The Efficacy of an Intervention Program for Pain Intensity Reduction in Patients Undergoing Arterial Sheath Removal after Coronary Artery Angioplasty

Background: Pain management after sheath removal is one of the most significant points in patient care. The use of a simple, practical, and combined method in this field is essential. The purpose of this study was to evaluate the efficacy of an intervention program for pain intensity reduction in patients undergoing arterial sheath removal after coronary artery angioplasty. Methods: This semi-experimental study was conducted in 2020 on 90 eligible patients selected via the purpose-based method and randomly assigned to experimental and control groups. The intervention program for the experimental group included training to relax the abdominal muscles, deep and slow breathing, and precise pressure on the femoral pulse. Pain intensity was measured before, during, and several times after arterial sheath removal. The independent t, Fisher exact, and χ2 tests were used to analyze the data. Results: Women comprised 66.6% of the study participants, who had a mean age of 58.20±8.70 years. No significant differences were observed concerning pain intensity, bleeding, pseudoaneurysm formation, and hematoma between the 2 groups before the intervention (P=0.531). However, during the intervention and in the fifth and tenth minutes after the intervention, pain intensity was lower in the experimental group (P<0.050), whereas no such differences were observed regarding bleeding, pseudoaneurysm formation, and hematoma. Conclusions: Given the effectiveness of our intervention program in ameliorating pain intensity and vasovagal response after arterial sheath removal, we suggest that this program, along with prescription drugs, be used for the management of patients’ pain.

Does Patient Demand Contribute to the Overuse of Prescription Drugs?

In an experiment in Mali, we tested whether patients pressure providers to prescribe unnecessary medical treatment. We varied patients’ information about a discount for antimalarial tablets and measure demand for both tablets and costlier antimalarial injections. We find evidence of patient-driven demand: informing patients about the discount, instead of letting providers decide to share this information, increased discount use by 35 percent and overall malaria treatment by 10 percent. These marginal patients rarely had malaria, worsening the illness-treatment match. Providers did not use the information advantage to sell injections—their use fell in both information conditions. (JEL D83, I11, I12, O15)

Role of Social Media Promotion of Prescription Drugs on Patient Belief-system and Behaviour

In the current scenario, extremely little information exists on the uses, benefits, and limitations of social media for health communication among the patients and health professionals. Further, how it is affecting the patient belief system and behavior is even less studied, but it is emerging on the research horizon due to its growing significance in this digital age. This is a review article using a systematic approach. We performed a systematic literature search for papers that address social media–related challenges and opportunities for pharmaceutical drugs. It identifies the needs that propel patients to take recourse to SMPs; the benefits they derive from these and their limitations. This review article confirms that healthcare information provided by the social media sites has been found to be beneficial in many ways for the stakeholders and that it complements existing patient-physician interaction. However, it has limitations that need to be explored and understood to avoid ill consequences.

Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

Inhaled antiseptics and inhaled antiviral non-prescription drugs in the prevention of ARVI, in particular COVID-19: an epidemiological study

BACKGROUND. The article presents the results of a continuous, cross-sectional, non-interventional, multicenter retrospective epidemiological study, which included cases of 3443 participants. Questionnaires and rapid test for antibodies to SARS-CoV-2 were used to collect data. OBJECTIVE. To determine the relationship between the systematic use of additional drugs for the prevention of COVID-19, including inhaled antiseptics and inhaled antiviral drugs, separately and in combination with other drugs, and the risk of developing of coronavirus disease (COVID-19). RESULTS AND DISCUSSION. 396 participants (11.8 %) took inhaled antiseptics in any period since March 2020, and 410 participants (12.2 %) took inhaled antivirals. A statistically significant protective relationship between episode of COVID-19 when taking inhaled antiseptics and inhaled antiviral drugs (risk ratio 0.901; 95 % confidence interval 0.856-0.948) was determined. CONCLUSIONS. The use of inhaled antiseptics and inhaled antiviral drugs as additional methods of prevention of COVID-19 has shown a statistically significant effect not only on reducing the risk of COVID-19, but different combinations of inhaled antiseptics or inhaled antiviral drugs with other drug groups as additional methods of preventing COVID-19 had a statistically significant protective relationship with the episode of the disease, with the severity of COVID-19 and with the need for hospitalization.

Factors Associated with Having Family/Whānau or Close Friends Who Used Alcohol or Other Drugs in Harmful Ways among University Students in New Zealand

The consequences of alcohol and other drug (AoD) use are well documented. This study investigated factors associated with having family/whānau or close friend who used AoD in harmful ways in New Zealand. Data came from a July–August 2020 cross-sectional survey of students from eight universities (n = 946). Participants were asked if they had family/whānau or close friends in New Zealand who consumed alcohol or used other drugs (cannabis, ecstasy/MDMA, methamphetamine, cocaine, heroin, prescription drugs, inhalants, or other) in a way that negatively impacted them, their family, or close friends in the last 12 months. Logistic regression assessed associations of having family/whānau or close friend who used AoD harmfully with student characteristics. Of respondents, 36.2% (33.1–39.4) had family/whānau or close friend who had consumed alcohol harmfully, and 42.9% (39.5–46.3) had family/whānau or close friend who had used at least one drug harmfully. Respondents’ age and ethnicity were significantly associated with having family/whānau or close friend who used AoD harmfully. The results suggest widespread harmful AoD use and potentially significant second-hand effects of AoD use in New Zealand. These data can be used to supplement information from traditional in-person surveys of individuals using alcohol and other drug (e.g., the New Zealand Health Survey).

