Hubungan Rasionalitas Penggunaan Obat Nyeri Terhadap Tingkat Nyeri Pada Lansia Dengan Osteoarthritis Di Panti Pelayanan Sosial Lanjut Usia Bisma Upakara Pemalang Tahun 2021

Osteoarthritis is a degenerative joint disease characterized by cartilage damage and often occurs in the elderly. Diseases that are often found in the community. Management of osteoarthritis is aimed at controlling or relieving pain. Inappropriate drug selection can cause the drug to be ineffective, exacerbate a disease, and cause unwanted effects. This study aims to determine the relationship between the rationality of the use of pain medication on the level of pain in the elderly with osteoarthritis. The research design is a descriptive correlative study with a cross sectional approach. The sampling technique used was total sampling with a total of 43 respondents. Data collection tools using a questionnaire and statistical tests using the Kolmogorov Smirnov test. The results of the study found that the percentage related to rationality of rational pain medication (69.8%) was irrational (30.2%) and at the level of pain experienced mild pain (18.6%), moderate pain (67.4%), and moderate pain. weight (14.0%). Statistical test results obtained p value of 0.042 (<0.05) Ho is rejected, which means that there is a significant relationship between the rationality of pain medication use and pain levels in the elderly with osteoarthritis at the Bisma Upakara Elderly Social Service Institution, Pemalang. . The results of this study recommend for health workers to provide or improve health education related to the rationality of using pain medication.Keywords: Pain, Osteoarthritis, Rationality AbstrakOsteoarthritis adalah penyakit radang sendi degeneratif dengan di tandai dengan adanya kerusakan kartilago dan sering terjadi pada lansia .Penyakit yang sering dijumpai pada masyarakat. Penatalaksanaan osteoarthritis ditujukan pada pengendalian atau menghilangkan nyeri. Pemilihan obat yang tidak tepat dapat menyebabkan obat menjadi tidak berkhasiat, memperparah suatu penyakit, dan menimbulkan efek yang tidak diinginkan.Penelitian ini bertujuan untuk mengetahui hubungan rasionalitas penggunaan obat nyeri terhadap tingkat nyeri pada lansia dengan osteoarthritis. Desain penelitian studi deskriptif korelatif dengan pendekatancross sectional. Teknik pengambilan sampel menggunakan total samplingdengan jumlah 43 responden. Alat pengumpulan data menggunakan kuesioner dan uji statistik menggunakan uji Kolmogorov Smirnov. Hasil dari penelitiandidapatkan persentase terkait rasionalitas obat nyeri yang rasional (69,8%) tidak rasional (30,2%) dan pada tingkat nyeri yang mengalami nyeri ringan (18,6%), nyeri sedang (67,4%), dan nyeri berat (14,0%).hasil uji statistik didapatkan p value sebesar 0,042 (< 0,05) yang berarti ada hubungan yang signifikan rasionalitas penggunaan obat nyeri terhadap tingkat nyeri pada lansia dengan osteoarthritis di Panti Pelayanan Sosial Lanjut Usia Bisma Upakara Pemalang. Hasil peneltian ini merekomendasikan bagi tenaga kesehatan untuk memberikan atau meningkatkan pendidikan kesehatan terkait dengan rasionalitas penggunaan obat nyeri. Kata kunci : Nyeri; Osteoarthritis; Rasionalitas

Reduction of drug-drug interaction and inappropriate prescription in polymedicated elderly who consult in the ambulatory

Introduction: Older adults or elderly people over 64 years of age are patients more vulnerable to suffering adverse events related to medication, and this can generate states of both physical and psychological discomfort, loss of autonomy, mental disorders, etc. Objectives: To analyze the drug-drug interaction and inappropriate prescription of drugs in the outpatient setting in the elderly and implement barriers to reduce this problem. Materials and methods: Quasi-experimental study, of the before after type. The Beers 2019 criteria were used to assess inappropriate drug prescribing. The Uptodate definition of drug-drug interactions and their classification were used. Results: 203 polypathological, sarcopenic elderly patients were studied. These patients attended the outpatient consultation during the 2016-2018 period. 99 patients participated in the pre-intervention and 104 in the post-intervention. The distribution by sex was: 110 (54.2%) women and 93 (45.8%) men. The mean age was 77.3 + 13.3 years. In the total sample analyzed before the intervention, 33 (33.3%) showed inappropriate prescription of drugs criteria. Drug interactions in the pre-intervention were present in 51 patients (51.5%). After the intervention that consisted of training doctors with the Beers criteria and editing a list with clinically relevant interactions in the elderly, which can cause adverse events, inappropriate prescription was reduced to 26 patients (25%), p = 0.05, and clinically relevant interactions were reduced from 51 (51.51%) to 12 (11.53%), p = 0.003. The association between inappropriate prescription and clinically relevant interactions is OR: 3.23 (95% CI 1.91-3.88). Conclusions: The proportion of patients with inappropriate prescription is within the ranges published by various authors as well as drug interactions, the intervention was good to reduce the two problems in this sample of patients.

