evidence currently exists for indicating taining OCs with increased likelihood of adverse medical a consumer preference for nonprescription OCs. The objec-consequences and the prescription-only system with an intive of this study was to measure perceptions of women re-creased likelihood of pregnancy avoidance. Women who pregarding nonprescription OCs and to assess their preference ferred nonprescription pills reported more favorable attifor acquiring OCs without a prescription. A cross-sectional tudes toward their use and stronger intentions to buy them survey research design employing a combination of mail and without a prescription. Perceptions of OC benefits seem to telephone survey methodologies was used to measure per-play a more significant role in decisions to favor nonprescripceptions, beliefs, and attitudes of a randomly selected sample tion pills than the perceptions of OC risks for those women of university women (N = 500) regarding the consequences of who preferred OTC pills. Currently, the support for nonpre-using OCs with and without a prescription. Of the women scription OCs among women is only moderate.

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Ndaki, Pendo, Martha Mushi, Joseph Mwanga, Eveline Konje, Nyanda Ntinginya, Blandina Mmbaga, Katherine Keenan et al. "Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study". Antibiotics 10, n.º 8 (23 de agosto de 2021): 1025. http://dx.doi.org/10.3390/antibiotics10081025.

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Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a ‘mystery client’ method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3–89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.

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Wulansari, Rahmawati, Diyah Woro Dwi Lestari, Dwi Utami Anjarwati y Eman Sutrisna. "THE INFORMATION ON STATUS OF ANTIBIOTIC RESISTANCE CHANGING THE PERCEPTION AND ATTITUDES OF WISELY ANTIBIOTIC USE IN BANYUMAS DISTRICT COMMUNITIES". Mandala Of Health 14, n.º 2 (27 de diciembre de 2021): 53. http://dx.doi.org/10.20884/1.mandala.2021.14.2.2280.

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The wise use of antibiotics in the Banyumas community is quite alarming. Most of them still buy antibiotics without a doctor's prescription, buy half a prescription and consume antibiotics without finishing it. Good enough knowledge about the dangers of using antibiotics unwisely has not formed a correct perception and attittude of antibiotic use. This study aims to evaluate changes in people's perceptions and attitudes about antibiotic use after being given information related to their resistance status . This research was conducted qualitatively on 10 informants. Retrieval of data through focus group discussion techniques is done before and after providing resistance status information. The results showed that before giving information, perceptions and attitudes towards the use of antibiotics most (80%) of informants were not correct despite having a good level of knowledge. Changes in perceptions and attitudes about the right pattern of antibiotic use wisely occur after being given information about the status of antibiotic resistance they experience. This study can be concluded that the provision of information on the results of the examination of resistance status has a positive effect causing the changing in perception and the right attitude regarding the use of antibiotics wisely in the Banyumas community

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Benita K, Ruby, Ganesh Kumar S, Murugamantham B y Murugan A. "Authentic Drug Usage and Tracking with Blockchain Using Mobile Apps". International Journal of Interactive Mobile Technologies (iJIM) 14, n.º 17 (13 de octubre de 2020): 20. http://dx.doi.org/10.3991/ijim.v14i17.16561.

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Tracking drugs became more difficult using the centralized architecture. Decentralized architecture using blockchain technology overcomes the difficulties faced by the centralized network like availability and recovery. Avoiding duplicate or fake drugs created by fake manufacturers is a big challenge in the centralized network. Authentic stock is managed and the supply chain is tracked efficiently using this blockchain technology. This is addressed by using the smart contract which helps to track the movement of drugs from manufacturer to supplier, supplier to the reseller, reseller to pharmacies and finally pharmacies to patient. By default, duplicate drugs or fake drugs are completely avoided by using the blockchain technology. Patients buy drugs without any prescription and it creates a lot of problems in real life. So, Patients cannot buy drugs without authenticated doctor’s prescriptions with the help of a QR Code scanner attached with the prescription which will be implemented using a mobile application and cannot buy excess drugs which might lose someone’s life. With the help of inventory management, the maximum limit of drugs to avoid overdose and pharmacies cannot sell those overdose drugs. Consulting a doctor before buying a drug for even a simple illness is important and it is tracked by using prescriptions provided by authentic doctors. In this project, these challenges are addressed using the smart contract which is written in solidity language and runs on a public ethereum network.

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Gardner, Robert Andrew, Kori L. Brewer y Dennis B. Langston. "Predicting opioid use disorder in patients with chronic pain who present to the emergency department". Injury Prevention 25, n.º 5 (6 de abril de 2018): 386–91. http://dx.doi.org/10.1136/injuryprev-2018-042723.

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BackgroundEmergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD).MethodsEighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs.ResultsThe 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p=0.005), current oxycodone prescription (p=0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (p<0.001). The state prescription monitoring database revealed the OUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively.LimitationsMajor limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias.ConclusionPatients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias.

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Coppersmith, Nathan, Joshua Sznol, Andrew Esposito, Emily Flom, Alexander Chiu y Peter Yoo. "The persistent benefits of decreasing default pill counts for postoperative narcotic prescriptions". PLOS ONE 19, n.º 6 (4 de junio de 2024): e0304100. http://dx.doi.org/10.1371/journal.pone.0304100.

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Background In 2017, a university-based academic healthcare system changed the opioid default pill count from 30 to 12 pills. Modifying the electronic default pill count influences short-term clinician prescribing practices. We sought to understand the long-term impact on postoperative opioid prescribing habits after an opioid default pill count reduction. Materials and methods A retrospective electronic medical record system (EMRS) review was conducted in a healthcare system comprised of seven affiliated hospitals. Patients who underwent a surgical procedure and were prescribed an opioid on discharge between 2017–2021 were evaluated. All prescriptions were converted into morphine equivalents (MME). Analyses were performed with the chi-square test and Bonferonni adjusted t-test. Results 191,379 surgical procedures were studied. The average quantity of opioids prescribed decreased from 32 oxycodone 5 mg tablets in 2017 to 21 oxycodone 5 mg tablets in 2021 (236 MME to 154 MME, p<0.001). The percentage of patients obtaining a refill within 90 days of surgery varied between 18.3% and 19.9% (p<0.001). Patients with a pre-existing opioid prescription and opioid-naïve patients both had significant reductions in prescription quantities above the default MME (79.7% to 60.6% vs. 65.3% to 36.9%, p<0.001). There was no significant change in refills for both groups (pre-existing 36.7% to 38.3% (p = 0.1) vs naïve 15.0% to 15.3% (p = 0.29)). Conclusions The benefits of decreasing the default opioid pill count continue to accumulate long after the original change. Physician uptake of small changes to default EMRS practices represents a sustainable and effective intervention to reduce the quantities of postoperative opioids prescribed without deleterious effects on outpatient opiate requirements.

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Phuong, Thuy Nguyen Thi, Binh Thanh Nguyen, Thang Do Xuan, Trung Quang Vo, Trung Duc Nguyen, Thuan Nguyen Van y Susi Ari Kristina. "Practice skills and compliance of private pharmacies with regulations on the prescription drug: A multi-method study in Vietnam". BIO Web of Conferences 75 (2023): 05013. http://dx.doi.org/10.1051/bioconf/20237505013.

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Professional practice of pharmacists plays a crucial role in the reinforcement of drug retailers’ services to achieve optimal health care provision to customers. To evaluate the professional skills and compliance of retail pharmacy staff with selling prescription drugs by surveying patients’ knowledge of drugs and role-playing the customer buying antibiotics without a prescription. A cross-sectional study was conducted with two kinds of surveys at 480 drug retail establishments using the cluster sample technique among 12 provinces/cities in Vietnam. Clients were interviewed to assess their knowledge about drugs. Moreover, the method of acting as a client was used in two common scenarios in order to evaluate the implementation of professional regulations and professional practice skills of drug sellers: a child acute respiratory infection (ARI) case and an amoxicillin case without a prescription. The data were presented as frequency and percentage. The basic tests were used to compare the ratios and means between the two groups. The total number of interviewed customers was 2389 while the figure for role-playing was 960 cases. When customers buy medications with a prescription, 100% of those were fully aware of the dosage of the drugs they purchased, which was higher than the scenario of buying without a prescription (93.1%). In role-play scenarios, the rate of drug sellers asking patients to explore information was higher in the ARI children case than in the amoxicillin case. Besides, 100% of customers were consulted on treatment in both cases, and the rate of advising was at a low rate in both scenarios 3.8% in the amoxicillin case compared to 15.4% in the ARI case. Drug sellers did not respond well to requirements in professional practice and were influenced by economic concerns in business.

