scholarly journals Assessment of drug utilization pattern of steroids in a district general hospital in Amravati region

2019 ◽  
Vol 5 (2) ◽  
pp. 57-64
Author(s):  
Mulchand Shende ◽  
Bhupesh Ghutke ◽  
Dhanshree Panekar ◽  
Aparna Kachewar
Keyword(s):  
Patient Safety ◽  
Adverse Effects ◽  
General Hospital ◽  
Steroid Therapy ◽  
Skin Diseases ◽  
Demographic Data ◽  
District General Hospital ◽  
Prescribing Patterns ◽  
Facial Swelling

Introduction: Rational use of corticosteroids is very important in the long term for improving patient safety. The main objective of the study was to analyze the prescribing patterns of steroids in a district general hospital, Amravati. Materials and methods: A prospective observational study was carried out over a period of six months in a district general hospital. All patients receiving any category of steroid therapy were enrolled, and the prescribing tapering patterns of steroids were reviewed. The demographic data, disease data and data on the utilization of various steroids were analyzed, and the knowledge of the patients was assessed by using a Michigan questionnaire. Results and discussion: 179 patients were recruited for the study. Steroids were prescribed for various (29.6%) respiratory conditions, (10.1%) CVS diseases, (11.7%) CNS, (1.6%) in hepatic disorders, (1.1%) musculoskeletal disorders, (3.4%) skeletal disorders, (0.6%) renal impairments, (3.9%) GI disorders, (19.0%) skin diseases and (19.0%) other diseases. The utilization of steroid dexamethasone was the most commonly prescribed to 111 patients (63.8%) followed by hydrocortisone (57 patients, 32.8%) and prednisolone (6 patients, 3.4 %). Dexamethasone was most commonly associated with adverse effects (1.8% of such as headaches, abdominal pains, and rashes), followed by prednisolone (0.8% of such as facial swelling), clobetasol (0.4%) and fluticasone (0.4 %). Conclusions: Very little variation was found in the prescription pattern amongst the healthcare professionals. Most of the drugs were prescribed rationally; the significance of the study is to improve the patient safety in the long-term use of steroid therapy by observing the prescribing patterns as irrational use of steroids can increase the risk of adverse effects.

Long-term follow-up of patients who had bronchial carcinoid tumours resected in a district general hospital

Lung Cancer ◽  
2019 ◽  
Vol 127 ◽  
pp. S63-S64
Author(s):  
M. Mccloskey ◽  
C. Yarr ◽  
K. Grant ◽  
M. Doherty ◽  
R. Sharkey ◽  
...  
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Bronchial Carcinoid ◽  
Carcinoid Tumours ◽  
Long Term Follow Up

scholarly journals Colonoscopy at a Combined District General Hospital and Specialist Endoscopy Unit: Lessons from 505 Consecutive Examinations

2002 ◽  
Vol 95 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Siwan Thomas-Gibson ◽  
Catherine Thapar ◽  
Syed G Shah ◽  
Brian P Saunders
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
British Society ◽  
Completion Rates ◽  
Endoscopy Unit ◽  
Pain Scores ◽  
Training And Supervision ◽  
Long Term Follow Up

Provisional reports from the Intercollegiate British Society of Gastroenterology National Colonoscopy audit show completion rates of 57–77%for the procedure and poor levels of training and supervision. We prospectively audited all aspects of colonoscopy performed at a combined district general hospital and specialist endoscopy unit. Details of referral, examination, endoscopist, complications and follow-up were recorded and patients were sent questionnaires for long-term follow-up. 505 patients (246 male) underwent colonoscopy by 27 different endoscopists. Their median age was 57 years (range 13–92) and 93%were outpatients. 64% patients were symptomatic and 36%were having surveillance or follow-up colonoscopy. The overall caecal intubation rate was 93%, with little difference between surgeons, physicians and experienced trainees (89%, 92%, 94%) and specialist endoscopists (98%). In only one case was an inexperienced trainee (<100 procedures) unsupervised. Pain scores estimated by the endoscopist were well matched with those given by the patient—medians 29 and 26 (maximum 100) respectively. Median satisfaction score was 96 (maximum 100). Polyp pick-up rate was 26.9%and there were 11 new cancers. 16 (3%) minor immediate complications were recorded—5 oversedation, 6 vasovagal attacks, 3 polypectomy haemorrhages and 2 mucosal injuries (neither requiring treatment). 3 patients died within 6 months of follow-up but no death was colonoscopy related. Completion rates in this setting were adequate for all endoscopists studied. Patient satisfaction with the procedure was high and very few immediate or long-term complications were encountered.

scholarly journals Latissimus dorsi myocutaneous reconstruction: a study of long-term outcomes in a district general hospital

2016 ◽  
Vol 98 (8) ◽  
pp. 574-577 ◽  
Author(s):  
C Kallaway ◽  
A Humphreys ◽  
N Laurence ◽  
R Sutton
Keyword(s):  
General Hospital ◽  
Latissimus Dorsi ◽  
Capsular Contracture ◽  
District General Hospital ◽  
Latissimus Dorsi Flap ◽  
Protective Mechanism ◽  
Term Outcome ◽  
Long Term Outcome

