scholarly journals Clinically Relevant Drug-Drug Interactions and Management Strategies: A Hospital based Study

2020 ◽  
Vol 2 (2) ◽  
pp. 109-114
Author(s):  
Arun Sharma ◽  
Sitaram Khadka ◽  
Bimal Kunwar ◽  
Kapil Amgain ◽  
Rinku Joshi ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Management Strategies ◽  
Clinical Importance ◽  
Cross Sectional Study ◽  
Automated System ◽  
Clinical Settings ◽  
Evaluation Tool ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Clinically Significant

Background: Drug-drug interactions (DDIs) are one of the significant drug related problems encountered in clinical settings. Better understanding of the mechanisms, severity, and likely consequences of clinically significant DDIs are essential for proper medication therapy management (MTM). This study is conducted with the aim to aware clinical practitioners about clinically significant DDIs that occur in clinical settings and to help them manage such events with the accurate knowledge and technique. Methods: A descriptive cross-sectional study was conducted in Shree Birendra Hospital, Kathmandu on the prescription of medical out-patient department from June to November 2020. Total 483 prescriptions were selected randomly. A panel of physicians, pharmacologists and clinical pharmacists under the supervision of a consultant physician using MICROMEDEX DRUG-REAX, Evaluation of Drug Interactions, Drug Interaction Facts, Drug Interactions: Analysis and Management was conducted. Main outcome measure was obtained by the supervisor’s endorsement on panelists' opinion about clinical importance of DDIs. Results: A total of 2006 medicines were prescribed in 483 prescription samples. The number of drugs per prescription was in a range from 2 to 11 with 4.15 on average. DDIs were found in 21.53% prescriptions (n=104). 168 DDIs were identified with major, moderate, and minor types in 32 (19%), 85 (51%), and 51 (30%) respectively. As per occurrence, the panel determined that 13 interactions were clinically important. Conclusion: The drug interactions identified by a panel of expert using standard evaluation tool are considered to be clinically important and likely to occur in the clinical settings. Clinically significant DDIs can be preventable and can also be used for the beneficial effects in MTM. Adequate knowledge regarding nature of DDIs, inclusion of automated system in prescribing and dispensing area, and inter-professional collaboration of a clinical team is liable to prevent and manage such events and help in rational drug therapy.

scholarly journals Time to blood cultures positivity of microorganisms using a continuous-monitoring automated blood cultures system

2019 ◽  
Vol 13 (2) ◽  
pp. 61-69
Author(s):  
Pajaree Krisanapan ◽  
Romanee Chaiwarith
Keyword(s):  
Blood Culture ◽  
Continuous Monitoring ◽  
Hematologic Malignancy ◽  
Cross Sectional Study ◽  
Blood Cultures ◽  
Common Source ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Blood Culture Positivity ◽  
Clinically Significant

Abstract Background Previous studies showed that clinically significant pathogens were detected within 3 days of incubation using a continuous monitoring automated blood culture instrument. Objectives To determine time to blood culture positivity (TTP) of microorganisms using a BD BACTEC™ FX. Methods A cross-sectional study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand from October to November 2014. Results One-hundred and eighty-one patients with 195 episodes of infection and 436 cultures were included in the analysis. Among 181 patients, 55.2% were male and the median age was 61 years (interquartile range (IQR) 50, 76). Of the 195 episodes of infections, the most common source was genitourinary tract (15.4%). Overall, the median TTP was 17 hours (IQR 11.5, 24.5), the shortest TTP was observed in Streptococcus agalactiae. Four-hundred and seventy-eight cultures (97.6%) and all (100%) were detected at 3 days and 5 days of incubation. Factors associated with TTP ≤24 hour were blood drawn from patients who had hematologic malignancy (odds ratio (OR) 9.6, 95% confidence interval (CI) 1.2, 74.3, P = 0.030), endocarditis and vascular infection (OR 8.7, 95% CI 1.1, 67.2, P = 0.038), thrombocytopenia (OR 2.4, 95% CI 1.3, 4.4, P = 0.004), clinical of systemic inflammatory response syndrome (SIRS) (OR 2.3, 95% CI 1.2, 4.5, P = 0.014), and not receiving antimicrobials within 72 hours before cultures taken (OR 2.2, 95% CI 1.4, 3.6, P < 0.001). Conclusions TTP varied depends upon the pathogens and clinical settings. However, bacteria were isolated from almost, but not all of the blood cultures within 3 days of incubation.

scholarly journals Potentially Inappropriate Prescribing and Potential Clinically Significant Drug–Drug Interactions in Older Outpatients: Is There Any Association?