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Roughead, Elizabeth Ellen, Renly Lim, Emmae Ramsay, Anna K. Moffat y Nicole L. Pratt. "Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study". BMJ Open 9, n.º 4 (abril de 2019): e023990. http://dx.doi.org/10.1136/bmjopen-2018-023990.

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ObjectiveTo determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids.Design, setting and participantsRetrospective cohort study using administrative health claims database from the Australian Government Department of Veterans’ Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds.Main outcome measuresThe outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge.ResultsIn 2014–2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone; oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%.ConclusionsOpioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.

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Swastini, Dewa Ayu y Made Krisna Adi Jaya. "Research study on patient’s desire to get oral antibiotics for self medication at community pharmacy in bali-indonesia". Journal of medical pharmaceutical and allied sciences 11, n.º 2 (30 de marzo de 2022): 4747–51. http://dx.doi.org/10.55522/jmpas.v11i2.3051.

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Oral antibiotics are one of the drugs that must be used wisely. Irrational use can cause fatal problems, including resistance and increased mortality due to infection. Many people try to get oral antibiotics without a doctor's prescription. This behaviour is worrying because it can lead to irrational use of antibiotics. This study aimed to identify the factors that encourage people to get oral antibiotics without a doctor's prescription, especially in Bali-Indonesia. A cross-sectional study design was conducted to identify factors that encourage patients to take oral antibiotics without a doctor's prescription. The identified factors were then analyzed in relation to the demographic characteristics of the patient. A total of 400 respondents were successfully observed. 59% of respondents came to the community pharmacy to try to get Amoxicillin, 75% of them stated that they had health problems such as cough, cold, painful swallowing. As many as 52% of respondents indicated that they knew about this antibiotic from their previous healing experience with the same symptoms, and 95% of them tried to buy oral antibiotics because it was more efficient and saved money. Factor analysis found three characteristics influencing this behaviour: age, distance from residence to the pharmacy, and insurance ownership. Most of the people in Bali tried self-medication with oral antibiotics. This condition is at risk of causing antibiotic resistance will be broader in the future. The founding of this. Keywords: Oral Antibiotics, Self Medication, Community Pharmacy, Bali.

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Hayes, Martina, Richeal Ni Riordain y Anthony Roberts. "Uses of Mouthwashes in Primary Dental Care". Dental Update 50, n.º 9 (2 de octubre de 2023): 758–62. http://dx.doi.org/10.12968/denu.2023.50.9.758.

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There are a large number of mouthwashes available, with the majority available to buy without prescription. Different active ingredients in mouthwashes serve different functions, and it can be confusing for patients who may seek guidance from their general dental practitioner on which formulation best suits their oral healthcare needs. It is important that patients are given direction by their dentist on the duration they should use a mouthwash for, side effects they may encounter, and where the mouthwash fits in their daily oral hygiene routine. CPD/Clinical Relevance: Mouthwashes are typically well tolerated, easy to use, and can be a useful addition to a patient's oral healthcare routine.

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Bleiberg, Benjamin Aaron, Kyle Andrew Westbrook, Chul Ahn y Saad A. Khan. "Analysis of opioid and adjunctive pain medication prescriptions in lung cancer patients." Journal of Clinical Oncology 39, n.º 15_suppl (20 de mayo de 2021): e24073-e24073. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24073.

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e24073 Background: Between 1999-2018, the CDC reported 232,000 deaths from prescription opioids. Lung cancer patients receive many opioid and adjunctive pain medication prescriptions. The frequency, duration, and impact of these prescriptions is unknown. Methods: We used the electronic medical record to catalogue opioid and adjunctive pain medication prescriptions given to adult cancer patients at our academic and county-affiliated health systems from 2009-2016. We identified the association of opioid and adjunctive pain medication use with patient characteristics including cancer stage and radiation therapy. Results: 1510 lung cancer patients were identified, of which 1061 had opioid prescriptions (70%). Of patients with prescriptions: hydrocodone was prescribed to 90%, morphine 35%, hydromorphone 17%, fentanyl 16%, and oxycodone 13%. 330/1061 patients had adjunctive medication prescriptions, of which, gabapentin was prescribed to 90%, pregabalin 14% and carbamazepine 2%. 296/330 patients prescribed adjunctive medications also had an opioid prescription with the following frequency: hydrocodone 90%, hydromorphone 33%, fentanyl 27%, morphine 41%, and oxycodone 23% 7/1061 patients with opioids had naloxone prescribed. Opioid usage by cancer stage is shown in the table. 211/1510 patients (13%) had prescriptions for ≥3 different opioids; 97/330 (33%) patients with adjunctive prescriptions, had prescriptions for ≥3 different opioids. Of patients treated with radiation for >4 weeks, 66% received opioids, with the proportion receiving opioids increasing with each fraction of radiation up to a rate of 90% with 5 or more fractions. 87% of patients prescribed opioids alone had an active opioid prescription 3 months after their last date of radiation as did 91% of those prescribed adjunctive medications in addition to opioids. In the total dataset: 55% of patients were from the university system and 45% were from the county system and other settings. Of the lung cancer patients with opioid prescriptions: 69% were from the university system and 31% were from other settings. Conclusions: Opioids are commonly prescribed in patients with any stage of lung cancer, particularly those with stage >1 with hydrocodone being the most prescribed. In the period under study, adjunctive medications such as gabapentin were prescribed much less than and rarely without opioids. Some lung cancer patients received ≥3 distinct opioids, with higher rates seen in those with adjunctive medicine prescriptions. Further studies to evaluate system wide opioid prescribing trends and discrepancies related to demographic factors are needed.[Table: see text]

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Melviani, Melviani y Rohama Rohama. "Faktor-Faktor yang Berhubungan dalam Pengelolaan Obat atau Obat Tradisional untuk Pengobatan Sendiri di Masa Pandemi". Jurnal Surya Medika 7, n.º 2 (1 de febrero de 2022): 199–204. http://dx.doi.org/10.33084/jsm.v7i2.3215.

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Self-medication or self-medication is the activity or act of self-medicating with medication without a proper and responsible prescription. Limited activities and activities caused by the COVID-19 pandemic eventually led to limited health care activities. People who have complaints of pain feel more vigilant to check the situation to medical personnel so choose to do the independent treatment. The purpose of this study is to find out the factors that affect the management of traditional drugs and drugs independently in the covid-19 pandemic. This research is descriptive. The sample in this study amounted to 113 people with convenience sampling techniques. The results obtained based on research are known that the management of drugs and traditional medicines independently is influenced by gender, occupation, and distance of the place to buy, based on statistical tests of factors that affect drug management both before the pandemic and after pandemic obtained a value of p 0,000 (<0,05), which means there is a meaningful relationship between drug use both before the pandemic and after the pandemic with gender, work, and the distance from where to buy.

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Lovecchio, Francis, Ajay Premkumar, Tyler Uppstrom, Jeffrey Stepan, Brittany Ammerman, Moira McCarthy, Beth Shubin Stein et al. "Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction". Orthopaedic Journal of Sports Medicine 8, n.º 4 (1 de abril de 2020): 232596712091354. http://dx.doi.org/10.1177/2325967120913549.

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Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.

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Ndon, Sifon, Todd Spock, Sina J. Torabi y R. Peter Manes. "Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery". Otolaryngology–Head and Neck Surgery 162, n.º 6 (14 de abril de 2020): 969–78. http://dx.doi.org/10.1177/0194599820915472.

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Objective To evaluate postoperative opiate use and patients’ opinions regarding pain management after endoscopic sinus surgery (ESS). Study Design Case series with planned data collection. Setting Tertiary referral medical center. Subjects and Methods We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7. Results A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, P < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3. Conclusion Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.

