Opinions, Attitudes, and Prescribing Practices of Oral Contraceptive Pills of General Practitioners and Gynecologists in India

Background Prescribing behavior of oral contraceptive pills (OCPs) by physicians, gynecologists, and alternative medicine practitioners (AMPs). Materials and Methods Close-ended questionnaire-based cross-section study was performed between 1st September 2012 and 28th February 2014 in three groups of responders, i.e., AMP, general medical practitioners (GMPs), and obstetricians and gynecologists (ObGy). A stratified random cluster sample was used. Data of 400 subjects in all three groups were obtained using both univariate and multi-variate sophisticated statistical analyses for analyzing attitude and practices and were recorded on an ordinal scale using appropriate non-parametric test. Results Of the 1,237 subjects surveyed, 400 completed questionnaires were received from each of the three groups viz; AMPs, GMPs, and ObGy. Remaining 37 incomplete questionnaires were not included in the final analysis. Conclusion There are equal misconceptions regarding OCPs among users and prescribing physicians. Preference for OCPs in married and unmarried women is also equally low. OCP usage and their prescription practices can be improved by removing potential barriers, developing public–private partnership, and training promoters.

THE INFLUENCE OF MORAL JUDGMENT ON PHYSICIANS' PRESCRIPTION BEHAVIOUR

Pharmaceutical promotion towards physicians’ prescription behaviour is strongly interrelated. Identifying and addressing the ethical challenges in physicians’ prescription behaviour to increase the ethical predisposition of prescribing medicines is prioritized in global health and development plans. Hence, the importance of ethics in the professionalism of healthcare practitioners is now a growing concern. The main objective of this research is to investigate the influence of moral judgment on physicians' prescription behaviour. A survey has been conducted among 152 medical practitioners from private healthcare facilities in the metropolitan area of Kuala Lumpur and Selangor states of Malaysia. The principal component analysis method in EFA and structural equation modelling technique in CFA has been used to analyze the data and validate the model. The study found that physicians’ moral equity factor has a significant and positive influence on physicians’ prescription behaviour whereas their relativism and contractualism factors were not significant. The empirical evidence obtained from this study would make significant contributions to advancing the current knowledge of ethical prescription behaviour. Recommendations to physicians for more ethical prescription practices have been discussed at the end of this paper.

Antimicrobial Prescription Practices for Outpatients with Cystitis: A Multicenter, Medical Record-Based Study

To promote antimicrobial stewardship (AMS) and appropriate antibiotic use, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment in Japan. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, targeting outpatients aged ≥20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). We divided eligible cases into two age groups (20–49 years and ≥50 years) and defined broad-spectrum antimicrobials as fluoroquinolones, third-generation cephalosporins, and faropenem. Primary and secondary outcomes were defined as the prescription rates of broad-spectrum antimicrobials for the disease and the association of antimicrobial types with recurrence. The data of 1,445 patients were collected and that of 902 patients were analyzed. The overall proportion of broad-spectrum antimicrobial prescriptions was 69.1%. The broad-spectrum agents were prescribed frequently in the older group, male patients, and internal medicine. Recurrence was observed in 37 (4.1%) cases, and age, sex, or antimicrobial types were not associated with the recurrence. Hence, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. Administration of broad-spectrum antimicrobials was not associated with the prevention of the recurrence of cystitis.

An observational and cross-sectional study of prescribing pattern of antifungal drugs in a tertiary care center of Bihar

Fungal infections take a toll on the health of all individuals, irrespective of ages, gender, ethnicity etc. But still major researchers have focused on antibacterial rather than antifungal till recent past, when the limelight has moved to antifungal medicines. Adding to the gravity of the situation, is the growing resistance against these drugs. Keeping these facts in mind, this study was planned to delineate the prescribing pattern of antifungal drugs by the various specialty in a tertiary care center in the eastern part of the country. This was an observational and cross-sectional hospital-based study. The study incorporated 218 patients from various departments of the hospital during the study duration that was from March 2021 to September 2021. Descriptive statistics was performed using SPSS ver 20.0. Results has been depicted in formof text and table. Antifungal medicines prescribed mostly for leukemia and other immunocompromised status. Most of the patients came from the department of general medicine. Majority of the patients had hematological disorders followed by infections. Anidulafungin was reported to have been prescribed most commonly by the department of surgery in patients with solid tumors. Patients with lung infections also received this drug by physicians. This use can be justified by its action against invasive aspergillosis, oesophageal candidiasis and peritonitis and intraabdominal abscess caused by candida species. Ketoconazole and clotrimazole were the least used antifungal agents in our study. These two agents are mainly indicated for topical use The current report will aid in understanding antifungal prescription practices. This will also form a basis for future researches and formulating guidelines for rational use of these drugs.