Analysis of the potential inappropriate use of medications in pediatric outpatients in China

Background The appropriate use of medications is essential in children. Yet, detailed information on how drugs are being prescribed and dispensed to pediatric populations is not documented in China. Aim The study objective was to analyze the details of medicine use and categorize the types of inappropriate use of medications on children. Methods A retrospective cross-sectional study was conducted on the prescriptions of pediatric outpatients aged < 18 years from 2019 to 2020 at a major Chinese tertiary academic center. Each age group’s demographic and clinical characteristics were collected, and the ratios of inappropriate prescriptions were analyzed. Results The total number of pediatric outpatients was 652,152, and 49.37% (322000) were prescribed medications, in which the most widely used medicines were respiratory, anti-infectives, and Traditional Chinese Medicines (TCMs). The prevalence rate of inappropriate prescriptions reached 20.49%, and in 2019 it was higher (21.71%) than that in 2020 (18.36%). The top three common inappropriate categories were indication-related off-label drug use, improper administration frequency, and overdosing, accounting for 67.93, 17.80 and 11.06% of all inappropriate prescriptions, respectively. The inappropriate prescriptions were more likely seen in patients aged 2–5 years and respiratory medicines. Conclusions The study findings indicate that inappropriate drug use in pediatric outpatients is still common, and great attention needs to be paid. More prospective trials are required to identify the effectiveness, safety, and necessity of off-label drug use of medicines in children.

Study on the Influence of Pharmaceutical Management on Rational Drug Use under Chinese Health Strategy

In order to better promote the implementation of the healthy China strategy and the innovation of public hospital system management, we can explore a modern public hospital management system that can meet the needs of the people in the new era from the aspects of medical service supply mode, collaborative governance design of public hospitals and internal management system of public hospitals. In this paper, 300 prescriptions in our hospital before and after May, 2020 were selected as research objects, and were randomly divided into two groups, one group was the control group (300 cases) without pharmaceutical management, and the other group was the observation group (300 cases) with pharmaceutical management. Then, the drug satisfaction, irrational drug use and inappropriate drug use of the two groups were compared. The results showed that the satisfaction of medication in the observation group was significantly better than that in the control group, and the irrational and inappropriate medication was lower than that in the control group, with statistical differences (P <0.05). It shows that the implementation of pharmaceutical management measures under the strategy of Healthy China can effectively improve patients' satisfaction with medication and prevent irrational medication.

A retrospective study on the evaluation of the appropriateness of oral anticoagulant therapy for patients with atrial fibrillation

Background The incidence of atrial fibrillation (AF) is increasing, and effective anticoagulation therapy can prevent adverse events. Selecting the appropriate OAC based on patient characteristics has become a challenge. Interventions are going to be a potential area of focus. Objectives To explore the discrepancies between clinician prescriptions and recommended guidelines of oral anticoagulants (OACs) for patients with atrial fibrillation (AF), and to provide direction for improving anticoagulation strategies for treating patients with AF. Materials and methods Data were collected from the electronic medical record system of Fuwai Yunnan Cardiovascular Hospital between July 2019 and January 2020. The suitability of prescribed OACs for patients with AF was assessed according to the Rules for Avoiding Prescription Inappropriateness, the prescribed medicine label, and any relevant antithrombotic guidelines for treating patients with AF. Results A total of 460 patients met the inclusion criteria. Of these, 53.7% received an appropriate prescription and 46.3% received an inappropriate prescription. Of the patients who received inappropriate prescriptions, 15.4% were prescribed without the presenting appropriate indicators, 1.3% were prescribed inappropriate drug selection, and 29.6% were prescribed inappropriate drug doses. For patients prescribed without providing appropriate indicators, 2.2% had no indication for medication and 13.3% had an indication for medication, but not a specific OAC. For patients with inappropriate drug selection, 1, 5 patients were on rivaroxaban, dabigatran respectively. The distribution of NOAC doses was as follows: dabigatran standard dose (45.2%), the low dose (54.8%). Rivaroxaban standard dose (58.9%), low dose (36.8%), high dose (4.3%). A total of 44 patients (9.6%) experienced bleeding events, 12 patients (2.6%) experienced embolic events, and 7 patients experienced other adverse events after dosing. Conclusions In clinical practice, it is common for patients with AF to receive inappropriate prescriptions of OACs. Therefore there is a need to enhance anticoagulation management in patients with AF to improve the appropriate use of OACs.