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Iram, Sadia y Abdullah Haider. "The overprescribing of opioids: a public health approach to an epidemic of addiction". Journal of the Pakistan Medical Association 73, n.º 6 (20 de mayo de 2023): 1358. http://dx.doi.org/10.47391/jpma.7539.

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Madam, Opioids a group of illegal drugs such as heroin, and analgesics available legally by prescription, including morphine. Opioids are very addictive as they induce euphoria and sedation, and upon the termination of chorionic use, patients can experience opioid withdrawal symptoms. Opioid crises are usually triggered by their overprescription as analgesics which can lead to diversion and misuse. The use of prescription opioid analgesics doubled between 2001-2013, with many countries affected by epidemics of opioid misuse during this period. In this context, overprescribing OPR’s (opioid related pain relievers) for post-surgical pain has been acknowledged as a noticeable public health concern and a potential contributor to the pattern of opioid misuse but this is ignored too.[1] From 1999-2011 oxycodone consumption increased by nearly 500% and hydrocodone almost doubled. Opioid misuse needs immediate attention to prevent national epidemics such as in the USA in these past two decades above five million opioid- related deaths have been reported, more than half of which involved prescription opioids.[2]. It has been observed that physicians prescribe opioids in more than half non-surgical hospital admissions, often in high doses. Postpartum opioid prescription is another contributing factor to the issue; approximately 80% of women are prescribed opioids after C-section and about 54% of women after normal delivery, although these figures vary in different regions. The risk of chronic opioid use related to opioid prescribing after birth may not seem high (Annual risk: 0.12-0.65%), but such a large number of women being exposed to opioids and those who become chronic users out of them per year is alarming.[3] In Pakistan, after cannabis, opiates and heroin are 2nd and 3rd most commonly used drugs, respectively.[4] Due to easy availability, opioid addiction is common, a survey showed approximately 1.6 million Pakistanis abusing prescription opioids for non-medical use.[5] The majority of the primary care physicians who prescribe opioids do not follow all the recommended approaches to reduce the occurrence of opioid overuse. According to the UNODC, Pakistan is among the top 10 countries with the highest rate of opioid addiction, with or without a prescription. In our country, the general physicians play a significant role, as opioids are routinely prescribed in OPD to manage acute and chronic pain. ---Continue

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Lundin, S. y R. Liu. "‘Where and how do you buy medicines?’ A pilot survey of consumption strategies among the public in Sweden". Journal of Public Health 42, n.º 3 (23 de julio de 2019): e268-e271. http://dx.doi.org/10.1093/pubmed/fdz075.

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Abstract Background Substandard and falsified (SF) medical products are a major danger to public health. They affect every region of the world, and have been identified in all major therapeutic categories. Studies from medicine, pharmacology, law and public health dominate this research area with a focus on the supply side. However, the spread of SF medical products cannot be fully understood without information about the demand side or a sociocultural perspective on market formation. The aim of this short report is to present findings from a pilot study that examines the attitudes of the Swedish public regarding consumption of medicines. Methods We conducted a pilot survey in 2016 ‘Where and how do you buy medicines?’ using LimeSurvey, an open-source online survey software. In total 155 respondents completed the survey. Results The majority of respondents turn to doctors within healthcare for prescription-only medicines (POM). Simultaneously, some respondents would consider buying POMs without prior contact with experts even if medicines may come from unsafe sources. Conclusions There is a tendency that people move away from formal healthcare towards an unregulated market. In parallel, people’s approach to doctors becomes more personalized and pragmatic than in former patriarchal relationships. Risk becomes a negotiable concept.

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Fareed Ali Karm, Ibtisam. "Detection of chemical contamination of some herbal slimming available in local markets". Al-Kufa University Journal for Biology 10, n.º 2 (11 de agosto de 2018): 73–78. http://dx.doi.org/10.36320/ajb/v10.i2.8127.

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Contamination by metals were investigated in this study for herbal slimming which have been widely used in our Iraqi community, Arsenic ( As), lead (Pb), cadmium (Cd), Nickle (Ni), iron (Fe) and copper (Cu), were determined using flame atomic absorption spectrophotometry. Experiment samples were divided to two groups , first group (G1) included five pocket samples of herbal were collected from pharmacy and moles in Baghdad ,second group (G2) included unpacked five samples of herbal that taken from local markets and spices shops . Results showed that G2 was more contaminated than G1, and there were significant differences (0.05 >p) for contamination by heavy metals between samples of G1 and G2. It has also been conducting an exploratory or a questionnaire study of a sample of people who deal with these herbs and put several questions about the way of taking the herbs, a place to buy these herbs and knowing about the risks of these herbs. Results appeared that 30% of people prefers taking samples from G1 but 70% prefers G2 because they are cheaper and easier to buy , also 40% of people were worry for the risks of these herbs while 60% don’t because of less understanding of their dangers. This study suggest that we must give more interest in dealing with these herbals and take it from specific and trusted places, adding no one should take it without prescription.

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Anilasree B. P y Biju C. R. "Assessment of knowledge, attitudes, and practices about anti biotics on kerala zone". International Journal of Allied Medical Sciences and Clinical Research 11, n.º 3 (12 de julio de 2023): 223–26. http://dx.doi.org/10.61096/ijamscr.v11.iss3.2023.223-226.

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To reduce the magnitude of antimicrobial resistance, there is a need to strengthen the knowledge for future prescribers regarding use and prescription of antibiotics. Before that, it is required to have conclusive evidence about knowledge, attitude, and practices of that group. To assess the knowledge, attitudes, and the practices of pharmacy students in India with respect to antibiotic resistance and usage. It was a cross‑sectional study which was done online through Google forms for a period of 4 months from July to October 2018. Materials and Methods: A structured questionnaire containing a five‑point scale was sent to medical students across India by sharing link through contacts of pharmacy students association kerala colleges. Respondent‑driven sampling technique was also adopted for the study. Descriptive statistics, parametric (Chi‑square), and nonparametric (Kruskal‑‑Wallis and Mann‑‑Whitney U) tests. A total of 474 responses were received from kerala colleges. The mean score of knowledge was 4.36 ± 0.39. As compared to first year students, knowledge was significantly higher among students of all the years. As much as 83.3% students have consumed antibiotics in previous year of the survey. Around 45% of medical students accepted that they buy antibiotics without a medical prescription. Conclusion: The knowledge level of pharmacy students was quite satisfactory. As far as attitude and practices are concerned, there is a substantial need for improvements.

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Ozawa, Sachiko, Joanna Billings, Yujiao Sun, Sushan Yu y Benjamin Penley. "COVID-19 Treatments Sold Online Without Prescription Requirements in the United States: Cross-sectional Study Evaluating Availability, Safety and Marketing of Medications". Journal of Medical Internet Research 24, n.º 2 (16 de febrero de 2022): e27704. http://dx.doi.org/10.2196/27704.

