SSA also produces a visualisation of sequence orders, enabling the temporality of sequences to be assessed. The visualisation displays the frequency of patients by time between incident dispensing of two medicines of interest and is usually produced as a summary by weeks between sequences. It can be a valuable addition in determining the likelihood that a statistically significant result repre- sents a signal for an adverse drug event as these are tem- porally associated with initiation of therapy, with the majority occurring within the first 4 months . Currently, while the null-effect sequence ratio adjusts for changes in prescribing trends over time, no method is available that provides an adjusted visualisation. We aimed to develop and evaluate a method of adjustment for prescribing trends applied to the SAA visualisation.
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prescribing trends over time. It was assumed that ADHD medications were prescribed to only patients with an ADHD diagnosis, but it is possible that these prescriptions may have been for reasons other than ADHD. Similarly, a large proportion of psychotropic polypharmacy could be used to treat diagnosed comorbid conditions other than ADHD; nonetheless, the ﬁndings from this study reﬂect a growing rate of psychotherapeutic polypharmacy in youth despite the underlying
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Discussion: Current clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have followed such recommendations. Clozapine is still underutilized especially in patients at risk of suicide. It seems that physicians are hesitant in prescribing clozapine due to concerns about serious adverse effects. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concerns about the underutilization of clozapine especially in patients at risk of suicide.
chances of women to undergo an exercise ECG, coronary angiography, anti platelet and Statins therapy were less than in men. The chances of revascularization in women with coronary diseases were also less than men ratio to suffer death or MI was double in them during 1-year follow-up period of data collectionGender is a significant variable to study trend, prevalence and prognosis of coronary artery disease with angina. In 2006, a designed study was conducted by taking less percentage of women than men in order to check trends of prevalence of Stable angina among them. The study revealed that such trend among genders is almost same with a moderate increase occurrence in females with angina i.e. (22.6%).Chest pain is twice likely to occur in females as compared to men and complexities are far more severe in females. Given the current rise of angina in Pakistan, this study was designed to evaluate the prescribing trends of stable angina and to find out the most prescribed drug in a stable angina in public sector hospitals Lahore, Pakistan and assessing its prevalence in both genders.
For studying the prescribing trends among consultants in a general hospital, and general practitioners, a total 1239 and 980 prescriptions were collected during the month of April, 2011 from a general hospital out-patients pharmacy and a community pharmacy in Emirate of Sharjah respectively. The prescriptions from the hospital were issued by consultants while those of the pharmacy represent general practitioners (GPs). Prescriptions were subjected to analysis using the World Health Organization (WHO) suggested indicators . These include pre- scriber’s information such as name, registration number and signature; patient’s information including the name, age, sex, and address of patient plus brief diagnosis and history of allergy. All prescriptions were examined for eligibility. In addition information on the medicine were determined including dosage regimen, number of en- counters per prescription, % generic drugs prescribed, most common therapeutic classes and the most common drug of each class. Prescriptions were also examined for medications prescribed as injections. In this study, names of patients were concealed in consideration of patients’ privacy protection. Data were collected and ana- lyzed using Microsoft Excel ® and expressed in terms of both counts and percentages.
Treatment-emergent sexual dysfunction is a frequent adverse effect of many psychotropic drugs. We have analyzed the prescribing trends and the likelihood of psychotropic-associated sexual dysfunction in outpatients with depression or other psychotic disorders treated by psychiatrists. A retrospective prescription audit was conducted at the Psychiatric Hospital, the only psychiatric facility in Bahrain that offers both inpatient and outpatient services. Psychotropic associ- ated sexual dysfunction was graded as negligible (0), moderate (2+), moderately severe (3+) and uncertain (U) for anti- depressants, and for antipsychotics as no effect (0), very low (1+), moderate (2+), moderately severe (3+) and uncertain (U) effect. As antidepressant monotherapy, a significant trend towards prescribing selective serotonin reuptake inhibi- tors (SSRIs; 3+) and selective norepinephrine reuptake inhibitors (SNRIs; 3+) in females, and tricyclic antidepressants (TCAs; 2+) in males was apparent. Atypical antidepressant mirtazapine (0) monotherapy was rarely prescribed. Mirta- zapine with SSRIs or SNRI was the most often prescribed combinations followed by TCAs with other antidepressants. Risperidone (0 to 3+), an atypical antipsychotic, was the most popular antipsychotic prescribed to augment antidepres- sants; there was no gender-based difference. Clozapine (0) and olanzapine (1+) were rarely prescribed to augment anti- depressant therapy. In Bahrain, the psychotropic prescribing trends suggest that there is a need to optimize drug therapy to achieve the therapeutic goal with minimal adverse impact on sexual function.
