Observational and cross-sectional study of prescription pattern in the pediatric out-patient department at a tertiary care center of Bihar

Medical therapy is the most common form of health care provided to the patients. More the practice, more the error is substantiated by the fact that medication errors are probably the most common medical error. Detailed information on these errors is the first step to prevent these errors becoming a health hazard for the individual as well as the society. To generate data on the extent of rational/irrational prescribing pattern, to review the prescribing practices.An observational study with cross sectional design Prescriptions of the patients attending the pediatric OPD were reviewed to collect required data.1200 prescriptions were reviewed that had 3384 drugs listed. The mean age was 8.3± 4.62 years with male> female. Weight of the patient was recorded in 82.8% of the prescriptions. The average number of drugs per prescription was 2.82. The range of drugs per encounter varied from zero to 5. Ailments like minor scratches or other non-organic problems were those where no drugs were prescribed. Around 50% of the drugs prescribed were in generic names. Syrups were most commonly prescribed followed by tablets and capsules. Injection use was very less. Antibiotics were widely used for treatment with 73.8% of the prescriptions had at least one antibiotic.The findings of the current study highlight the continuing crisis of the irrational drug practice in this part of the country. This will help authorities to take necessary action and formulate guidelines on proper and rational drug prescription.

Well Integrity Diagnostics Using Acoustic Event Classification on Distributed Acoustic Sensing Data

Injection wells experience extremes of pressure and temperature as well as expansion and contraction during their normal operating cycles. This can cause numerous well integrity issues related to corrosion, leakage, degradation of barrier elements, operational practices that all put the health of the well at risk and require appropriate management. This paper will describe a case of a North Sea injection well that over time had developed sustained casing pressure (SCP) in the B-annulus. As a critical well in the development it was necessary to understand the origin and nature of the SCP as this would set further operational plans for the well helping to decide whether the well could continue to be operated safely, would require an intervention, or potentially will be abandoned. A leak investigation was needed to try to determine the source of the pressure, the type of fluid causing the pressure, the fluid path, and whether there was an injection out-of-zone as a result. To address all of the set objectives Distributed Fibre Optic (DFO) system was selected as a technology of choice. DFO provides an advantage over traditional leak detection methods through the ability to simultaneously monitor entire length of the well recording both acoustic and temperature profiles. Distributed Acoustic Sensing (DAS) was used to record acoustic signature of the well helping to determine the leak origin and likely pathway, while Distributed Temperature Sensing (DTS) was used to record well outflow profile and advise on possibility of out-of-zone injection. Use of pattern recognition techniques allowed to extract leak signature from background noise and other acoustic signals helping to pinpoint leak location. As a result of the application of DFO technology coupled with appropriate processing techniques way ahead for the well was identified providing an operator with a confident answer and saving on further intervention costs.

P114 STING. Steroid Injections DurinG Covid-19. A cross speciality call

Introduction An important clinical question during the Covid -19 pandemic is the safety of steroid use. Guidelines published by rheumatology, physiotherapy, orthopaedic and pain medicine societies have advised on the restricted use of corticosteroids for musculoskeletal and rheumatic conditions. For clinicians across the specialities there is a challenge to safely conducting best practice, yet ensuring patients have access to the significant functional benefits of steroid injections. Methods The STING prospective service evaluation will collect data on steroid injections undertaken during this part of the pandemic. Clinicians will be able to input information on patient demographics, background Covid risk and steroid injection specifics. At follow up at 4-6 weeks complications and Covid specific outcomes will be recorded, as well as patient perceived symptom improvement. Each unit collecting data will have assigned collaborator(s), with a senior consultant validating the data. Data will be collected and managed using Research Electronic Data Capture (REDCap). Data collection and management will adhere to Caldicott II principles and GDPR. Results Results will be analysed through RedCap and compared to national Covid incidence. Local complication and patient reported outcomes will be compared between specialities, environments and steroid specifics (volume, location etc.). Conclusion A pan-speciality look at steroid injection use during the pandemic will be useful primarily to contribute to understanding the safety of steroid use. Secondarily to look at cross speciality differences in administration, PROMs and to appreciate patient groups who may be excluded from steroid treatment. Join the team! Head to RSTN to get involved.