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 332
Author(s):  
Zorica Cvetković ◽  
Aneta Perić ◽  
Silva Dobrić
Keyword(s):  
Drug Interactions ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Inappropriate Drugs ◽  
Stopp Criteria ◽  
Clinically Significant

Background and Objectives: The purpose of the study was to determine the prevalence rate of potentially inappropriate prescribing (PIP), by using the Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria in older outpatients, and its association with potential clinically significant drug–drug interactions (csDDIs). Materials and Methods: A cross-sectional study included 248 outpatients ≥65 years old divided into two groups depending on the presence of csDDIs. For estimating the clinical significance of csDDIs we used Medscape′s "Drug Interaction Checker". We applied the thirty PIP indicators from the STOPP criteria. Results: The presence of PIP (25.00%; all patients) was significantly higher in the group with potential csDDIs compared to the other group (43 vs. 19, respectively; Chi-square test, χ2 = 9.947; p < 0.01). The most common PIP included the inappropriate use of proton pump inhibitors, long acting benzodiazepines, usage of thiazide diuretic in patients with gout, and duplication of therapeutic class. Patients with potential csDDIs had 43 potentially inappropriate medications (PIMs) prescribed. Out of this number, 12 (27.91%) PIMs were identified to participate in potential csDDIs. There was a correlation between the number of medications prescribed and the number of PIMs (ρ = 0.297; p < 0.01) and between the number of PIPs and the number of potential csDDIs (ρ = 0.170; p < 0.01). Conclusions: Older outpatients with potential csDDIs in relation to those with no potential csDDIs had significantly more prescribed drugs in total as well as inappropriate drugs. Almost 30% of these PIMs were included in potential csDDIs.

DRUG INTERACTIONS IN OUTPATIENT TREATMENT AT THOT NOT GENERAL HOSPITAL

2021 ◽  
Vol 62 (5) ◽  
Author(s):  
Nguyen Tran Cam Tu ◽  
Tran Do Hung ◽  
Do Van Mai
Keyword(s):  
Drug Interactions ◽  
General Hospital ◽  
Clinical Significance ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Outpatient Treatment ◽  
District General Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Clinically Significant

Objective: Analyzing drug interactions in outpatient treatment at Thot Not District General Hospital in 2020.Subjects and methods: cross-sectional study on 400 prescriptions for insured patients with outpatient medical records at Thot Not general hospital from January 1st, 2020 to June 30th, 2020.Results: Five pairs of clinically significant drug interactions were recorded with the databases used in the study. The rate of prescription of drug interactions with clinical significance was 11%. The number of prescriptions with a drug interaction accounted for the highest proportion (10.8%) and only one prescription with two drug interactions detected (0.2%). The pair of drug interactions thatappeared with the most frequency were clopidogrel and proton pump inhibitors (34.1%), followed by interactions between aspirin and NSAIDs (25%), interactions between codeine and clopheniramin(20.4%). There was no relationship between the patient’s age and the ability of drug interactions (p> 0.05) but there was an association between the sex and the amount of drugs used in the prescriptionand the ability of drug interactions was statistically significant (p <0.05).Conclusion: The rate of prescription drug interactions with clinical significance was 11%. The pair of drug interactions that appeared with the most frequency were clopidogrel and proton pump inhibitors(34.1%). There was an association between the sex and the amount of drugs used in the prescription and the ability of drug interactions was statistically significant (p <0.05)

Gambling-like video game practices: A cross-sectional study of links with problem gambling and disordered gaming

2019 ◽  
Author(s):  
David Zendle
Keyword(s):  
Video Games ◽  
Problem Gambling ◽  
Video Game ◽  
Large Scale ◽  
Significant Degree ◽  
Cross Sectional Study ◽  
Video Gaming ◽  
Cross Sectional ◽  
Streaming Services ◽  
Clinically Significant

