Elderly people, or those over 65 years of age, are known to comprise 10% of the United States population today and are projected to reach nearly 12% by the year 2000. Further, 5% of this population is reported to be institutionalized resulting in approximately 1.1 million chronic care patients or 0.5% of the population. The use of drugs in this population comprises approximately 25% of the prescription drug market in the United States which is directly related to the greater occurrence of pathological problems associated with the aging process. While it is evident that the beneficial outcome of drug therapies is partially related to the increased longevity observed in these elderly people, this population is also well-known to be the most prone to adverse drug reactions. Factors complicating drug use in the elderly include high usage, chronic therapy, long-term hospitalization, inappropriate and multiple prescribing of drugs, inadequate monitoring of adverse drug effects, susceptibility to physical deterioration and senility. Therefore, the objective of this project is to test the hypothesis that the quality and cost of drug therapy in SNF patients can be significantly improved by implementing measures to improve the utilization of drugs.

Analysis of drug utilization of antibiotics for systematic administration in the Czech Republic in 2005-2019 Author: Lenka Suchopárová Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: Mgr. Petr Domecký Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles university Introduction and aims: Antibiotics (ATB) are substances with a bacteriostatic or bactericidal effect. Treatment with ATB carries a risk of side effects, drug interactions and risk of resistance occurence. The reason for monitoring the consumption of ATB is not only the apparent coherence between their consumption and the increase of resistance, but also the economic side of bacterial infections treatment. The aim of this study was to analyze the consumption of ATB for systematic administration in the Czech Republic (CR) in 2005-2019. Methods: The analysis of the consumption of ATB was performed as a retrospective analysis of data from the database of the State Institute of Drug Control in the period from 1. 1. 2005 to 31. 12. 2019. Anatomical-therapeutic-chemical classification based on defined daily doses (DDD) of individual drugs was used for the analysis. The consumption of ATB was calculated as DDD per thousand inhabitants per day (TID). The data on the number of residents was acquired from the...

Background: In the treatment of hypertension, physicians’ attitudes and practice patterns are receiving increased attention as contributors to poor blood pressure (BP) control. Thus, current use of antihypertensive drugs in primary care was analyzed and the association with selected physician and patient characteristics was assessed. Methods: The Hypertension and Diabetes Risk Screening and Awareness (HYDRA) study is a cross-sectional point prevalence study of 45,125 primary care attendees recruited from a representative nationwide sample of 1912 primary care practices in Germany. Prescription frequencies of the various antihypertensive drugs in the individual patients were recorded by the physicians using standardized questionnaires. We assessed the association of patient variables [age, gender; co-morbidities such as diabetes, nephropathy or coronary heart disease (CHD)] and physician variables (general practitioner vs internist, guideline adherence, etc.) with drug treatment intensity and prescription patterns. Results: Of all 43,549 patients for whom a physician diagnosis on hypertension or diabetes was available, 17,485 (40.1%) had hypertension. Of these hypertensive patients, 1647 (9.4%) received no treatment at all, 1191 (6.8%) received non-pharmacological measures only, and 14,647 (83.8%) were given one or more antihypertensive drugs. Drug treatment rates were lower in young patients (16–40 years: 57.4%). BP control was poor: 70.6% of all patients were not normalized, i.e., had BP ≥140/90 mmHg. Antihypertensive treatment was generally intensified with increasing age, or if complications or comorbidities were present. The use of the different drug classes was rather uniform across the various patient subgroups (e.g., by age and gender). Individualized treatment with regard to co-morbidities as recommended in guidelines was not the rule. Adherence to guidelines as self-reported by physicians as well as other physician characteristics (region, training etc.) did not result in more differentiated prescription pattern. Conclusions: Despite the broad armamentarium of drug treatment options, physicians in primary care did not treat hypertension aggressively enough. Treatment was only intensified at a late stage, after complications had occurred. Treatment should be more differentiated in terms of coexisting morbidities such as diabetes, nephropathy, or CHD.