A scoping review of factors that influence opioid overdose prevention for justice-involved populations

Background There is a high risk of death from opioid overdose following release from prison. Efforts to develop and implement overdose prevention programs for justice-involved populations have increased in recent years. An understanding of the gaps in knowledge on prevention interventions is needed to accelerate development, implementation, and dissemination of effective strategies. Methods A systematic search process identified 43 published papers addressing opioid overdose prevention in criminal justice settings or among justice-involved populations from 2010 to February 2020. Cross-cutting themes were identified, coded and qualitatively analyzed. Results Papers were coded into five categories: acceptability (n = 8), accessibility (n = 4), effectiveness (n = 5), feasibility (n = 7), and participant overdose risk (n = 19). Common themes were: (1) Acceptability of naloxone is associated with injection drug use, overdose history, and perceived risk within the situational context; (2) Accessibility of naloxone is a function of the interface between corrections and community; (3) Evaluations of overdose prevention interventions are few, but generally show increases in knowledge or reductions in opioid overdose; (4) Coordinated efforts are needed to implement prevention interventions, address logistical challenges, and develop linkages between corrections and community providers; (5) Overdose is highest immediately following release from prison or jail, often preceded by service-system interactions, and associated with drug-use severity, injection use, and mental health disorders, as well as risks in the post-release environment. Conclusion Study findings can inform the development of overdose prevention interventions that target justice-involved individuals and policies to support their implementation across criminal justice and community-based service systems.

Decrease in opioid and intra-articular corticosteroid burden after intra-articular hyaluronic acid for knee osteoarthritis treatment

Aim: We studied changes in opioid prescriptions and corticosteroid injection use for knee osteoarthritis patients before and after intra-articular hyaluronic acid (HA) use and opioid prescriptions before and after knee arthroplasty (KA). Materials & methods: A total of 1,017,578 knee osteoarthritis members were ascertained from a commercial claims database (Health Intelligence Company LLC, IL, USA) using ICD9/ICD10 diagnosis codes. Results: Eighty two percent of HA patients did not fill opioid prescriptions postinjection, with 54% of opioid users discontinuing fills. Two-thirds of KA patients filled opioid prescriptions within 6 months postsurgery, with 78% of opioid users continuing fills and 62% of nonusers initiating use. Conclusion: Alternative therapies, such as HA, that reduce opioid use may alleviate opioid addiction risks for KA patients who use opioids in the pre- and postoperative periods.

Risk of Hepatitis E among Persons Who Inject Drugs in Hong Kong: A Qualitative and Quantitative Serological Analysis

Hepatitis E virus (HEV) is an important cause of hepatitis, which can be transmitted via the bloodborne route. However, risk of hepatitis E among persons who inject drugs (PWIDs) is poorly understood. This study aimed to elucidate whether PWIDs are at risk for hepatitis E. We performed HEV IgM, IgG and nucleic acid detection on a cohort of 91 PWIDs and 91 age- and sex-matched organ donors. Blood HEV IgG was measured using the WHO HEV antibody standard. The effects of age, gender and addictive injection use on HEV serostatus and concentration were assessed. HEV IgG seroprevalence was 42/91 (46.2%) in the PWID group and 20/91 (22%) in the donor group (odds ratio = 3.04 (1.59–5.79), p = 0.0006). The median HEV IgG concentration was 5.8 U/mL (IQR: 2.5–7.9) in the PWID group and 2.1 U/mL (IQR: 1.2–5.3) in the donor group (p = 0.005). Increasing age and addictive injection use were significantly associated with HEV IgG serostatus, but only addictive injection use was associated with HEV IgG concentration (p = 0.024). We conclude that PWIDs are at increased risk for hepatitis E and are prone to repeated HEV exposure and reinfection as indicated by higher HEV IgG concentrations.

Effects of Different InGaN/GaN Electron Emission Layers/Interlayers on Performance of a UV-A LED

In this study, we investigated the effects of InGaN/GaN-based interlayer (IL) and electron emitting layer (EEL) consisting of a GaN barrier layer grown with different metal-organic (MO) precursors of gallium (Ga), which were grown underneath the active layer. The growth behavior of GaN with triethyl Ga (TEGa) showed an increasing growth time due to a lower growth rate compared with GaN grown with trimethyl Ga (TMGa), resulting in the formation of columnar domains and grain boundary with reduced defect. UV-A light emitting diode (LED) chips with three types of ILs and EELs, grown with different MO sources, were fabricated and evaluated by light output power (LOP) measurements. The LOP intensity of UVLED-III with the GaN barrier layer-based IL and EEL grown by TEGa was enhanced by 1.5 times compared to that of the IL and EEL grown with TMGa at 300 mA current injection. Use of the GaN barrier layer in ILs and EELs grown by TEGa improved the crystal quality of the post grown InGaN/GaN multiple quantum well, which reduces leakage current. Therefore, for the UV-A LED with ILs and EELs grown with TEGa MO precursors, electrical and optical properties were improved significantly.