A variety of practices have recently emerged which are related to both video games and gambling. Most prominent of these are loot boxes. However, a broad range of other activities have recently emerged which are also related to both gambling and video games: esports betting, real-money video gaming, token wagering, social casino play, and watching videos of both loot box opening and gambling on game streaming services like Twitch.Whilst a nascent body of research has established the robust existence of a relationship between loot box spending and both problem gambling and disordered gaming, little research exists which examines whether similar links may exist for the diverse practices outlined above. Furthermore, no research has thus far attempted to estimate the prevalence of these activities.A large-scale survey of a representative sample of UK adults (n=1081) was therefore conducted in order to investigate these issues. Engagement in all measured forms of gambling-like video game practices were significantly associated with both problem gambling and disordered gaming. An aggregate measure of engagement was associated with both these outcomes to a clinically significant degree (r=0.23 and r=0.43). Engagement in gambling-like video game practices appeared widespread, with a 95% confidence interval estimating that 16.3% – 20.9% of the population engaged in these activities at least once in the last year. Engagement in these practices was highly inter-correlated: Individuals who engaged in one practice were likely to engage in several more.Overall, these results suggest that the potential effects of the blurring of lines between video games and gambling should not primarily be understood to be due to the presence of loot boxes in video games. They suggest the existence of a convergent ecosystem of gambling-like video game practices, whose causal relationships with problem gambling and disordered gaming are currently unclear but must urgently be investigated.

scholarly journals Parent and Child Factors Associated with Household versus Community Adversity among Black and Hispanic Children

2021 ◽  
Author(s):  
Kristen R. Choi ◽  
Tatum Stewart ◽  
Jewel D. Davies ◽  
Sara Naureckas ◽  
Angela Venegas-Murillo ◽  
...  
Keyword(s):  
Behavioral Problems ◽  
Clinical Sample ◽  
Cross Sectional Study ◽  
Clinical Settings ◽  
Hispanic Children ◽  
Cross Sectional ◽  
Childhood Experiences ◽  
Factors Associated ◽  
Trauma Informed Care ◽  
Trauma Informed

AbstractThe purpose of this study was to describe exposure to within-household and community adverse childhood experiences (ACEs) and to identify child- and parent-level factors associated with exposure to different kinds of ACEs. This cross-sectional study used a clinical sample of 257 Black and Hispanic children ages 3–16 years and their caregivers who were seeking care at two federally qualified health centers in Chicago, Illinois and screened positive for a behavioral health problem. The sample had high levels of within-household ACEs (76% reported at least one) and community ACEs (71% reported at least one). Black children experienced more overall and within-household ACEs than Hispanic children, including forced separation from a caregiver and family member incarceration. Hispanic children experienced more bullying and violent media exposure. Significant associations to all categories of ACEs were observed for depression, child behavioral problems, and older child age. Tailored assessment of ACEs and interventions such as trauma-informed care are needed in pediatric clinical settings, including assessment of ACEs children in experience in communities.

scholarly journals Knowledge and Practice of Health Professionals in the Management of Dysphagia

2021 ◽  
Vol 18 (4) ◽  
pp. 2139
Author(s):  
Eduardo Sánchez-Sánchez ◽  
Ylenia Avellaneda-López ◽  
Esperanza García-Marín ◽  
Guillermo Ramírez-Vargas ◽  
Jara Díaz-Jimenez ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Clinical Settings ◽  
Sectional Study ◽  
Swallowing Disorder ◽  
Cross Sectional ◽  
Anonymous Questionnaire ◽  
Knowledge And Practice ◽  
Definition Of ◽  
Management Of Dysphagia

The aim of this study was to determine healthcare providers’ knowledge and practices about dysphagia. A descriptive cross-sectional study was carried out based on a self-administered and anonymous questionnaire addressed to healthcare providers in Spain. A total of 396 healthcare providers participated in the study. Of these, 62.3% knew the definition of dysphagia as a swallowing disorder. In addition, up to 39.2% of the participants reported that they did not know whether the EatingAssessmentTool (EAT-10) dysphagia screening test was usedin their own clinical settings. Similarly, up to 49.1% of them did not know the ClinicalExaminationVolume-Viscosity (MECV-V) method. Nearly all participants (98.8%) reported that thickeners must be used forall liquids administered to patients. A higher percentage of respondents based the choice of texture on patient’s tolerance (78.2%) rather than on the MECV-V result (17.3%). In addition,76.4% of the professionals had witnessed a bronchoaspiration; after it, 44.4% (n = 175) of them reported the appearance of pneumonia, and 14.5% (n = 57) the death of the patient (p = 0.005). The participants revealeda moderate/low knowledge ofthe definition, diagnosis, and clinical management of liquid dysphagia, which indicates some room for improvements.