Background Drug utilization review (DUR) is a central role of the pharmacist, especially within the community pharmacy setting. Previous literature has shown risk of “alert fatigue”, supporting the necessity of pharmacists to utilize a step-wise approach in evaluation of drug therapy during the verification process. Many students are intimidated by this process, and may lack verification practice or experience until their first day as a licensed pharmacist. Educational Activity and Setting An innovative skills-based laboratory exercise was developed for third-year pharmacy students to develop DUR skills. Through simulation of patient prescriptions, profiles, and drug information resources, students were tasked with completing a DUR for each patient case. Students were expected evaluate the clinical significance of various drug-related problems, determine if they would or would not dispense the prescription, and were required to provide rationale for their decision. Findings This learning activity was well-received by the student population; however, students struggled with the volume of cases along with identifying a solution to the clinical scenario. On average, students required nine minutes per case, which is likely longer than community pharmacists can devote to a single DUR in practice. Discussion In response, to student challenges with the activity, the number of cases was condensed to highlight key concepts and cases that facilitated strong discussion. To improve students’ approach to the DUR process, faculty developed a vodcast to watch prior to the activity explaining a systematic approach to the DUR process as well as considerations a pharmacist should have. Summary Development and integration of an active-learning, simulated dispensing activity allowed students to gain valuable experience completing the DUR process, a foundational community pharmacy practice skill; however, repeated experience should be provided to ensure competency.

The aim of this study was to gain insight into the exercise practices, in conjunction with dietary habits and medication routine of insulin dependent diabetics. The study design adopted for the study was that of descriptive and analytical survey. The gathering of data was conducted over a period of seven months using a questionnaire as a data collection instrument, which was administered to 200 insulin dependent diabetics utilizing the outpatient facilities at 12 hospitals in Kwa-Zulu Natal. In determining the respondent's attitude towards exercise, the significant (p<0.001) overall majority (85%) had a positive attitude towards exercise. In probing the perceived efficacy of exercise as a therapeutic modality, a significant (p<0.001) majority (93%) of the respondents stated that exercise/sport is beneficial to a diabetic. Of the overall sample, the significant (p<0.001) majority (68%) of respondents were active participants in exercise (exercisers) versus 32% who were not active (non-exercisers). The profile of the exercisers indicated that the significant (p<0.001) majority participated in exercise of an aerobic type at frequency of 4 or more times per week, at an intensity eliciting an approximate heart rate of between 110 to 130 beats per minute corresponding with an RPE of 11 to 13, for a duration of 20 to 45 minutes. A significant (p<0.001) overall majority (98%) stated that a good diet is an important factor when trying to achieve near normoglycemia. In probing the respondent's knowledge as to what group certain types of food belong to, an overall significant (p<0.001) majority (82%) was accurate in this regard, while significantly (p<0.1) more exercisers (84%) were aware of correct food grouping than non-exercisers (67%). In probing their knowledge of the normal range of blood glucose levels, an overall significant (p<0.001) number of respondents (66%) stated a correct response, while exercisers (67%) were significantly (p<0.1) more knowledgeable than non-exercisers (52%) in this regard. The significant (p<0.001) majority of respondents injected themselves three and more times a day (54%), before meals (71%), in the thigh (35%) and abdominal areas (48%), as opposed to the gluteal area (10%) and the arm (8%). The mean overall dosage of long-acting insulin (12.2 units) and short-acting insulin (10.5 units) for lunch was significantly lower (p<0.1) than for breakfast and supper, however there was no significant difference (p>0.1) between the breakfast and supper dosages. The same pattern was observed for non-exercisers and exercisers. The respondent's knowledge of good diabetic management goals reflected that a significant (p<0.001) overall majority (83%) were aware that diet, insulin and exercise