Grapes: Trivia Game Increases Sickle Cell Disease Knowledge in Patients and Providers and Mitigates Health Biases

Introduction Pediatric patients with sickle cell disease (SCD) face racial bias and healthcare stigma compounded by limited age-appropriate health education. Due in part to a lack of dedicated SCD education, providers can hold misconceptions about SCD and biases against patients. Gamification improves disease education and mitigates stigma in various clinical settings. In this study, we created the GRAPES tool (Game to Raise Awareness for Patient/Provider/Public Education of SCD, www.tinyurl.com/GRAPESgame), a free, online, trivia-based educational game. We hypothesized that utilization of the GRAPES tool will improve patient and provider SCD knowledge and mitigate SCD stigma among providers. Methods The GRAPES tool is a single-player, interactive game developed using Figma, a collaborative user-interface design software. Multiple-choice questions are structured into five educational modules (science, treatment, epidemiology, myths, and symptoms) with customizable red blood cell characters and hand-drawn screens to promote user-friendliness. Hyperlinked resources and an answer booklet provide further education. To promote health literacy for users of all ages, especially children, content is written at a fifth-grade Lexile level. The GRAPES tool was tested in two cohorts at St. Louis Children's Hospital: 1) pediatric patients 10 years of age or older with any genotype of SCD and 2) registered nurses at any career stage who care for patients with SCD. Both cohorts completed a 20-question, multiple-choice knowledge questionnaire pre- and post-gameplay to assess knowledge gains. Provider healthcare experiences were assessed pre- and post-gameplay through the 17-item short-form General Perceptions About Sickle Cell Patients Scale (GPASPS, Haywood et al., 2010). Post-gameplay, both cohorts completed a satisfaction scale and provided written feedback for game improvement. Non-parametric testing was used to compare paired-sample pre- and post-assessments. Results Of the 29 pediatric hematology-oncology nurses approached, 25 nurses (18 inpatient, 7 outpatient) were recruited. 49 patients with SCD were approached, and 25 patients (20 HbSS, 2 HbSβ 0, 1 HbSC, 1 HbSβ +, 1 HPHF) consented (Table 1). Four of the patients with SCD had prior curative hematopoietic stem cell transplants. The providers worked in the nursing field for a median of 6.0 [IQR 3.0-9.0] years. Recruited participants completed all study activities, including pre- and post-gameplay assessments. Patients with SCD completed the game with a median time of 17.0 [IQR 11.5-20.5] minutes. With data from 12 providers, the median gameplay time was 12.5 [IQR 10.0-16.5] minutes. All participants (p &lt; 0.001), including within the provider (p &lt; 0.001) and patient (p = 0.019) cohorts, showed increase in knowledge after gameplay (Fig. 1). Both providers and patients indicated the game was of high quality and relevance (Table 2). Patients wrote: "It was helpful to know about my sickness. The treatment part was helpful," and, "The terms were helpful because I didn't know them before." One provider wrote, "I liked how there were helpful links that I could click on for more info." Some suggestions for improvement included an introductory slide about SCD and a back button. Provider negative attitudes (Q1-6, Fig. 2) were reduced (p = 0.0072) post-gameplay, but positive attitudes did not significantly change (Q7-10, Fig. 2). Providers also showed a significant decrease (p=0.0014) in the belief that patients changing their behavior around providers indicates inappropriate drug-seeking behavior (Fig. 3). Conclusion Patients and providers demonstrated significant improvement in SCD knowledge after playing GRAPES. Providers also held reduced negative attitudes towards patients with SCD post-gameplay. In the context of positive feedback from both cohorts, this study demonstrates the feasibility and acceptability of the GRAPES tool as a potential digital, behavioral intervention to decrease stigma against SCD patients and provide engaging educational materials for patients and their providers in different clinical settings. Our GRAPES tool won first prize in the 2021 NHLBI Hope for SCD Challenge (www.tinyurl.com/NIHgrapes). We are excited to continue evaluating the benefits of the GRAPES tool in a larger multi-institutional study and collaborate with the NHLBI for future dissemination among patients, families, and providers. Figure 1 Figure 1. Disclosures Badawy: Vertex Pharmaceuticals Inc: Consultancy; Bluebird Bio Inc: Consultancy; Sanofi Genzyme: Consultancy. Fields: Global Blood Therapeutics: Consultancy; Proclara Biosciences: Current equity holder in publicly-traded company.