scholarly journals Diabetic maculopathy: multicolour and SD-OCT versus fundus photography

2021 ◽  
Vol 6 (1) ◽  
pp. e000514
Author(s):  
Obaid Kousha ◽  
Martina Maria Delle Fave ◽  
Mariano Cozzi ◽  
Elisa Carini ◽  
Sergio Pagliarini
Keyword(s):  
Macular Oedema ◽  
Cross Sectional Study ◽  
Fundus Photography ◽  
Diabetic Maculopathy ◽  
Perfect Agreement ◽  
Cross Sectional ◽  
Clinically Significant ◽  
Fundus Photographs ◽  
Diabetic Eye Screening ◽  
Sd Oct

ObjectiveThe English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening.Methods and analysisThis cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.ResultsIntergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema.ConclusionMulticolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.

Ophthalmologists and WhatsApp: Teleophthalmology is already here

2021 ◽  
pp. 112067212110026
Author(s):  
Edward Barayev ◽  
Ofri Vorobichik Berar ◽  
Gad Dotan ◽  
Alon Skaat ◽  
Orly Gal-Or ◽  
...  
Keyword(s):  
Medical Records ◽  
Cross Sectional Study ◽  
Work Hours ◽  
Clinical Settings ◽  
Sectional Study ◽  
Cross Sectional ◽  
Policy Makers ◽  
Media Messages ◽  
Rapid Responses ◽  
Wide Availability

Purpose: To estimate the extent of WhatsApp utilization using text and media messages for inter-physician consultations among ophthalmologists (residents and specialists) at various clinical settings and its perceived benefits for ophthalmologists and their patients. We also aimed to detect obstacles that concern ophthalmologists when using WhatsApp as a consultation platform. Methods: This was a cross-sectional study using a self-administered survey through Google Forms, which was sent to 660 practicing ophthalmologists during April to May 2020. Results: One hundred and ninety-two ophthalmologists completed the questionnaire, 151 of which (78.6%) were specialists and 41 (21.4%) were residents. Most ophthalmologists reported using WhatsApp at least once a day for both personal and professional use. Residents reported lower rates of contacting patients using WhatsApp than specialists (1.51 ± 0.98 vs 2.72 ± 1.32, p < 0.001). Respondents reported WhatsApp consultations frequently replaced referrals of patients to other physicians, with a median of once a week. 97.8% of residents and 91.4% of specialists reported the ability to share media is a major advantage of WhatsApp over other medias, followed by rapid responses for consultations. Conclusion: Many ophthalmologists already use WhatsApp as a tool for professional consultations with other providers, mainly thanks to its simplicity and wide availability. Residents use it more frequently than specialists, and ranked it higher when asked how much WhatsApp has improved the clinical setting. Policy makers should address concerns brought up by physicians, such as documentation in medical records and proper compensation for consulting ophthalmologists during and after work hours.

scholarly journals Clinical Assessment and Management of Spondyloarthritides in the Middle East: A Multinational Investigation

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammed Hammoudeh ◽  
Hanan Al Rayes ◽  
Adel Alawadhi ◽  
Kamel Gado ◽  
Khalid Shirazy ◽  
...  
Keyword(s):  
Middle East ◽  
Disease Burden ◽  
Clinical Laboratory ◽  
Management Strategies ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
East Region ◽  
Appropriate Treatment ◽  
Treatment Data ◽  
Middle East Region

Data on spondyloarthritis (SpA) from the Middle East are sparse and the management of these diseases in this area of the world faces a number of challenges, including the relevant resources to enable early diagnosis and referral and sufficient funds to aid the most appropriate treatment strategy. The objective was to report on the characteristics, disease burden, and treatment of SpA in the Middle East region and to highlight where management strategies could be improved, with the overall aim of achieving better patient outcomes. This multicenter, observational, cross-sectional study collected demographic, clinical, laboratory, and treatment data on 169 consecutive SpA patients at four centers (Egypt, Kuwait, Qatar, and Saudi Arabia). The data collected presents the average time from symptom onset to diagnosis along with the presence of comorbidities in the region and comparisons between treatment with NSAIDs and biologics. In the absence of regional registries of SpA patients, the data presented here provide a rare snapshot of the characteristics, disease burden, and treatment of these patients, highlighting the management challenges in the region.

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