are all important constituents in obtaining good diabetic management, while significantly (p<0.1) more exercisers (84%) than non-exercisers (71%) were aware of this. A significant (p<0.001) majority (83%) of non-exercises stated that they were willing to participate in exercise, but cited time constraints and physical discomfort, inter-alia, as antecedents to non-participation. In conclusion, the results indicated that the provision of educational support for insulin dependent diabetics to overcome the perceived barriers to exercise would increase participation, enhance appropriate exercise prescription and compliance to this important aspect of the diabetic regimen. / Dissertation (MA (Human Movement Science))--University of Pretoria, 2002. / Biokinetics, Sport and Leisure Sciences / unrestricted

The aims of this research were to establish the drug use patterns of an elderly population in the southern suburbs of the Cape peninsula and to determine the extent of knowledge with respect to their medicines. In addition, the relationship between drug use patterns and medication knowledge and the socioeconomic status of the elderly, the health care services utilised by them and the amount of information conveyed on medicine container labels was assessed. Two hundred and sixty non-institutionalised Caucasian elderly over the age of 65 years and living in old age residences were interviewed. The interviews were structured with 4 major components: 1. a questionnaire designed to collect participant particulars; 2. an interview schedule to collect information on drug use patterns and to assess participant knowledge of medicines used (Knowledge score). 3. a container label assessment schedule (Label score); 4. a cognitive function test to identify and exclude severely cognitively impaired elderly from the study population. Analysis of the data showed the majority of the participants were English-speaking women of social class 1 or 2. Approximately one fifth of all participants were male. The State-run health care services were utilised by 38% of the participants whilst 73% retained their own general practitioner. A total of 843 medicines were used with an average of 3.2 medicines per capita. Ninety-five percent of all participants took prescribed medicines, with diuretics, non-narcotic analgesics/antipyretics, and tranquillisers the 3 most frequently prescribed classes. A smaller percentage - 41.5% - of participants used self-prescribed medicines, of which non-narcotic analgesics, homeopathic and herbal medicines, and vitamins were taken most frequently. When assessed against container label directions approximitely one third of participants were non-compliant with their dosage regimens. The majority of all medicines had been used on a continuous basis for 1 to 10 years. Average knowledge score was 58%. The majority of participants had very little knowledge about interactions, side effects, and maximum permissible dose for their medicines. Just over one fifth of all participants could correctly state both the name and the strength of their medicine. Average knowledge score was found to decline with increasing age, but no relationships were found to exist with the other patient characteristics. Similarly, no relationship was found to exist between knowledge score and label score. Participants utilising the public health care services tended to have a lower knowledge score than those receiving treatment from the private sector. Twenty-six percent of all labels did not have specific usage directions. The private sector suppliers were most frequently culpable of omitting instructions. Label legibility also proved to be a problem for the elderly participants. The drug use patterns identified in this study are similar to those of the American and British elderly and should be of value in compiling a health care plan for the South African elderly, although further research involving other race and cultural groups is needed.

tudies in teaching and non-teaching hospitals have shown that one- quarter to one-third of all patients receive an antimicrobial (AMC) drug during their hospital stay." 1-30 Many of these patients (ranging from 30 to 60%), particularly those on the surgical services, have no definite evidence of infection. Inquiry regarding the use of AMC drugs can be traced back more than two decades. In 1961, the Commission on Professional and Hospital Activities in its Professional Activity Study (CPHA-PAS) surveyed 24 hospitals." They found that approximately 27% of all patients were given an AMC drug; however, it was estimated by PAS that only about 12% of these patients should have received AMC therapy under the most conservative medical practice.

