Current Issue : April - June Volume : 2018 Issue Number : 2 Articles : 6 Articles
Approximately 40% of patients admitted to the medical intensive care unit (ICU) require mechanical ventilation. An accurate\nprediction of successful extubation in patients is a key clinical problem in ICUdue to the fact that the successful extubation is highly\nassociated with prolonged ICU stay.The prolonged ICU stay is also associated with increasing cost and mortality rate in healthcare\nsystem. This study is retrospective in the aspect of ICU. Hence, a total of 41 patients were selected from the largest academic\nmedical center in Taiwan. Our experimental results show that predicting successful rate of 87.8% is obtained from the proposed\npredicting function. Based on several types of statistics analysis, including logistic regression analysis, discriminant analysis, and\nbootstrap method, threemajor successful extubation predictors, namely, rapid shallowbreathing index, respiratory rate, and minute\nventilation, are revealed. The prediction of successful extubation function is proposed for patients, ICU, physicians, and hospital\nfor reference....
The purpose of the study was three-fold: (1) to estimate the national trends in antipsychotic\n(AP) polypharmacy among 6- to 24-year-old patients in the U.S.; (2) to identify frequently used AP\nagents and mental disorder diagnoses related to AP polypharmacy; and (3) to assess the strength\nof association between AP polypharmacy and patient/provider characteristics. We used publicly\navailable ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital\noutpatient department settings to conduct a cross-sectional study. First, national visit rates between\n2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in\nAP polypharmacy were identified. Third, a multivariate logistic regression model was developed to\nassess the strength of association between AP polypharmacy and patient and provider characteristics.\nBetween 2007 and 2011, approximately 2% of office-based or hospital outpatient department visits\nmade by 6- to 24-year-old patients included one or more AP prescriptions. Of these visits, 5% were\nclassified as AP polypharmacy. The most common combination of AP polypharmacy was to use two\nor more second-generation APs. Also, bipolar disorder and schizophrenia were the two most frequent\nprimary mental disorder diagnoses among AP polypharmacy visits. The factors associated with\nAP polypharmacy were: older age (young adults), black, having one or more non-AP prescriptions,\nand having schizophrenia or ADHD....
Consumers are confident managing minor ailments through self-care, often self-medicating\nfrom a range of over-the-counter (OTC) medicines available from community pharmacies.\nTo minimise risks, pharmacy personnel endeavour to engage in a consultation when consumers\npresent with OTC enquiries however they find consumers resistant. The aim was to determine\nstakeholder perspectives regarding barriers and facilitators for information exchange during OTC\nconsultations in community pharmacies and to understand the elicited themes in behavioural terms.\nFocus groups were undertaken with community pharmacist, pharmacy assistant and consumer\nparticipants. Independent duplicate analysis of transcription data was conducted using inductive\nand framework methods. Eight focus groups involving 60 participants were conducted. Themes that\nemerged indicated consumers did not understand pharmacists� professional role, they were less likely\nto exchange information if asking for a specific product than if asking about symptom treatment,\nand they wanted privacy. Consumers were confident to self-diagnose and did not understand OTC\nmedicine risks. Pharmacy personnel felt a duty of care to ensure consumer safety, and that with\nexperience communication skills developed to better engage consumers in consultations. They also\nidentified the need for privacy. Consumers need education about community pharmacists� role and\nresponsibilities to motivate them to engage in OTC consultations. They also require privacy when\ndoing so....
Older adults are demanding increased healthcare attention with regards to prescription use\ndue in large part to highly complex medication regimens. As patients age, medications often have a\nmore pronounced effect on older adults, negatively impacting patient safety and increasing healthcare\ncosts. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and\nhelp to avoid inappropriate medication use. Previous literature has shown that such CMRs can\nsuccessfully identify and reduce the number of medication-related problems and improve acute\nhealthcare utilization. The purpose of this pharmacy resident research study is to examine the impact\nof pharmacist-conducted geriatric medication reviews to reduce medication-related problems within\na leading community health system in southwest Michigan. Furthermore, the study examines type of\npharmacist interventions made during medication reviews, acute healthcare utilization, and physician\nassessment of the pharmacist�s value. The study was conducted as a retrospective post-hoc analysis\non ambulatory patients who received a CMR by a pharmacist at a primary care practice. Inclusion\ncriteria included patients over 65 years of age with concurrent use of at least five medications who\nwere a recent recipient of a CMR. Exclusion criteria included patients with renal failure, or those\nwith multiple providers involved in primary care. The primary outcome was the difference in\nnumber of medication-related problems, as defined by the START and STOPP Criteria (Screening\nTool to Alert doctors to Right Treatment/Screening Tool of Older Persons� Prescriptions). Secondary\noutcomes included hospitalizations, emergency department visits, number and type of pharmacist\ninterventions, acceptance rate of pharmacist recommendations, and assessment of the pharmacist�s\nvalue by clinic providers. There were a total of 26 patients that received a comprehensive medication\nreview from the pharmacist and were compared to a control group, patients that did not receive\na CMR. The average patient age for both groups was 76 years old. A total of 11 medication-related\nproblems in the intervention group patients were identified compared with 24 medication-related\nproblems in the control group (p-value 0.002). Pharmacist-led comprehensive medication reviews\nwere associated with a statistically significant different in the number of medication-related problems\nas defined by the START and STOPP criteria....
This prospective study was planned to find the medication prescribing pattern in children taking outpatient treatment. This study was carried out using 500 prescriptions. Only pre-compounded prescription orders that call for a drug or mixture of drugs supplied by the pharmaceutical company were included in the study. The patients attending private clinics and government hospitals were randomly approached either outside the clinic or at chemist shop with a request to have their prescriptions photocopied. Necessary data were obtained from prescriptions and analyzed for (i) Number of medicines per prescription, (ii) Type of dosage form, (iii) Revisit or follow up pattern, (iv) Use of antibiotics. In the present study, on an average 2.93 medicines were prescribed per patient. It was observed that maximum dosage forms prescribed were of oral route specially drops and syrups. It was also observed that the maximum number of patients did not require revisit as most of the children were suffering from general health problems and very less number of patients required revisit within seven days. Maximum number of prescriptions prescribed contains at least one antibiotic. Thus from this study we found that extensive polypharmacy, over prescribing and increased uses of antibiotics are common errors in prescribing practices....
Medication review and supply by pharmacists involves both cognitive and technical\nskills related to the safety and appropriateness of prescribed medicines. The cognitive ability of\npharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal\nmedicines use, yet few studies have investigated the clinical reasoning and decision-making processes\npharmacists use when supplying prescribed medicines. The objective of this study was to examine the\npatterns and processes of pharmacists� clinical reasoning and to identify the information sources used,\nwhen making decisions about the safety and appropriateness of prescribed medicines. Ten community\npharmacists participated in a simulation in which they were required to review a prescription and\nmake decisions about the safety and appropriateness of supplying the prescribed medicines to the\npatient, whilst at the same time thinking aloud about the tasks required. Following the simulation\neach pharmacist was asked a series of questions to prompt retrospective thinking aloud using\nvideo-stimulated recall. The simulated consultation and retrospective interview were recorded\nand transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply\nof two prescribed medicines to the simulated patient. Qualitative analysis identified seven core\nthinking processes used during the supply process: considering prescription in context, retrieving\ninformation, identifying medication-related issues, processing information, collaborative planning,\ndecision making and reflection; and align closely with other health professionals. The insights from\nthis study have implications for enhancing awareness of decision making processes in pharmacy\npractice and informing teaching and assessment approaches in medication supply....
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