Burkholderia cepacia: An unusual cause of pneumonia

Burkholderia Cepacia is a gram negative organism, an uncommon cause of pneumonia. When isolated, it usually represents colonisation. In the presence of immunocompromising conditions, it can cause disease, ranging from mild illness to the highly fatal Cepacia syndrome. The organism is intrinsically resistant to many antibiotics. We report a 57 years old male farmer, who has diabetes mellitus and bronchial asthma, who presented with a acute history of high grade fever, pain abdomen and cough. He was diagnosed with a ruptured liver abscess, with the infection spreading to the right lower lobe. Laparotomy was performed. Pus culture grew Pseudomonas aeruginosa. He improved upon antibiotic therapy, only to return after one month with severe cough, chest X-ray revealing a lung abscess in the right lower lobe. Bronchoalveolar lavage culture grew Burkholderia cepacia, and sensitive antibiotics were initiated, however the patient succumbed to the illness. The implicated source of the organism was the nebulisation solution which he was using regularly. Emphasis should be laid on the need for improved aseptic practices while using medical solutions at either hospital or home setting. An index of suspicion may guide optimal antibiotic prescription practices in susceptible individuals.

Medications Reconciled at Discharge Versus Admission Among Inpatients at a Children’s Hospital

BACKGROUND AND OBJECTIVES Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. METHODS Electronic medication reconciliation data were extracted for inpatient admissions at The Hospital for Sick Children from January 1, 2016, to December 31, 2017 (n = 22 058). Relative changes in the number of medications and relative risks (RRs) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by the following: sex, age group, diagnosis of a complex chronic condition, surgery, or ICU (PICU) admission. Micronutrient supplements, nonopioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. RESULTS Medication counts at discharge were 1.27-fold (95% confidence interval [CI]: 1.25–1.29) greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a complex chronic condition, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Postsurgical patients had higher RRs of opioid prescriptions at discharge (versus admission; RR: 13.3 [95% CI: 11.5–15.3]) compared with nonsurgical patients (RR: 2.38 [95% CI: 2.22–2.56]). CONCLUSIONS Pediatric inpatients were discharged from the hospital with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in postsurgical patients is a priority target for educational and clinical decision support interventions.

Knowledge about Prescription of the Antibiotic for Endodontic’s Treatment among Final Year Students.

Background: Since antibiotic’s discovery, they have been widely utilized for treatment of the odontogenic infections. Writing a prescription is a vital determining factor of the good doctor/clinician. Drug Prescription is a dynamic and personalized clinical process, which is established as a result of necessities of the patient & acquaintance of practitioner & is also the component of curriculum of graduation. Aim: To evaluate and assess knowledge about prescription of the antibiotic during the endodontics’s treatment and the errors made by final year students at the dental hospital. Setting: Multan Medical & Dental College Multan Methodology: This survey-based research was led among 48 students of Multan Dental College Multan. A form was designed, regarding pattern of the antibiotic’s prescription & conditions/situations for which the drugs were recommended by students of final year. Results: The medication of choice was mostly Amoxicillin alone (75%) and Amoxicillin + clavulanic acid (55%). Most of antibiotic prescriptions were written for Perio-endo lesion (85%), acute apical abscess (80%). Chronic apical abscess with sinus tract (80%), Ch. apical abscess with periodontitis (65%), Patients with swelling & difficulty in swallowing (62%). In this study the greatest numbers of antibiotics prescribed were prophylactically for congenital cardiac sicknesses 69.7%, and uncontrolled diabetes mellitus 60%. Prosthetic joint in past 2 years 40% & Chemo/radio therapy 30%. Conclusion: There is a dearth of knowledge as well as information concerning the suitable indication, kind, & dose of the antibiotics in practice of dentistry. The curriculum should propose great accent on prescription, and decent prescription practices should also be taught in clinical rotation’s, using actual or imaginary cases. Keywords: Antibiotics, Endodontics, Prescription writing, prophylaxis, Root canal treatment (RCT)

Optimizing Post-Cesarean Opioid Prescription Practices at Mayo Clinic: A Quality Improvement Initiative

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

Prescription Practices of Medical Cannabinoids in Children with Cerebral Palsy - A Survey of the Swiss Cerebral Palsy Registry

Aim Medical cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess the prescription practices of cannabinoids in children with cerebral palsy with a particular focus on indications and preparations used and how well cannabinoids are tolerated. Furthermore, we investigated how physicians acquire knowledge on cannabinoid medication. Methods We asked physicians with expertise in the care of children with CP on their prescription practices of medical cannabinoids. Data was collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, about experiences regarding efficacy and the observed side effects of the therapy. Results Seventy physicians from Europe, North America and Australia completed the survey. Forty-seven participants were experienced in the treatment of children with cerebral palsy by cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The prescribed preparations and doses varied considerably. Half of the participants evaluated the effect of the medical cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently in the form of drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhoea (13%). Conclusions Despite the lack of evidence to date, medical cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.