Objetivo. Avaliar o perfil de saúde, o acesso aos serviços de saúde e as condições de vida dos deficientes em áreas do Estado de São Paulo. Metodologia. A pesquisa utilizou os dados de um Inquérito Multicêntrico de Saúde no Estado de São Paulo em 2002 e de outro, realizado na capital em 2003. Os entrevistados que referiram deficiências foram a população estudada segundo as variáveis que compõem o banco de dados. Os dados foram digitados em Epi-Data e analisados em SPSS e STATA. Resultados. A prevalência de alguma deficiência foi de 143,2 por mil; deficiência visual (DV), 63,21 por mil; deficiência auditiva (DA), 43,01 por mil e a deficiência física (DF) de 11,06 por mil. Os acidentes de trabalho foram a segunda causa de DA em homens; os acidentes de trânsito foram a segunda causa das DF nos homens. As prevalências das deficiências aumentaram com a idade; foram maiores nas mulheres e nas pessoas com menos de 3 anos de escolaridade. A prevalência de DA e DF foi maior entre os homens. Entre os deficientes a prevalência de algumas doenças crônicas foi maior que entre os não-deficientes. Houve mais morbidades nos 15 dias anteriores à entrevista entre os DV e DA quando comparados com os não-deficientes. Entre os DV, 18,94% necessitavam de assistência médica regular; entre os DA, 15,38%; entre os DF, 57,16%. A principal causa das deficiências foi a doença. Mais DF relataram uma ou mais internações e menor uso de serviços odontológicos. Menor prevalência de exame das mamas entre DA e DF e de exames de próstata entre os DF e maior consumo de remédios entre os DV e DF, comparados com não-deficientes. Conclusão. As deficiências aumentaram com a idade, foram mais prevalentes em mulheres e em pessoas com menor escolaridade, sendo sua principal causa, as doenças. A DV foi a mais prevalente das três deficiências. A DA e a DF foram mais prevalentes nos homens. Entre os DV e os DA houve mais morbidades nos 15 dias anteriores à entrevista. Houve mais doenças crônicas entre os deficientes do que entre os não-deficientes. Os DF foram os mais necessitados de assistência médica periódica. O consumo de medicamentos maior entre os DV e DF. Políticas de saúde específicas devem ser ampliadas e outras criadas para atender as necessidades de saúde dos deficientes. / Objective. Evaluate health profile, access health services patterns and life conditions of the handicapped in some areas of the State of São Paulo. Methodology. The research used data from the Multicenter Survey Health in the State of São Paulo, 2002, and from another study carried through in São Paulo city, in 2003. The interviewed that had answered positively to disability were the target population studied according to the variables of the data bank. These data were typed in Epi Data and analyzed in SPSS and STATA. Results. The prevalence for any disability found was 143.2 for a thousand; visual disability (VD) 63.21 for a thousand; hearing disability (HD) 43.01 for a thousand and physical disability (PD) 11.06 for a thousand. The work accidents were the second cause of HD in men; the traffic accidents were the second major cause of PD in men. The prevalence of disability increases with the age; it was bigger in women and in the people who have less than 3 years of instruction. In all three groups of disability studied, the prevalence to the handicapped in some chronic diseases was grater comparing to the not-disability ones. Among VD, 18.94% needed regular medical assistance; among the HD, 15.38%; among PD, 57.16%. The main cause of all disabilities was the disease itself. More PD had told one or more hospitalization and minor use of odontological services. Lesser prevalence of breast examination between HD and PD, and prostate examination among the PD; and bigger drug consumption compared with the not-disability. Conclusion. The disabilities increased according to the age, were more prevalent in women and people with lesser years of study, being the diseases its main cause. The VD was the most prevalent comparing to the other three disabilities. The HD and the PD had been more prevalent among men. Among VD and HD had been found more morbidity in the 15 days before the interview. There was more chronic illness among handicapped comparing to the not handicapped. The PD were the most needed in terms of regular medical assistance. Specific health politics must be extended and others created in order to taking care of handicapped health necessities.

