Drug use patterns for the prevention of paediatric low cardiac output syndrome in Europe

Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

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Personality, Motivation, and Adolescent Drug Use Patterns

School Psychology Review ◽

10.1080/02796015.1976.12086364 ◽

1976 ◽

Vol 5 (2) ◽

pp. 17-23

Author(s):

Samuel E. Krug ◽

Thomas J. Henry

Keyword(s):

Drug Use ◽

Adolescent Drug Use ◽

Use Patterns ◽

Drug Use Patterns

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Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

Annals of Intensive Care ◽

10.1186/s13613-021-00808-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Rafael Alves Franco ◽

Juliano Pinheiro de Almeida ◽

Giovanni Landoni ◽

Thomas W. L. Scheeren ◽

Filomena Regina Barbosa Gomes Galas ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Prolonged Mechanical Ventilation ◽

Kidney Injury ◽

Composite Endpoint ◽

Tissue Perfusion ◽

Hospital Length Of Stay ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Noninferiority Trial

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

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The Relationship between Self-Reported Religiosity and Drug Use by College Students

Journal of Drug Education ◽

10.2190/4u8t-yrwt-2349-21mj ◽

1979 ◽

Vol 9 (1) ◽

pp. 67-78 ◽

Cited By ~ 17

Author(s):

Carol J. Turner ◽

Robert J. Willis

Keyword(s):

College Students ◽

Drug Use ◽

Private College ◽

Drug Usage ◽

College Counselors ◽

Use Patterns ◽

Current Drug ◽

Drug Use Patterns ◽

Drug Problems ◽

The Relationship

As part of an extensive questionnaire on student drug use patterns at a small private college, this study was completed to determine the relationship between self-reported religiosity of college students and 1) the nature and incidence of current drug usage, 2) reasons for abstaining from drug use, 3) acceptable sources for referral in case of drug problems, and 4) persons with whom students would discuss their attitudes toward drugs. Statistically significant differences between religious and non-religious students at the 0.01 level were found in the current use of alcohol and marijuana, in reasons for abstaining from marijuana, amphetamines, barbiturates, and hallucinogens; in referral of drug problems to drug wise friends; and in discussing drug attitudes with parents and with college counselors.

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