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Background The COVID-19 pandemic has increased online purchases and heightened interest in existing treatments. Dexamethasone, hydroxychloroquine, and lopinavir-ritonavir have been touted as potential COVID-19 treatments. Objective This study assessed the availability of 3 potential COVID-19 treatments online and evaluated the safety and marketing characteristics of websites selling these products during the pandemic. Methods A cross-sectional study was conducted in the months of June 2020 to August 2020, by searching the first 100 results on Google, Bing, and Yahoo! mimicking a US consumer. Unique websites were included if they sold targeted medicines, were in English, offered US shipping, and were free to access. Identified online pharmacies were categorized as rogue, unclassified, or legitimate based on LegitScript classifications. Patient safety characteristics, marketing techniques, price, legitimacy, IP addresses, and COVID-19 mentions were recorded. Results We found 117 websites: 30 selling dexamethasone (19/30, 63% rogue), 39 selling hydroxychloroquine (22/39, 56% rogue), and 48 selling lopinavir-ritonavir (33/48, 69% rogue). This included 89 unique online pharmacies: 70% were rogue (n=62), 22% were unapproved (n=20), and 8% were considered legitimate (n=7). Prescriptions were not required among 100% (19/19), 61% (20/33), and 50% (11/22) of rogue websites selling dexamethasone, lopinavir-ritonavir, and hydroxychloroquine, respectively. Overall, only 32% (24/74) of rogue websites required prescriptions to buy these medications compared with 94% (31/33) of unapproved and 100% (10/10) of legitimate websites (P<.001). Rogue sites rarely offered pharmacist counseling (1/33, 3% for lopinavir-ritonavir to 2/22, 9% for hydroxychloroquine). Drug warnings were unavailable in 86% (6/7) of unapproved dexamethasone sites. It was difficult to distinguish between rogue, unapproved, and legitimate online pharmacies solely based on website marketing characteristics. Illegitimate pharmacies were more likely to offer bulk discounts and claim price discounts, yet dexamethasone and hydroxychloroquine were more expensive online. An inexpensive generic version of lopinavir-ritonavir that is not authorized for use in the United States was available online offering US shipping. Some websites claimed hydroxychloroquine and lopinavir-ritonavir were effective COVID-19 treatments despite lack of scientific evidence. In comparing IP addresses to locations claimed on the websites, only 8.5% (7/82) matched their claimed locations. Conclusions The lack of safety measures by illegitimate online pharmacies endanger patients, facilitating access to medications without appropriate oversight by health care providers to monitor clinical response, drug interactions, and adverse effects. We demonstrated how easy it is to go online to buy medications that are touted to treat COVID-19 even when current clinical evidence does not support their use for self-treatment. We documented that illegitimate online pharmacies sidestep prescription requirements, skirt pharmacist counseling, and make false claims regarding efficacy for COVID-19 treatment. Health care professionals must urgently educate the public of the dangers of purchasing drugs from illegitimate websites and highlight the importance of seeking treatment through authentic avenues of care.

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&NA;. "The majority of US adults (51%) support the trend which allows consumers to buy more drugs over the counter (OTC) without a prescription",. Inpharma Weekly &NA;, n.º 1468 (diciembre de 2004): 4. http://dx.doi.org/10.2165/00128413-200414680-00007.

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Susilo, Avrilya Iqoranny y Zamharira Muslim. "Community Behavior Study Regarding Drug Purchases at Bengkulu City Pharmacies in 2021". SANITAS: Jurnal Teknologi dan Seni Kesehatan 13, n.º 1 (21 de junio de 2022): 33–43. http://dx.doi.org/10.36525/sanitas.2022.4.

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At this time the practice of self-medication or self-medication is increasingly being carried out by the community. This is done for various reasons, including feeling that the disease they are suffering from is only a minor illness that does not need to be treated by a doctor. This study aims to get a picture of people's behavior when searching for drugs at pharmacies in their self-medication practice in the Bengkulu City area. The research was conducted using a direct survey research method using observation sheets. Determination of the sample of pharmacies and respondents was done by using purposive sampling technique. People already have a choice of what medicine they will buy at the pharmacy to relieve the pain they feel (84.7%) and ask pharmacists for advice in making choices (15.3%). Most of the drugs used in the practice of self-medication by the community are brand-name drugs (81%) and a small percentage of people use generic drugs (19%). The choices in the use of drugs are over-the-counter drugs (21.4%), limited over-the-counter drugs (28.8%) and hard drugs (49.8%). Based on this, the behavior of people who go to pharmacies to practice self-medication, most of them already have a choice of what medicine they will buy to relieve the pain they feel. The thing that must be a concern is that many people choose to use hard drugs in their self-medication practice without asking for advice from pharmacists at the pharmacy (49.8%), while hard drugs in their use must use a doctor's prescription.

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Shabaraya, A. Ramakrishna, Mohammed Adil Ashraf y Jewel Janice Fernandes. "Assessment of Storage of Medicines at Home using Home Medication Review in Pediatric Population - A Community Based Study". International Journal of Research and Review 8, n.º 7 (14 de julio de 2021): 149–53. http://dx.doi.org/10.52403/ijrr.20210720.

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People take medicines and vitamins to feel well and to stay well. However, any medicine, including those we buy without a prescription, can cause harm if taken in the wrong way or by the wrong person. That too in case of pediatric population it has to be considered very much.Medicines stored incorrectly at home can pose a health risk. Adult cold medications and antibiotics were the most commonly stored drugs at home, followed by analgesics. The most popular location for storing drugs was the refrigerator (50.6 percent). The majority of people did not read the packaging inserts. Self-medication was reported by a large percentage of homeowners (53.6%), and antibiotics recommended by doctors were frequently reused. There was a link between self-medication and educational attainment, but not with age, sex, marital status, occupation, or insurance type. There is a need for more public awareness and information about the storage and risks of reusing prescription drugs. The study conducted here is a community based prospective study where the paediatric storage of medicines was obtained through home medication review. Out of 150 pediatric participants, it was found that 20.66% of them stored in box or drawer or bag with lock and 79.33% without lock. The checking of expiry date was also enquired and in that those who checked expiry date never was 28%, timely 25% and before administration 47%.Therefore awareness of storage of medicines and looking into the expiry date of medicines is a less focused area among people.Consumers who use medications in the community should be urged to keep them in a way that preserves the medicine's quality while also protecting the consumer, their family, and visitors to their house. Keywords: Pediatric storage of medicines, Home medication review, Expiry date of medicines.

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Detha, Annytha, Diana Agustiani Wuri, Filomena Ramos, Desi Biru, Margie Mila Meha y Anita Lakapu. "Penggunaan Antibiotik yang Kurang Tepat pada Peternakan Babi di Kota Kupang, Nusa Tenggara Timur". Jurnal Veteriner 22, n.º 2 (30 de junio de 2021): 162–67. http://dx.doi.org/10.19087/jveteriner.2021.22.2.162.

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Misuse of antibiotics has the potential to accelerate the emergence of types that are resistant to inappropriate drugs. This study aims to evaluate the inappropriate use of antibiotics in pig farms in the City of Kupang, East Nusa Tenggara. This antibiotic use evaluation study was conducted from March to May 2018. This study was conducted on 100 pig farmers spread across 6 (six) districts in Kupang City. The sampling technique was done by stratified random sampling method based on the characteristics or types of the population. This research used descriptive analysis method from the results of questionnaire data collection that had been filled out by pig farmers in Kupang City. Based on the results obtained that 84% of pig farmers or respondents did not know the function of antibiotics, and 83% of respondents did not know that the administration of antibiotics must be done with the supervision of a veterinarian. The results also showed that 86% of pig farmers buy antibiotics without a veterinarian’s prescription, with the type of antibiotics most often used were the tetracycline and sulfonamide groups. These results conclude that dominant respondents apply antibiotics without veterinary supervision, which can contribute to the spread of resistant bacteria so that it adversely affects human health.

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Benitez-Aurioles, J., D. Jenkins, C. Ramirez Medina, N. Peek y M. Jani. "OP0269 DEVELOPMENT AND EVALUATION OF MACHINE LEARNING ALGORITHMS FOR THE PREDICTION OF OPIOID-RELATED DEATHS AMONG UK PATIENTS WITH NON-CANCER PAIN". Annals of the Rheumatic Diseases 82, Suppl 1 (30 de mayo de 2023): 177–78. http://dx.doi.org/10.1136/annrheumdis-2023-eular.3510.