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR &lt;60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p &lt;0.001) and with CKD end-stages (G4: 16.90, 11.38–25.12, p &lt; 0.001; G5: 19.38, 11.51–32.64, p &lt; 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

Targeting Brain-Derived Neurotrophic Factor (BDNF) - An Important Strategy to Alzheimer's Disease

Many theories have been proposed to explain why candidate disease-modifying drugs (DMTs) for Alzheimer's disease (AD) failed. Late initiation of treatments during AD development, inappropriate drug dosages, incorrect selection of main therapeutic targets, and primarily inadequate understanding of the complex pathophysiology of AD are the most prominent ones. Reduced expression of Brain Derived Neurotrophic Factor (BDNF) is essential in the pathogenesis of Alzheimer's disease. BDNF plays important functions in cell survival and differentiation, neuronal outgrowth and plasticity. It can be a novel target for the treatment of the disease. In Alzheimer's disease, the hippocampus, parietal, entorhinal, and frontal cortex all have the most extreme BDNF deficits. Lower levels of BDNF can be linked to neuronal death, masking any gene-related effects. High BDNF levels have been attributed to a lower risk of dementia and Alzheimer's. Improvements in BDNF levels imparted by exercise, plant based drugs, trkB receptor agonist and BDNF enhancer drug have been proved to enhance cognitive performance. Plant-based products and nutraceuticals can boost BDNF levels. Polyphenols are essential plant compounds with a wide range of therapeutic potentials. Flavonoids like calycosin, genistein, isorhamnetin, and luteolin have been shown to affect the level of BDNF. Curcumin, a compound derived from spice turmeric (curcuma longa), has a variety of biological functions in the brain, including antidepressant properties which also increase BDNF level in the hippocampus. Riluzole is used to treat amyotrophic lateral sclerosis (ALS). In a depression model with chronic corticosteroid intake, riluzole also restores hippocampal BDNF levels. Evidence indicates that BDNF deficiency plays a role in the pathogenesis of Alzheimer's disease. Drugs used to treat Alzheimer's disease have the unintended property of modulating BDNF levels in brain regions specifically involved in the disease's pathophysiology. The discovery of molecules that precisely control BDNF in particular cellular phenotypes could increase the effectiveness of therapy against AD.

Identifying patients at high risk of inappropriate drug dosing in periods with renal dysfunction

Introduction: Dosing of renally cleared drugs in patients with kidney failure often deviates from clinical guidelines but little is known about what is predictive of receiving inappropriate doses. Methods and materials: We combined data from the Danish National Patient Register and in-hospital data on drug administrations and estimated glomerular filtration rates for admissions between 1 October 2009 and 1 June 2016, from a pool of about 2.9 million persons. We trained artificial neural network and linear logistic ridge regression models to predict the risk of five outcomes (>0, ≥1, ≥2, ≥3 and ≥5 inappropriate doses daily) with index set 24 hours after admission. We used time-series validation for evaluating discrimination, calibration, clinical utility and explanations. Results: Of 52,451 admissions included, 42,250 (81%) were used for model development. The median age was 77 years; 50% of admissions were of women. ≥5 drugs were used between admission start and index in 23,124 admissions (44%); the most common drug classes were analgesics, systemic antibacterials, diuretics, antithrombotics, and antacids. The neural network models had better discriminative power (all AUROCs between 0.77 and 0.81) and were better calibrated than their linear counterparts. The main prediction drivers were use of anti-inflammatory, antidiabetic and anti-Parkison's drugs as well as having a diagnosis of chronic kidney failure. Sex and age affected predictions but slightly. Conclusion: Our models can flag patients at high risk of receiving at least one inappropriate dose daily in a controlled in-silico setting. A prospective clinical study may confirm this holds in real-life settings and translates into benefits in hard endpoints.

Prevalence and factors contributing to medication errors in a referral hospital in Iran: A retrospective study

Background: A medication error is defined as any inappropriate drug administration that can harm the patient while being preventable and equally occurring under the supervision of a medical team. Objectives: The current study was conducted to clarify the error status, evaluate the regularity of medical mistakes in a referral hospital in the South West of Iran. Methods: Data were gathered from multiple wards at various shift works based on an optional error reporting form, either self-reporting or colleague-reporting, and then it has been made available to the "Quality Improvement Office" experts. Since the current study was retrospective, the samples were calculated from 2017 to 2019. The average and standard deviations were implemented to describe qualitative variables, and ANOVA to determine any statistically significant differences between groups. Results: Of 305 medication errors reported to the Quality Improvement Office, the "Administering the wrong drug" rate was 32.5%, and it has dedicated the most significant percentage of mistake types. The most-reported medication errors occurred in the general ward, and there was no significant difference in the number of mistakes in other shifts. Conclusion: Results suggest there is an association between the incidence of medication errors and the therapeutic ward. Although the most prevalent medication error in this study was "Administering the wrong drug. Keywords: medical error, error reporting, drug administration, mistakes, hospital