Trends in Injection Opioid Use and Bloodborne Pathogen Related Diseases in New Jersey

ObjectiveTo utilize New Jersey’s syndromic surveillance data in the study and comparison of trends in injection opioid use and infection with selected bloodborne pathogens (BBPs) over the years 2013-2017.IntroductionWhen the opioid epidemic began in the early 1990s, pills such as oxycodone were the primary means of abuse. Beginning in 2010, injection use of, first, heroin and then synthetic opioids dramatically increased, which led the number of overdose deaths involving opioids to increase fivefold between 1999 and 2016.1 It would be expected that BBP rates would rise with this increase in injection use, and, nationally, there has been a rise in acute hepatitis C (HCV) rates, although the other two main BBPs, acute hepatitis B (HBV) and acute human immunodeficiency virus (HIV) have been flat and declining, respectively.2,3In this study, we compared New Jersey’s reported incidence of these three BBPs (acute HBV, acute HCV, and HIV) over five years (2013-2017) with syndromic surveillance data for opioid use over the same time period in order to test the hypothesis that emergency department (ED) visits for opioid use could be used as a predictor of BBP infection.MethodsTo indirectly track the number of injection opioid users, we wrote a custom classifier for EpiCenter, New Jersey's statewide syndromic surveillance system, to search ED chief complaints for the number of visits related to injection opioid usage. Our custom classifier creation started with the CDC’s National Syndromic Surveillance Program (NSSP) ESSENCE Chief Complaint Category classifier for opioid overdose.4 As we were looking to count not just overdoses but all visits likely to be associated with injection drug use, we chose not to omit the keyword “withdrawal,” differing from CDC’s classifier in which it is a negative indicator.Positive indicator keywords included “opioid,” “heroin,” “narcot,” “opiate,” “fentanyl,” “naloxo,” “narcan,” "ivdu," and the ICD-9 and ICD-10 codes e850.[0-2], 304, 305.5, f11, t40.[0-6], and 965. These keywords were used to target the chief complaints of people using injection opioids. Negative indicators included “patch,” “allerg,” and “med” to eliminate medical opioid use. Negative indicators also included “vicodin,” “tramadol,” “percocet,” “oral,” and t40.5 to filter out opioids most commonly used in pill form, as well as other drugs.Cases of acute HCV and acute HBV were totaled using CDRSS, New Jersey's Communicable Disease Reporting and Surveillance System. In order to maintain consistency, we used the respective 2012 case definition for each disease. Numbers of new HIV infections were accessed from NJ’s reportable disease list.5 All of the data sets followed the epidemiologic years 2013–2017 (based upon MMWR weeks).ResultsHIV diagnosis rates slightly decreased over time. HBV rates trend upwards, similar to the rates of injection drug use (IDU) for the first three years but start to drop after 2015. Aside from an unexplained dip in 2016, the HCV rates generally track the EpiCenter data for IDU (Figure 1). On a regional scale, NJ’s Northwest region had the highest rates per capita of the five NJ regions and the most similar trending between the HCV and EpiCenter data sets (Figure 2). This result follows the nationwide trend of the opioid epidemic occurring more widely in rural areas, as this region is the most rural region in New Jersey.6In figures 1 & 2, IDU (EpiCenter) and HIV are plotted on the primary (left) axis and HCV and HBV are plotted on the secondary (right) axis.ConclusionsBoth IDU related visits and cases of acute HCV show an ongoing upward trend. This result agrees with the initial hypothesis. However, the association between acute HBV cases and IDU wasn’t as strong. This finding can be attributed to the fact that while HBV is a BBP, it is most commonly transmitted vertically from an infected mother to her child at birth, whereas HCV is primarily transmitted through the sharing of needles or syringes.7,8 There is no apparent relationship between HIV rates and injection drug rates, likely because HIV has a 0.3% infection risk rate from a single infected needlestick versus the 1.8% risk of acquiring HCV and 22-31% risk of acquiring HBV.9References1. Centers for Disease Control and Prevention (CDC), Understanding the Epidemic; August 30, 2017. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 13 July 2018.2. CDC, Viral Hepatitis; May 19, 2016. https://www.cdc.gov/hepatitis/hbv/statisticshbv.htm. Accessed 24 July 2018.3. CDC, HIV in the United States: At A Glance; June 26, 2018. https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 24 July 2018.4. CDC, NSSP Update; May, 2017. https://www.cdc.gov/nssp/documents/nssp-update-2017-05.pdf. Accessed 23 July 2018.5. NJDOH, HIV, STD, and TB Services; December, 2016. https://www.cdc.gov/hiv/statistics/overview/ataglance.html Accessed 27 July 20186. Schranz, A.J., Barrett, J., Hurt, C.B. et al. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep. 2018;15(3):245-254.7. Rolls, David A. et al. Hepatitis C Transmission and Treatment in Contact Networks of People Who Inject Drugs. PLoS ONE. 2013;8(11).8. Perrillo, R.P. Hepatitis B: transmission and natural history. Gut. 1993;34(2):S48-S49.9. Berry, Arnold J. Needle stick and other safety issues. Anesthesiology Clinics of North America. 2004; 22(3):493-508.