The Prescription of Drugs That Inhibit Organic Anion Transporters 1 or 3 Is Associated with the Plasma Accumulation of Uremic Toxins in Kidney Transplant Recipients

The renal elimination of uremic toxins (UTs) can be potentially altered by drugs that inhibit organic anion transporters 1/3 (OAT1/OAT3). The objective of the present study was to determine whether the prescription of at least one OAT1/OAT3 inhibitor was associated with the plasma accumulation of certain UTs in kidney transplant recipients. We included 403 kidney transplant recipients. For each patient, we recorded all prescription drugs known to inhibit OAT1/OAT3. Plasma levels of four UTs (trimethylamine N-oxide (TMAO), indole acetic acid (IAA), para-cresylsulfate (pCS), and indoxylsulfate (IxS) were assayed using liquid chromatography-tandem mass spectrometry. Plasma UT levels were significantly higher among patients prescribed at least one OAT inhibitor (n = 311) than among patients not prescribed any OAT inhibitors (n = 92). Multivariate analysis revealed that after adjustment for age, estimated glomerular filtration rate (eGFR), plasma level of albumin and time since transplantation, prescription of an OAT1/OAT3 inhibitor was independently associated with the plasma accumulation of pCS (adjusted odds ratio (95% confidence interval): 2.11 (1.26; 3.61]). Our results emphasize the importance of understanding the interactions between drugs and UTs and those involving UT transporters in particular.

Impact of the Pilot Volume-Based Drug Purchasing Policy in China: Interrupted Time-Series Analysis with Controls

Centralizing procurement for prescription drugs has the potential to reduce drug spending by creating economies of scale and by improving purchasing power. In March 2019, the Chinese government launched a volume-based purchasing (VBP) pilot program using a competitive bidding process to purchase accredited generic drugs for which branded drug substitutes were available. We performed an interrupted time-series design to estimate the change in monthly drug purchase quantity and spending comparing 14 months before and 7 months after the VBP pilot. We obtained monthly prescription drug purchase data for all purchases from public medical institutions in the three large pilot cities (Beijing, Shanghai and Xi’an) and two non-pilot cities (Changsha and Zhengzhou) between January 2018 to September 2019. We used negative binomial regression and log-linked Gamma Generalized Linear Model for purchase quantity and spending respectively. We evaluated heterogeneity of impact by pilot city, drug type (selected or non-selected drugs), and therapeutic class (cardiovascular disease, mental disorder and cancer) separately. The implementation of the pilot reform was associated with a 132% (95%-CI: 104–165%, p &lt; 0.001) increase in the purchase quantity of selected drugs in pilot cities compared to an 17% decrease (95%-CI: 9–25%, p &lt; 0.001) in control cities. In contrast, the purchase quantity of branded and other drugs in pilot cities decreased by 38% (95%-CI: 27–46%, p &lt; 0.001) and 77% (95%-CI: 71–81%, p &lt; 0.001), respectively; while in control cities, these remained at similar levels. Overall, in pilot cities, there was a 35% (95%-CI: 28–41%, p &lt; 0.001) decrease in the purchase spending for all drugs in the first post-policy month, from 8.1 billion CNY estimated in the absence of VBP down to 5.3 billion CNY; in control cities, the change was negligible. The largest reduction in spending occurred for drugs for the treatment of cardiovascular diseases. The evidence suggests a positive impact of the VBP pilot in reducing overall drug spending and increasing the use of accredited generics in three pilot cities. This overall trend is not observed in two non-pilot cities. Assessments of long-term impact of the VBP policy on additional key outcomes including drug prescriptions, drug utilization, patients’ health outcomes and payments on drugs are needed.

Older Driver Safety: A Renewed Perspective in a Survey Study in Illinois, U.S

Older adults (aged 65 or older) are at higher risk of involvement in motor vehicle crashes. Many studies have been conducted on older road users’ safety, but how older people’s driving behavior and demographic characteristics, and warnings of side effects of prescription medication, are associated with their crash risk has not been fully investigated. Aimed to address this knowledge gap, a mail survey of older drivers in Illinois, U.S. was conducted. Information on respondents’ driving behaviors, demographic characteristics, physical conditions, medication use, crash experience, etc. was gathered. Response distributions, odds ratios, and logistic regression models were employed to analyze the survey data. The results showed that most respondents kept a high level of mobility despite driving difficulty and medication use. Older drivers’ crash risk is mainly affected by external factors (driving exposure, alcohol consumption, and medication use) rather than their demographic characteristics and driving difficulty. Warnings from physicians on the side effects of prescription drugs had no significant effects on older drivers’ crash risk. Given the importance of mobility to older adults, the focus needs to be placed on providing a safe roadway system and safe driving advice for older drivers, particularly those who are on medication.