INTRODUCTIONThe aim of this study was to evaluate the long-term outcome and durability of both autologous and implant-assisted latissimus dorsi reconstruction in a district general hospital over a 10-year follow-up period.METHODSA prospective cohort study was carried out using a detailed database of all latissimus dorsi flap reconstructions performed by a single consultant surgeon between 2003 and 2013 at the Royal United Hospital, Bath. The long-term outcome following reconstruction was assessed by analysing all episodes of ‘reconstruction-specific’ operations required from 6 months after the initial surgery.RESULTSThe study included 110 patients with latissimus dorsi flap reconstructions, 21 autologous and 95 implant-assisted. Radiotherapy was given to 27 patients with reconstructed flaps. Mean follow-up was 69 months. Further reconstruction-specific surgery was needed in 27 (23%) cases, with 5 of these being post-radiotherapy flaps. Implant-related surgery was the most common reason for further surgery. Complications of the implant itself made up 52% of these cases, chronic sepsis being the most common. The rate of symptomatic capsular contracture requiring further surgery was 4.2%. Of these, one of four patients had undergone radiotherapy.DISCUSSIONIn our institution, latissimus dorsi reconstruction is durable and safe over the long term, with limited need for further substantial intervention to maintain a good outcome from the initial reconstruction. Autologous flaps were less likely to require further surgery over the long term compared with implant-based reconstructions. The low rate of symptomatic capsular contracture may be due to the protective mechanism provided by the extended harvest flap used.

scholarly journals Steroid induced psychiatric adverse effects: an overview of risk factors, clinical features and management

2020 ◽  
Vol 8 (6) ◽  
pp. 2365
Author(s):  
Anant Parasher ◽  
Jeplin Bez
Keyword(s):  
Adverse Effects ◽  
Steroid Therapy ◽  
Wound Repair ◽  
Glucocorticoid Receptors ◽  
Psychiatric Symptoms ◽  
Immunosuppressive Drugs ◽  
Psychotic Symptoms ◽  
Metabolic Disturbances ◽  
Duration Of Treatment

Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients. 

A Decreased Incidence of Necrotizing Enterocolitis After Prenatal Glucocorticoid Therapy

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 682-688 ◽  
Author(s):  
Charles R. Bauer ◽  
John C. Morrison ◽  
W. Kenneth Poole ◽  
Sheldon B. Korones ◽  
John J. Boehm ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Necrotizing Enterocolitis ◽  
Steroid Therapy ◽  
Short Term ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Intestinal Maturation ◽  
Blinded Trial ◽  
Long Term Adverse Effects

In a large multicentered, collaborative randomized and blinded trial utilizing antenatal corticosteroids, the goals included determining the effectiveness of these agents in accelerating lung maturation, as well as monitoring any short-term or long-term adverse effects of this treatment on the parturient, fetus, and/or infant. More than 100 specific items, pertaining to diagnoses, complications, and outcomes were recorded for the 696 mothers enrolled in the study and their 745 infants. A significantly decreased incidence of necrotizing enterocolitis (P = .002) was found in the infants treated with steroids. The possibility of accelerated intestinal maturation induced by antenatal maternal steroid therapy exists. This treatment regimen is particularly attractive as adverse aspects of steroid therapy at the dosage utilized have not been demonstrated.

scholarly journals Antibiotics prescribing patterns in medical wards of Yangon General Hospital, Myanmar

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Aye Thi Khaing ◽  
Nang Hla Hla Win
Keyword(s):  
General Hospital ◽  
Demographic Data ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Medical Wards ◽  
Pro Forma

Introduction: Irrational and inappropriate prescribing of antimicrobial is common in hospitals and contributes to the development of antibiotic resistance in clinical practice. In Myanmar, there is insufficient information concerning antibiotics prescribing patterns in some hospitals. Therefore, the aim of this study was to determine the prescribing patterns of antibiotics in various infections. Methods: A descriptive cross-sectional study was carried out over a 3- month period in the medical wards of Yangon General Hospital. A total 1054 patients who were prescribed with antibiotics for post-admission day were selected. Relevant demographic data, discharge diagnosis, antibiotic prescribing patterns and outcomes of the patients were collected through pro-forma. Results: The result revealed that the antibiotics prescribing rate in Yangon General Hospital was 49%. Amongst the major indications included acute gastroenteritis (10%), chest infections (6.8%), skin and soft tissue infections (6.5%), pneumonia (6.1%) and spontaneous bacterial peritonitis (6.0%). The most frequently prescribed antibiotics were combination of aminopenicillin with beta lactamase inhibitors (29.4%), metronidazole (28.2%), ceftriaxone (24.4%), azithromycin (15.2%) and cefixime (12.8%). The majority of the patients were discharged from hospital (73.7%) whereas the expired population was 8.6%. Conclusions: This study offers useful information in developing antibiogram for medical wards of Yangon General Hospital, Myanmar. The findings of this study could contribute to improvement in the treatment outcomes.

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