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BackgroundThere has been a sharp rise in opioid use for non-cancer pain globally, including for rheumatic and musculoskeletal conditions. Despite increased awareness of adverse effects, they remain commonly prescribed in most countries. Clinical prediction models (CPMs) offer the possibility of assessing individual risk allowing better allocation of resources towards those at risk. Machine learning (ML) approaches can address nonlinear relationships and complex interactions between variables and are increasingly used to develop CPMs.ObjectivesTo develop, validate, and compare the performance of three CPMs based on regression and ML, which leverage primary care data to estimate the risk of opioid-related death in patients prescribed opioids for non-cancer pain.MethodsPatients ≥18 years old without prior cancer who were prescribed any opioid between 01/01/2006 and 31/12/2017 were identified in the Clinical Practice Research Datalink (CPRD), representative of national patient data from UK primary care. Only new opioid users were included. Index date was date of first prescription, with censoring at withdrawal from the CPRD or after not having an opioid prescription for two years. Baseline data were extracted from each patient’s records, including demographic information, comorbidities, concomitant medications, and the opioid type being prescribed. 49 candidate predictors were used to train three competing risk models: a Fine&Gray regression model with LASSO regularisation, a survival random forest (RF), and a neural network (DeepHit). The outcome was opioid-related mortality and other cause mortality the competing event, defined using a curated ICD-10 codelist. Predictive performance of the models, like area under the receiver characteristic operator curve (AUCROC) were calculated using 5-fold cross validation.ResultsWe included a total of 1,029,681 patients, of which 1,240 experienced an opioid-related death, and 52,833 experienced a competing death.The Fine&Gray, RF and DeepHit models achieved average AUCROC values of 0.83(95% CI: 0.81-0.85), 0.78(0.77-0.79) and 0.81(0.80-0.82) respectively (Figure 1). At optimum risk cut point, as per Youden’s index, the models achieved sensitivities of 0.82(0.78-0.85), 0.75(0.67-0.82) and 0.80(0.78-0.83), and specificities of 0.78(0.73-0.82), 0.75(0.68-0.83) and 0.78(0.75-0.8) when predicting 12-month risk, respectively.In the Fine&Gray model, factors associated with increased risk were history of substance use disorder (hazards ratio [HR]: 3.40, 95% CI:3.12-3.69) and alcohol abuse (HR:3.07, 95% CI:2.93-3.22). COPD (HR:1.53, 95% CI:1.48-1.58) and moderate liver disease (HR:1.31, 95% CI:0.99-1.63) were the comorbidities associated with highest risk. Morphine (HR:2.39, 95% CI:2.08-2.69) and oxycodone (HR:1.10, 95% CI:1.00-1.20) at initiation and concomitant gabapentinoids (HR:1.99, 95% CI:1.80-2.18) and benzodiazepines (HR:1.30, 95% CI:1.24-1.36) were associated with an increased risk. HR for rheumatologic diseases was 1.08 (95% CI:1.01-1.14).Figure 1.AUCROC of the three models vs. prediction horizon of the model. 95% CI of mean performance shaded.ConclusionThe Fine&Gray and DeepHit models showed comparable discriminative performance. Substance abuse, lung and liver comorbidities, morphine or oxycodone at initiation and co-prescription of gabapentinoids and benzodiazepine, were some of the factors associated with a higher risk of opioid-related mortality.AcknowledgementsJBA acknowledges the receipt of studentship awards from the Health Data Research UK-The Alan Turing Institute Wellcome PhD Programme in Health Data Science (Grant Ref: 218529/Z/19/Z).MJ is funded through an NIHR Advanced Fellowship (NIHR301413).Disclosure of InterestsNone Declared.

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Muquebil Ali Al Shaban Rodriguez, O. W., S. Ocio León, M. Gómez Simón, M. J. Hernández González, E. Álvarez de Morales Gómez-Moreno, J. R. López Fernández, D. F. Frías Ortiz et al. "Tests Get Me Nervous: A Case of Pharmacological Enhancement". European Psychiatry 33, S1 (marzo de 2016): S520. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1925.

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IntroductionThe use of drugs to improve cognitive performance (pharmacological enhancement) is a practice that increases in frequency, especially in individuals with a high degree of academic education, university students, and workforce with high responsibilities. Legal substances such as alcohol and caffeine, prescription drugs such as modafinil or methylphenidate and some illegal drugs such as amphetamines or cannabis are utilized to improve cognitive performance, maintain wakefulness, or induce sleep. Perception of risk is low in many cases. Internet has facilitated the illicit access to prescription drugs with astonishing ease.Objective and methodsWe want to exemplify through a clinical case, how the access to some of these substances through internet is very easy, and how, in this case, the use of Modafinil (drug indicated for narcolepsy) with the objective of maintaining academic performance aggravates symptoms of anxiety in a 22-year universitary patient.ResultsExposition of clinical case in the poster.ConclusionsThe use of substances (“smart drugs”) presents risks for both physical and psychological health that sometimes are not perceived by the user. It is surprising that a highly educated individual has taken Modafinil without researching for a deep understanding of the side effects of the drug.Internet access of regulated substances that should only be prescribed by a physician to be used on very concrete symptoms is extremely easy. In the case of the Modafinil, it is possible to access its purchase by simply searching the words “purchase/buy Modafinil” in any internet browser.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Alucema, Alejandrina, Nicole Chavarría y Marisela Valdés. "Patrones de automedicación en clientes de una farmacia comunitaria de la ciudad de Antofagasta". Journal of Pharmacy & Pharmacognosy Research 1, n.º 1 (1 de septiembre de 2013): 54–63. http://dx.doi.org/10.56499/jppres13.008_1.2.54.

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Context: Self-medication is the use of unprescribed drugs; this means that people obtain drugs on their own initiative and without the assistance of health professionals. This is an increasingly common practice among the population that can cause numerous problems, becoming a public health problem. Aims: To determine the patterns of self-medication in customers who frequented a community pharmacy in the city of Antofagasta. Methods: A survey was conducted to 297 users over 18 years and with adequate mental and communicative power to answer the questions, and attending the pharmacy to buy a drug without a prescription. Results: The study revealed that of the 297 people who practiced self-medication, 41% do it with a frequency of at least once a month. The woman practiced in 64% and the men in 36%. The range of age of the studied group was between 31-50 years. The main reason to practice the self medication was to recognize symptoms (33%), within the most notable was the headache (11%). The therapeutic group of the most requested medicines was the NSAIDs (20%), and of them the paracetamol was the most used. Conclusions: The results reveal that a high percentage of customers surveyed self-medicate, which shows this practice as a real problem, so it is necessary to educate people.

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Andreansyah, Agus. "Aplikasi Pengenalan Pola Citra Logo Obat Medis Menggunakan K-Means Clustering". Jurnal Elektronika Listrik dan Teknologi Informasi Terapan 2, n.º 1 (3 de julio de 2020): 8. http://dx.doi.org/10.37338/e.v2i1.115.

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Trends in drug abuse have occurred since 2014 such as ATS abuse or chemicals such as over-the-counter PCC. People no longer follow the rules of using drugs according to applicable regulations, but many who buy and consume drugs without a doctor's prescription. These behaviors and actions can endanger health, so people need to know the use of drugs to be more safe for consumption, one of them by paying attention to the type of logo on the drug packaging. To make it easier to find out the name of the logo type on drug packaging, it is necessary to develop an application using digital image processing. The study began with taking a drug pattern image using a smartphone camera and the results were carried out cropping the logo image in detail. Furthermore, cropping (RGB) images are converted into binary images and grayscale images to be performed a feature extraction process that is metric, eccentricity, and GLCM. The results of testing the test image data, a percentage of 91.5% with an accuracy rate of 100% types of over-the-counter drugs, hard drugs, and narcotics, while over-the-counter drug images are limited to 66%.

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Hung, Kin Wai (Tony) y Natasha Banerjee. "ChemoPalRx: Development and implementation of a chemotherapy mobile provider order entry system in a safety net hospital." Journal of Global Oncology 5, suppl (7 de octubre de 2019): 73. http://dx.doi.org/10.1200/jgo.2019.5.suppl.73.

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73 Background: Computerized provider order entry (CPOE) systems have been shown to enhance the safety and efficiency of prescribing chemotherapy over the handwritten ordering process. However, many institutions lack the financial ability, technological capability, or operational flexibility to invest in and implement such a system. In particular, Olive View-UCLA Medical Center (OVMC), a Los Angeles County safety net hospital, is among these institutions with unique restrictions that preclude the use of chemotherapy CPOE and mandate handwritten orders. Methods: In an effort to bridge the gap for safe chemotherapy prescribing, we aimed to develop and implement an effective, scalable, and sustainable chemotherapy provider order entry solution that was operationally sensitive to institutions without a chemotherapy CPOE. The solution was designed as a mobile application using Xcode, the integrative development environment of Apple Inc., with the Swift programing language. Results: On September 5th, 2018, we launched a free, chemotherapy provider order entry solution on the worldwide Apple App Store – ChemoPalRx. Using ChemoPalRx, providers can search, customize, and print common chemotherapy regimens in prescription format. Along with a reference library of over 120 order set and 450 medications, ChemoPalRx is equipped with the functions to automate dosage calculation, suggest pre-medications and safety parameters, and trigger alerts for missing prescribing information. As a quality improvement initiative, we implemented ChemoPalRx at OVMC. Implementation stages include obtaining administrative buy-in, consulting with multidisciplinary staffs, investing $100 USD for a prescription printer, and encouraging providers to download ChemoPalRx on their own mobile devices. An ongoing prospective cohort study is being conducted to determine ChemoPalRx effectiveness in reducing errors compared to handwritten orders. Conclusions: ChemoPalRx is developed to enhance the safety and efficiency of chemotherapy prescribing. Implementation of this mobile application is feasible in the safety-net hospital setting and has the potential to transform oncology practices globally.

