M.Sc. (Med), Faculty of Health Sciences,University of the Witwatersrand, 2011 / Background: Many factors affect the prescribing of medication to patients with schizophrenia including variables that relate to physicians and may result in marked variance in the choice of drugs, dosages, drug combinations, route of administration and the use of antipsychotic, anticholinergic, sedative and other adjuvant drugs. Clinical practice guidelines were developed to address this variance and for other reasons, including the management of side-effects, drug innovation, rising costs, information overload, changes in treatment goals and the management of medication non-adherence. There are advantages and disadvantages to using clinical practice guidelines including those pertaining to context and cultural norms, but they remain the best method of assessing prescribing quality. Many guidelines are based on the results of randomised clinical trials (with a single drug) or are the consensus of experts in the field. Despite the development and publication of these guidelines over the past two decades, they are frequently not adhered to resulting in much variance in treatment. Aims and objectives: The aim of the study was to determine to what extent the prescribing of psychotropic drugs in the treatment of schizophrenia was consistent with the most recent version of each of five guidelines that originate outside South Africa (two from the United States and one each from Canada, the United Kingdom, and Australia and New Zealand); and one that was developed locally. Methodology: A retrospective, cross-sectional prescription chart review with data sampling at three time points (on hospital admission, at fourteen days thereafter and on hospital discharge) was undertaken. A sample population was drawn over a three year period during which the patients’ physician had access to the same drug formulary. Seventy patients met the study selection criteria in terms of age, diagnosis and receipt of antipsychotic medication during hospital stay and on discharge. Seventy patients met the study selection criteria, and their prescriptions for psychotropic medication (exclusively) were examined for a number of parameters including: drug class, drug name, dose, route of administration and whether the medication was to be administered routinely or ‘as needed’. Findings and discussion: As compared with the recommendations made in some or all of the guidelines, first generation antipsychotic agents were over-prescribed especially early on in the patients’ hospital stay, whereas second generation antipsychotics were under-prescribed. The profile changed after fourteen days and on discharge there were more patients on second generation drugs than on the older drugs. More patients were discharged on depot antipsychotic treatment than were admitted which is considered a favourable finding, however, many patients receiving the depot form continued to be prescribed the oral drug on a routine basis and for an indefinite period, resulting in antipsychotic polypharmacy. Anticholinergic drugs were prescribed as prophylaxis for the extra-pyramidal side-effects of the first generation antipsychotic drugs and more than a quarter of the sample received these drugs on discharge, after which they were to be taken routinely and indefinitely. A similar finding was made with the use of benzodiazepine sedatives, where nearly a quarter of patients received these drugs on discharge - again to be taken routinely and for an unspecified period. Sodium valproate was given increasingly to many patients in the sample and was prescribed to over a quarter of those upon discharge, without an indication of duration. Limitations: The study was retrospective in design, without the benefit of the patients’ clinical histories and treatment progress, and the findings were compared with guidelines whose age spanned more than a decade and some of which had become redundant. Conclusions: The study demonstrated some prescribing habits that were not in accord with the guidelines used for comparison in the study. The extent of the disagreement reveals the need for a prospective pilot study that will include the patients’ clinical progress in the study design which will provide greater insight into why specific medication parameters were chosen by the physician for the individual patient. If the findings justify it, then a programme promoting better adherence to the most current guidelines should be commenced.

No description available.

Background: Mannitol has been used in the past for the prevention of cisplatin-induced nephrotoxicity. Studies on its efficacy have conflicting results. An educational newsletter was designed for local oncologists on the conflicting data of mannitol use in preventing cisplatin-induced nephrotoxicity. Purpose: The purpose of this study was to determine whether a pharmacist-created newsletter intervention led to changes in the mannitol prescribing practices of local oncologists. Methods: A newsletter describing the paucity of evidence to support mannitol use to prevent cisplatin-induced nephrotoxicity was distributed via e-mail to local oncologists in October 2010. Mannitol prescribing rates were retrospectively evaluated before and after newsletter distribution. The Mann-Whitney U test was used to compare nonparametric continuous data. The chi-square test was used for nominal data. Descriptive statistics were performed for baseline demographics, and odds ratios were calculated for possible risk factors for acute kidney injury (AKI). The primary endpoint was a change in mean mannitol dose before and after the newsletter intervention. The secondary endpoint was the difference in the rate of AKI before and after the intervention. Data were collected for 67 patients with various malignancies. Results: There was a difference in the average mannitol dose before and after newsletter intervention (P = .02). The rates of AKI before and after newsletter were similar. Conclusion: A pharmacist-led newsletter intervention was associated with significantly decreased rates of mannitol usage after intervention.

Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences. Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p&lt; 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal. Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated. Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy. A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found. / <p>Diss. Umeå : Umeå universitet, 1983, härtill 7 uppsatser</p> / digitalisering@umu

No description available.