Nos últimos anos, o uso dos psicotrópicos em idosos, aumentou expressivamente em decorrência da ampliação das indicações terapêuticas dessa classe, do lançamento de agentes com menor perfil de toxicidade e do reconhecimento de que determinados quadros clínicos, prevalentes nessa faixa etária, podem ser tratados com esses medicamentos. Todavia, o uso de psicotrópicos pode estar relacionado a eventos adversos que causam impacto no perfil de morbi-mortalidade desse grupo de indivíduos. Desse modo, os objetivos do presente estudo foram identificar a prevalência e os fatores associados ao uso de psicotrópicos entre os idosos do Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo Saúde, Bem-estar e Envelhecimento SABE. A amostra foi constituída de 1.115 idosos de 65 anos ou mais, que foram reentrevistados no ano de 2006. Para coleta de informações utilizaram-se as seções do questionário sobre Informações pessoais (A), Avaliação cognitiva (B), Estado de saúde (C), Estado funcional (D), Medicamentos (E) e Uso e acesso a serviços (F). Os psicotrópicos foram classificados de acordo com a Anatomical Therapeutical Chemical Classification System (ATC). Na analise dos dados utilizou-se o pacote estatístico STATA com realização de regressão logística. Considerou-se nível de significância de p<0,05. A prevalência de uso de psicotrópicos de 12,2%, a qual foi representada por antidepressivos (7,2%), benzodiazepínicos (6,1%) e antipsicóticos (1,8%). No grupo que usou psicotrópicos, 15,9% pertenciam ao sexo feminino, 15,1% apresentaram 75 anos ou mais, 21% relataram possuir quatro e mais doenças e 27,5% usar cinco ou mais medicamentos. Os fatores associados ao uso de psicotrópicos foram : sexo feminino (OR = 1,70; IC95% 1,05 - 2,74), limitação de atividade instrumental de vida diária (OR = 1,871; IC95% 1,16 - 3,04), presença de declínio cognitivo (OR = 1,76; IC95% 1,02 - 3,03), depressão (OR = 5,36; IC95% 3,34 - 8,61) e uso de cinco ou mais medicamentos (OR = 1,28; IC95%1,16 - 1,42). Cerca de um em cada dez idosos do SABE utilizou psicotrópicos, principalmente os antidepressivos. O conjunto dos fatores de risco associados ao uso de psicotrópicos pode indicar que os idosos mais vulneráveis foram aqueles com maior grau de dependência, seja em decorrência de comprometimento clínico causado por doenças, seja pelo uso de psicotrópicos inapropriados / Over the last years, the use of psychotropic drugs in the elderly has risen expressively, due to the increasing of the therapeutic indications of this class, the launching of agents with a profile of low level of toxics, and to the acknowledgement that certain clinical conditions, dominant within this age group, can be treated with this medicine. However, the use of psychotropic drugs can be linked to adverse events which cause impact in the profile of morbid-mortality of this age group. Therefore, the aim of the present study has been to identify the prevalence and factors associated to the use of psychotropic drugs among elderly people in São Paulo City. It is a transversal, population based study, obtained from the Estudo Saúde, Bem-estar e Envelhecimento SABE. The sample was constituted of 1.115 elderly people, aging 65 and over, who were re-interviewed in 2006. For the gathering of information, the sections of the questionnaire on Personal Information (A), Cognitive Evaluation (B), Health State (C), Functional State (D), Medicine (E) and Use and Access to Facilities (F) were used. Psychoactive drugs were classified according to the Anatomical Therapeutical Chemical Classification System (ATC). In the data analysis, it was used the statistic component STATA with logistic regression. A level of significance was considered of being p<0,05. The prevalence of the use of psychotropic drugs of 12,2%, which was represented by anti-depressants (7,2%), benzodiazepine (6,1%) and anti-psychotics (1,8%). In the group that used psychotropic drugs, 15,9% were female, 15,1% were 75 years old and older, 21% claimed having four or more different diseases, and 27,5% making use of five or more different sorts of medicine. The factors associated to the use of psychotropic drugs were: female gender (OR = 1,70; IC95% 1,05 - 2,74), limitation of daily life instrumental activity (OR = 1,871; IC95% 1,16 - 3,04), presence of cognitive decreasing (OR = 1,76; IC95% 1,02 - 3,03), depression (OR = 5,36; IC95% 3,34 - 8,61) and use of five or more sorts of medicine (OR = 1,28; IC95%1,16 - 1,42). About one in ten elderly people in SABE used psychotropic drugs, mainly anti-depressants. The range of risk factors associated to the use of psychotropic drugs may indicate that the most vulnerable elderly people were those with higher level of dependency, whether in consequence of a clinical implication caused by diseases, or by the use of inappropriate psychotropic drugs