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Hung, Kin Wai (Tony) y Natasha Banerjee. "ChemoPalRx: Development and implementation of a chemotherapy mobile provider order entry system in a safety net hospital." Journal of Clinical Oncology 37, n.º 15_suppl (20 de mayo de 2019): e18071-e18071. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18071.

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e18071 Background: Computerized provider order entry (CPOE) systems have been shown to enhance the safety and efficiency of prescribing chemotherapy over the handwritten ordering process. However, many institutions lack the financial ability, technological capability, or operational flexibility to invest in and implement such a system. In particular, Olive View-UCLA Medical Center (OVMC), a Los Angeles County safety net hospital, is among these institutions with unique restrictions that preclude the use of chemotherapy CPOE and mandate handwritten orders. Methods: In an effort to bridge the gap for safe chemotherapy prescribing, we aimed to develop and implement an effective, scalable, and sustainable chemotherapy provider order entry solution that was operationally sensitive to institutions without a chemotherapy CPOE. The solution was designed as a mobile application using Xcode, the integrative development environment of Apple Inc., with the Swift programing language. Results: On September 5th, 2018, we launched a free, chemotherapy provider order entry solution on the worldwide Apple App Store – ChemoPalRx. Using ChemoPalRx, providers can search, customize, and print common chemotherapy regimens in prescription format. Along with a reference library of over 120 order set and 450 medications, ChemoPalRx is equipped with the functions to automate dosage calculation, suggest pre-medications and safety parameters, and trigger alerts for missing prescribing information. As a quality improvement initiative, we implemented ChemoPalRx at OVMC. Implementation stages include obtaining administrative buy-in, consulting with multidisciplinary staffs, investing $100 USD for a prescription printer, and encouraging providers to download ChemoPalRx on their own mobile devices. An ongoing prospective cohort study is being conducted to determine ChemoPalRx effectiveness in reducing errors compared to handwritten orders. Conclusions: ChemoPalRx is developed to enhance the safety and efficiency of chemotherapy prescribing. Implementation of this mobile application is feasible in the safety-net hospital setting and has the potential to transform oncology practices globally.

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Manchikanti, Laxmaiah. "Opioids in the Management of Chronic Non-Cancer Pain: An Update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines". Pain Physician 2s;11, n.º 3;2s (14 de marzo de 2008): S5—S62. http://dx.doi.org/10.36076/ppj.2008/11/s5.

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Background: Opioid abuse has continued to increase at an alarming rate since our last opioid guidelines were published in 2005. Available evidence suggests a continued wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. Objectives: The objectives of opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) are to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of abuse and drug diversion. Design: A broadly based policy committee of recognized experts in the field evaluated the available literature regarding opioid use in managing chronic non-cancer pain. This resulted in the formulation of the review and update of the guidelines published in 2006, a series of potential evidence linkages representing conclusions, followed by statements regarding the relationships between clinical interventions and outcomes. Methods: The elements of the guideline preparation process included literature searches, literature synthesis, consensus evaluation, open forum presentations, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians, and peer review. Based on the criteria of the U.S. Preventive Services Task Force, the quality of evidence was designated as Level I, II, and III, with 3 subcategories in Level II, with Level I described as strong and Level III as indeterminate. The recommendations were provided from 1A to 2C, varying from strong recommendation with high quality evidence to weak recommendation with low-quality or very low-quality evidence. Results: After an extensive review and analysis of the literature, which included systematic reviews and all of the available literature, the evidence for the effectiveness of long-term opioids in reducing pain and improving functional status for 6 months or longer is variable. The evidence for transdermal fentanyl and sustained-release morphine is Level II-2, whereas for oxycodone the level of evidence is II-3, and the evidence for hydrocodone and methadone is Level III. There is also significant evidence of misuse and abuse of opioids. The recommendation is 2A – weak recommendation, high-quality evidence: with benefits closely balanced with risks and burdens; with evidence derived from RCTs without important limitations or overwhelming evidence from observational studies, with the implication that with a weak recommendation, best action may differ depending on circumstances or patients’ or societal values. Conclusion: Opioids are commonly prescribed for chronic non-cancer pain and may be effective for short-term pain relief. However, long-term effectiveness of 6 months or longer is variable with evidence ranging from moderate for transdermal fentanyl and sustained-release morphine with a Level II-2, to limited for oxycodone with a Level II-3, and indeterminate for hydrocodone and methadone with a Level III. These guidelines included the evaluation of the evidence for the use of opioids in the management of chronic non-cancer pain and the recommendations for that management. These guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a “standard of care.” Key words: Chronic pain, persistent pain, non-cancer pain, controlled substances, substance abuse, prescription drug abuse, dependency, opioids, prescription monitoring, drug testing, adherence monitoring, diversion

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Rogero, Ryan, Daniel Fuchs, Kristen Nicholson, Rachel J. Shakked, Brian S. Winters, David I. Pedowitz, Steven M. Raikin y Joseph N. Daniel. "Postoperative Opioid Consumption in Opioid-Naïve Patients Undergoing Hallux Valgus Correction". Foot & Ankle International 40, n.º 11 (18 de julio de 2019): 1267–72. http://dx.doi.org/10.1177/1071100719862606.

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Background: Postoperative pain management following orthopedic surgeries can be challenging, and the opioid epidemic has made it essential to better individualize opioid prescriptions by patient and procedure. The purpose of this subgroup analysis of a prospective study was to investigate immediate postoperative opioid pill consumption and prolonged use in patients undergoing operative correction of hallux valgus (HV). Methods: Patients undergoing outpatient HV correction procedures with 5 fellowship-trained foot and ankle surgeons over a 1-year period were included. Patients were excluded if they were being prescribed chronic opioid analgesics for an underlying condition prior to the date of initial injury or if they underwent concomitant nonforefoot procedures. At the patient’s first postoperative visit, opioid pills were counted, and these were standardized to the equivalent number of 5-mg oxycodone pills. Linear regression analysis was performed to determine if any of the procedure categories or patient factors were independently associated with postoperative opioid consumption. Prolonged use of opioids 90 to 180 days after the procedure was also examined using our state’s online Prescription Drug Monitoring Program (PDMP). One-hundred thirty-seven patients (86% female) were included. Thirty-six patients (26%) underwent primary chevron osteotomies, 78 (57%) underwent primary proximal osteotomies (Ludloff, scarf), 10 (7%) underwent soft tissue–only procedures with or without a first proximal phalanx osteotomy (modified McBride, Akin), and 13 (9%) underwent first metatarsophalangeal arthrodeses. Results: Overall, patients consumed a median of 27 pills. There was no significant difference in postoperative opioid intake between the 4 procedures, including when subdivided into those with and without lesser toe procedures. Higher preoperative visual analog scale pain levels ( P = .028) and younger patient age ( P = .042) were associated with higher opioid pill consumption. A total of 1.5% of patients demonstrated prolonged opioid use. Conclusion: Our study demonstrated a lack of difference between HV procedures in terms of postoperative opioid consumption and an overall low rate of prolonged use in opioid-naïve patients. Level of Evidence: Level III, comparative study.

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Kunkel, MD, Frank, Elizabeth Fey, MS, Damon Borg, PhD, Richard Stripp, PhD y Christine Getto, BS. "Assessment of the use of oral fluid as a matrix for drug monitoring in patients undergoing treatment for opioid addiction". Journal of Opioid Management 11, n.º 5 (1 de septiembre de 2015): 434. http://dx.doi.org/10.5055/jom.2015.0293.

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Drug testing is an important clinical tool that is available to physicians who are assessing the effectiveness of drug treatment as well as patient compliance to the administered program. While urine has traditionally been the matrix of choice for drug monitoring, oral fluid, a filtrate of the blood, has shown great promise as an alternative matrix for such applications. Oral fluid collection can be accomplished without the need for highly trained medical staff through the use of a simple, noninvasive oral fluid collection device, which obtains an adequate sample in only a few minutes. There has been a significant amount of research performed on the use of oral fluid for forensic toxicology application; however, more studies assessing the use of oral fluid drug testing are required to validate its ability to achieve clinical drug monitoring goals. Testing for various drugs in oral fluid may yield a different result when compared to the same drugs in urine, requiring an assessment of the utility of oral fluid for such practices. The purpose of this study was to examine the application of oral fluid drug testing in patients undergoing buprenorphine treatment for opioid dependence. A retrospective analysis of drug testing results obtained from 6,928 patients (4,560 unobserved urine collections and 2,368 observed oral fluid collections) monitored for heroin metabolite, amphetamine, benzodiazepines, buprenorphine, tetrahydrocannabinol, cocaine, codeine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone was completed. Results of this statistical exercise indicated that patients undergoing observed oral fluid collection tested positive more frequently than those unobserved urine collections for several illicit drugs and prescription medications targeted. Oral fluid was shown to detect illicit drug use as well as noncompliance in this patient population under the studied conditions more often than the urine specimens.

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Birudala, Ramadevi, Shruthi Hassan Nagaraj, Kousar Begum Bannala y Vijayarangam ShivaKumar. "Over the counter medication: a study among dermatology outpatients". International Journal of Research in Dermatology 5, n.º 3 (24 de julio de 2019): 607. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20193238.

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Background: Over-the-counter (OTC) medicine or non-prescription medicine refer to medicine that you can buy without a prescription from a health care professional. The prevalence, clinical patterns and causative agents of cutaneous drug reactions vary among different populations. The most widely used over the counter medication in dermatological practice are topical steroids. The main objective is to know awareness among the people about over the counter medication and clinical analysis of effects caused by them, to find the most commonly used OTC medication.Methods: Prospective questionnaire based study comprising of 453 cases of cutaneous effects due to over the counter medication was carried out for a period of 1 year. Diagnosis was made mainly based on clinical features.Results: Super potent and high potent steroids were the most common OTC medication used which caused nodulocystic acne in 51.6% patients, atrophy in 3.97% patients, tinea incognito in 23.8% patients. Irritant contact dermatitis (due to hydroquinone, cotrimoxazole, neomycin) was seen in 18.5% patients. Fixed drug eruption was seen in 1.32% patients, cushingoid features in 0.66% patient.Conclusions: Indiscriminate abuse of steroids by people due to lack of awareness should be stopped. This misuse and damage have serious effect on the quality of life of the patients in general and the skin of the face in particular. Management is difficult and necessitates psychological counselling as well as physical soothing of the sensitive skin. For the safety of people Indian association of Dermatology, Venereology and Leprology (IADVL) also started IADVL Task force Against Topical Steriod Abuse (ITATSA).

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Coffey, Rebecca, Kathryn Schubauer, Henry Xiang y John Kevin Bailey. "867 The Effect of Financial Reward on Opioid Use After Thermal Injury to the Upper Extremity". Journal of Burn Care & Research 41, Supplement_1 (marzo de 2020): S272—S273. http://dx.doi.org/10.1093/jbcr/iraa024.433.

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Abstract Introduction The widespread use of opioids for the treatment of pain has come under progressive scrutiny in an attempt to address multiple unintended consequences. Despite multiple psychological, social, biological, and legal factors that contribute to pain management strategies, narcotics remain a mainstay for the treatment of burn-pain. As efforts are underway to test novel methods for mitigating pain, it is essential to clearly define models for testing these tools and strategies. This study examines the impact of financial incentives alone on the use of opioids at a single center. Methods Patients with thermal injury to the upper extremity, managed as outpatients, no more than three days from the date of injury and were prescribed the state-encouraged narcotic dosage of no more than 4 tablets (oxycodone, 5mg) per day for no more than 7 days were included. Enrolled patients (n=33) then answered a series of descriptive questions, completed the QuickDASH and had grip strength measurements of each hand. Patients were randomized to one of two groups. Both groups were offered a financial incentive to return a completed pill diary. One group (Incentivized- IC) was offered the possibility of additional financial incentive for each unused oxycodone tablet returned at one week follow up. Only patients who presented a completed pill diary were included in analysis (n=23). Results The Unincentivized (UIC)(n=13) and IC (n=10) were similar age, gender race, ethnicity, mean burn size (1.72% TBSA) and completed level of education. Mechanism of injury was predominantly scald burns (17 scalds, 5 flame injuries, 1 contact injury). Mean difference in grip strength between hands was similar between study groups at enrollment for both UIC and IC patients (-16.60 ±15.92lbs p=0.32,-16.45 ± 12.681lbs p=0.21). The initial QuickDASH scores (15.6lbs, SD 24.6 vs. 7.3lbs SD±10.4 p=0.01) were significant between groups. At one week follow up the difference between grip strength in each hand had improved similarly in each group (-13.16 ±19.71lbs p = 0.51vs. 3.07 ±19.44 lbs, p=0.87 and the increase in QuickDASH score was similar (34.83 SD 23.90 vs.46.09 SD 30.67 p=0.33). The UIC group used a mean of 2.5 tablets/day (±1.5 tab/day) versus the IC group used 2.1 tablets/day (±1.5 tab/day), p=0.46. Conclusions Modest financial incentives do not appear to alter opioid use for acute pain from thermal injury involving the upper extremity. These results support the use of financial rewards, which may encourage participation in future studies without independently affecting opioid use. Finally, it also appears that our state’s encouragement of more stringent prescription practices is appropriate for this mechanism of injury. Applicability of Research to Practice Ongoing research is needed to identify the best tools to decrease use of opioids in acute injury.

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Lucy, Wheeler y Lewis Anthony. "P22 Reducing the time that short stay surgical patients wait for discharge medication". Archives of Disease in Childhood 103, n.º 2 (19 de enero de 2018): e1.27-e1. http://dx.doi.org/10.1136/archdischild-2017-314584.33.

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AimTo reduce the amount of time that short stay surgical patients wait for their discharge medication.MethodAn audit was carried out during 1 week in September 2016 of all discharge prescriptions written on the paediatric surgical ward. It measured time taken for the prescription to be processed by pharmacy and the number of prescriptions for paracetamol and ibuprofen.An intervention was introduced in February 2017: Parents/carers of children coming in for elective surgery were instructed (as part of their pre-admission letter) to buy paracetamol and ibuprofen. Nursing staff also reminded parents/carers when the child was admitted, that they would need to have these medicines on discharge.When a discharge letter was written, patients were not given paracetamol and ibuprofen. They were given a dosing instruction letter completed by the pharmacist at point of clinical check.Provision was made to supply the medication if a parent/carer could not provide it.The letter and dosing were designed by a paediatric pharmacist in conjunction with a paediatric anaesthetist to ensure patients were discharged on optimal pain control.1A re-audit was carried out over the course of 1 week in June 2017.ResultsIn September 2016, a total of 37 prescriptions were written from the paediatric surgery ward over a 1 week period. The average (mean) time to dispense a prescription was 76 min (range 16–200 min).In June 2017, a total of 30 prescriptions were written over a 1 week period. The average (mean) time to dispense a prescription was 51 min (range 10–124 min).There was a reduction in the mean waiting time of 25 min but this did not reach statistical significance (p=0.3).In September 2016, 12 prescriptions (32%) were for elective patients for paracetamol and ibuprofen only. Average time to dispense these prescriptions was 70 min.In June 2017, 7 prescriptions (23%) were for elective patients for paracetamol and ibuprofen only and an instruction letter was issued on the ward. Average time to complete these prescriptions was 21 min. There was a reduction in the mean waiting time of 49 min which was statistically significant (p=0.001). Time was measured from the time the pharmacist was informed the prescription was ready, to the time the medication or letter was ready and on the ward.ConclusionIntroduction of an instruction letter given to elective surgical patients on discharge appeared to lead to a shorter wait for discharge medication, although this was not statistically significant.A significant reduction in waiting time was seen for patients who were only prescribed paracetamol and ibuprofen and could be discharged without their prescription leaving the ward.Further work will look at trying to dispense/prepare more prescriptions at ward level, as this seems to be the most efficient system.It was noted that the number of prescriptions was slightly reduced (30 for the re-audit and 37 for the initial audit). The number of patients admitted and having surgery had remained constant.ReferenceAssociation of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management (2nd ed.). Paediatr Anaesth2012;22(Suppl. 1):S1–79.