Introdução: Reação Adversa a Medicamento (RAM) é qualquer resposta prejudicial ou indesejável e não intencional que ocorre com medicamentos em doses normalmente utilizadas no homem para profilaxia, diagnóstico, tratamento de doença ou para modificação de funções fisiológicas. Atualmente, representa uma das principais causas de morbidade e mortalidade na área da saúde. Objetivo: Analisar as reações adversas a medicamentos e fatores associados em pacientes ortopédicos tratados com antibióticos. Método: Coorte prospectiva conduzida com 273 pacientes ortopédicos internados no Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brasil. A coleta de dados ocorreu nos anos de 2012 e 2013, por meio de instrumento composto por variáveis demográficas-clínicas e terapia medicamentosa. Para identificação das RAMs realizou-se o monitoramento ativo, composto de: entrevista, análise de prontuários e exames laboratoriais. As RAMs consideradas graves foram analisadas por meio do formulário do Instituto Catalão de Farmacologia, Espanha. Na análise dos dados utilizaram-se os testes Mann-Whitney, Qui-Quadrado, exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de RAM foi de 41%. O grupo com RAM apresentou maior média de idade (43,3; DP 10,9), tempo de internação (72,7; DP 40,9) e número de medicamentos concomitantes (13,2; DP 4,1). Os fatores associados foram número de medicamentos, uso de antimicobacteriano (OR 2,44; IC 1,3944,270) e carbapenêmicos (OR 2,38; IC 1,167 4,872). Identificaram-se 466 RAM, cuja maioria (67,1%) foi classificada como leve. No grupo de pacientes com RAMs graves identificaram-se leucopenia (46,6%), insuficiência renal aguda (40%) e hepatite medicamentosa (26,6%). Os antibióticos foram os principais medicamentos suspeitos de causar as RAMs graves (76,4%), sendo os mais frequentes (23,5%) formados pela tríade: amicacina + vancomicina + piperacilina com tazobactam. Conclusão: A incidência de RAM é maior quando se incorpora ao serviço de farmacovigilância a técnica de monitoramento contínuo dos pacientes hospitalizados e se utiliza a analise de exames laboratoriais como preditores para suspeitas de RAMs potencialmente graves / Introduction: Adverse Drug Reaction (ADR) is any noxious, undesired or unintended response which occurs in the use of normal dosages of drugs for prophylaxis, diagnosis, treatments or for modifying physiologic functions. Nowadays, ADR represents one of the main causes of morbidity and mortality in the health service area. Objective: To analyze the occurrence of adverse reaction to drugs and factors related to orthopedic patients treated with antibiotics. Method: The prospective cohort study was conducted in 273 orthopedic patients hospitalized at the Brazilian Institute of Traumatology and Orthopedics in Rio de Janeiro. The data collection was made during the years 2012 and 2013, using instruments composed by demographic-clinical variables and drug therapies. With the purpose of identifying occurrences of ADRs, during active monitoring, interviews were conducted, medical charts and exams were analyzed. In addition, the occurrence of ADRs considered harmful was analyzed by using a form provided by the Catalan Institute of Pharmacology, Spain. In the study of the data collected, was made use of Mann-Whitney tests, Chi-Squared test, Fishers exact test and logist regression, with p-value 0,05. Results: The occurrence of ADRs was of 41%. This group was composed by individuals with major age rage (43,3, SD 10,9), major time spent hospitalized (72,7; SD 40,9), and quantity of concurrent drugs used (13,2; SD 4,1). Also, the related factors were the number of drugs, the usage of Antimicobacterial agents (OR 2,44, CI 1,394-4,270) and Carbapenemases (OR 2,38; CI 1,167 4,872). During the study, there were identified 466 ADRs, and the majority (67,1%) was classified as low-grade. Additionally, in the group of patients with harm adverse reactions, it was possible to identify leukopenia (46,6%), acute kidney failure (40%) and drug-induced hepatitis (26,6%). The antibiotics were the main drugs suspected to be the cause of potentially harmful ADRs (76,4%), being the most frequent (23,5%) formed by the triad: amikacin + vancomycin + piperacillin-tazobactam. Conclusion: The occurrence of ADRs is higher when the practice of continuous monitoring of hospitalized patients is incorporated to the pharmacovigilance service, and the analyzes of lab exams are used as predictors for the suspicion of potentially harmful ADRs