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Shrestha, Shristi, Smita Joshi y Ram K. Tamang. "Knowledge and Practice Regarding Topical Corticosteroids Among Dispensers in Community Pharmacies of Kathmandu Valley: A Cross-Sectional Survey". Journal of Institute of Medicine Nepal 43, n.º 3 (31 de diciembre de 2021): 55–60. http://dx.doi.org/10.59779/jiomnepal.1187.

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Introduction: Topical corticosteroids (TCS) abuse and misuse are constantly rising in an alarming proportion, the main reason for this being free availability of such drugs over the counter (OTC) and pharmacists are one of the major prescribers of TCS. The present study was thus conducted to address the gap in information regarding the knowledge and practice of using corticosteroids among dispensers in community pharmacies. Methods: A descriptive cross-sectional survey was carried out among the dispensers in community pharmacies inside Kathmandu valley from March 2020 to March 2021. A survey was conducted with a questionnaire which included questions to assess the knowledge and practice regarding TCS among dispensers in community pharmacies. Microsoft Excel 2010 and Statistical Package for Social Science (SPSS) 16 were used for data analysis. Results: Among 209 participants, 83.73% of the participants had education related to pharmacy. They had good knowledge about brand names, generic names, and side effects of steroids. Maximum number (40.19%) of the participants responded that while coming to buy steroid creams, the patients come without prescription but with the name or cover of medicine. Majority of participants (66.51%) responded that they encounter 1-5 patients per day with recurrence of skin problems after stopping the application of creams. Conclusion: The dispensers at community pharmacies reported having good knowledge about TCS. However, there is a need to strengthen the knowledge regarding indications of TCs including ethical and rational use of TCs among the dispensers in community pharmacies.

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Patel, Jai Narendra, Elizabeth Jandrisevits, Danielle Boselli, Tiffany Gabrielle Kneuss, Armida Parala-Metz y Declan Walsh. "Opioid screening and urine toxicology results in outpatient oncology palliative medicine." Journal of Clinical Oncology 39, n.º 15_suppl (20 de mayo de 2021): e24068-e24068. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24068.

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e24068 Background: Opioid misuse is a major public health issue. Given widespread opioid prescribing in cancer patients (pts), screening for potential misuse is critical. There is lack of real-world data on opioid screening and urine toxicology testing in outpatient oncology palliative medicine. Methods: This is a retrospective clinical analysis of adult cancer pts previously consented for a pharmacogenomics specimen collection study between August 2019-March 2020. Pts completing ≥ 1 outpatient palliative medicine visit with at least half undergoing urine toxicology screening (UTS) per standard practice were included. Pt demographics, medication(s), UTS results, symptoms using Edmonton Symptom Assessment Scale, and opioid screening using Screener and Opioid Assessment for Patients with Pain - Short Form (SOAPP-SF) were collected at baseline and follow up visits, if available. The primary endpoint was the frequency and type(s) of non-compliant (NC) UTS. Secondarily, risk factors for NC UTS were evaluated using univariate and multivariate logistic regression. Results: Of 189 pts (632 visits), 113 underwent UTS, 125 SOAPP-SF, and 75 had both. The median age was 56, 56% were female, 58% white, 40% black, 48% had stage IV disease, and median pain score was 7. More black pts (72%) underwent UTS compared to white pts (53%) (p = 0.001). The mean age of pts with a UTS was 53 compared to 59 in those without UTS (p = 0.002). Oxycodone was the most prescribed drug (N = 125). Median SOAPP-SF was 3 (range 0-11); 38% had a score ≥ 4 (considered high risk). About half (54%; N = 61) who underwent a UTS were NC. Of these, 32 had 1 NC UTS, whereas 29 had 2 or more. The most common reason was presence of a substance not prescribed (N = 44 pts and 128 results), whereas 33 pts (53 results) were NC for substance(s) not present but prescribed. Four had presence of marijuana only and 21 with marijuana plus another NC substance; presence of cocaine and alcohol were the 2nd and 3rd most frequent aberrant result. Of those with a NC UTS and SOAPP-SF score (N = 44), 59% had a score ≥ 4. In univariate analyses, SOAPP-SF ≥ 4 (p = 0.004), nausea (p = 0.05), depression (p = 0.02), anxiety (p = 0.01), and prescriptions for antidepressants (p = 0.006), acetaminophen (p = 0.03), and/or dronabinol (p = 0.04), were associated with NC UTS. In multivariate analyses, SOAPP-SF Q4 (use of illegal drugs) (OR 2.86, 95% CI 1.64 to 5.02; p < 0.001) and prescription with muscle relaxants (OR 2.90, 95% CI 1.19 to 7.09; p = 0.019) were associated with increased odds of a NC UTS. Conclusions: About half of those undergoing UTS were NC. SOAPP-SF Q4 and prescription with muscle relaxants were associated with a NC UTS. Overall, pt demographics (e.g. younger, more female, more black patients, severe pain) varied from the typical cancer population. Screening using SOAPP-SF, UTS, pain contracts, prescription drug monitoring databases, and evaluating pt-specific risk factors is important to reduce opioid misuse risk.

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Jani, Meghna, Nadyne Girard, David W. Bates, David L. Buckeridge, Therese Sheppard, Jack Li, Usman Iqbal et al. "Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study". PLOS Medicine 18, n.º 11 (1 de noviembre de 2021): e1003829. http://dx.doi.org/10.1371/journal.pmed.1003829.

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Background The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time. Methods and findings We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period. Conclusions In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.

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Muhammad Abdul Quddoose, Azhar Hussain, Madeeha Malik y Nabeel Siddique. "Assessment of Perception, Knowledge and Practice of Healthcare Professionals Regarding Pharmaceutical Advertisement (PA) in Pakistan". International Journal of Research in Pharmaceutical Sciences 12, n.º 2 (3 de mayo de 2021): 1360–66. http://dx.doi.org/10.26452/ijrps.v12i2.4690.

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Pharmaceutical advertising (PA) effects both healthcare professionals and consumers. Ethical and legal challenges of PA are often odious and unmet to the standards. This study was designed to assess perceptions, knowledge, and practices of healthcare professionals towards pharmaceutical advertisement in Pakistan. A survey-based descriptive cross-section study, of 764 sample records and analyzed by SPSS, version 21. A Chi-square test was performed (p ≤ 0.05) to find out differences among variables. We found 34.8% (n=266) physicians, 8.4% (n=64) dentists, 13.6% (n=104) hospital pharmacists, 15.7% (n=120) community pharmacists, 8.4% (n=64) regulatory pharmacists, 8.3% (n=63) marketing pharmacists and 10.9% (n=83) physicians and pharmacists from distributions and other relevant fields participated in this study. The result showed that 81.4 % (n=622) believed that medical advertisements should seek government approval, 71.3% (n=545) assumed that only registered drugs could be advertised. 34.0% (n=260) answered only prescription drug could be advertised. 7.2% (n=284) showed a negative response towards advertised drugs. 33.0% (n=252) answered that advertising encourages the patients to decide on their choice of a drug without the help of a healthcare professional, while 31.4%(n=240) of the respondents were agreed that advertising provided reliable information regarding a medicine. 36.4% (n=278) of respondents were agree that advertisements increased drugs cost. 32.7% (n=250 and 37.4% (n=286) answered that patients buy an advertised drug without referring a doctor. This study concluded that the awareness regarding PA was low among the healthcare professionals in Pakistan. Healthcare personals were in the favor of advertisement, regardless of little knowledge about the current advertisement rules in the country. Comparatively, Pharmacists have better knowledge of PA than physicians do.

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