Even if clinicians try to prescribe accurately, limited CL power availability in 0.25 DC steps of power may contribute to suboptimal vision. The prescriptions for CLs were limited to −0.75, − 1.25 , − 1.75 and − 2.25 DC despite the spectacle distributions showing that intermediate cylinder powers exist in this population. Further limited CL power availability for sphere powers stronger than 5.00 DS limits prescribing to half and full diopter steps. A previous study has observed that in some populations, practitioners prescribe to half diopter steps apparently from preference. 22 The current data indicates that
This retrospective secondary analysis of open source data demonstrates a sustained and significant increase in the rate of prescribing between April 2013 and March 2018 of gabapentin, pregabalin, and oxycodone. A variation in rate of prescribing per capita per GP practice was strongly associated with the deprivation quintile of GP practice, with the practices within the most deprived quintile prescribing more on average of each of the drugs than those in the least deprived quintile. There was a geospatial pattern in CCGs with a rate of prescriptions 1.5 greater than the mean national rate, with predominantly northern and eastern CCGs in this category.
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There has been a trend toward becoming more lib- eral with statin prescribing for primary prevention of CVD during the past decade. In the United States, for example, the 2013 American Heart Association and the American College of Cardiology guidelines for the treat- ment of cholesterol now advocate for consideration of statin therapy in individuals who have a 10-year risk of CVD that is 7.5% or higher, which is lower than the 10% cutoff quoted in the 2001 and 2004 guidelines published by the National Heart, Lung, and Blood Institute. 17-19
Prescription based surveys helpsin improving prescribing practice of the physicians and ultimately, the clinical standards. Therefore to promote rational use of drugs a continuous supervision and systematic audit of prescriptions is necessary. Antihypertensive drugs prescribing pattern study comprising of 227 prescriptions revealed that 29.95%patients were suffering from essential hypertension, 39.20% patients HTN associated with CAD of which 42.1% were males of 50-59years. The outcome of the study demonstrated that combination therapy (67.84%) outweighed monotherapy (32.15%). Monotherapy was more used in females (36.55%) while combination therapy was preferred in males (70.89%). As per recommendations of JNC V, VI and VII diuretics are considered to be first line treatment for HTN, but in our study not even a single patient was prescribed with diuretic as monotherapy. In combination therapy, diuretics were prescribed in a fixed dose combination with angiotensin receptor blocker (losartan). In dual therapy this was the most prescribed combination in patients of essential hypertension. The under utilization of low cost diuretics in monotherapy in present study was found to be not in accordance with JNC VII. Preference to combination therapy is also evidenced from Hansson et al Hypertension Optimal Treatment (HOT) study in which 70% of patients were given combination therapy, of which 90% patients achieved diastolic blood pressure of <90 mm Hg. Studies like Controlled Onset Verapamil Investigation of Cardiovascular Endpoints (CONVINCE) and International Verapamil-Trandolapril Study (INVEST) also confirmed combination therapy to be more effective in management of HTN as compared to monotherapy, .It may be attributed to multiple pressor mechanisms contributing in raising blood pressure so multiple inhibitory mechanisms are likely to be more effective than a single one. Also, the individual drug in a combination therapy counteracts feedback mechanisms that act to limit the efficacy of the other antihypertensive drug. Likewise, combining an ARB, an ACE inhibitor, or a β blocker with a thiazide diuretic are examples of logical combinations. These drugs compensate reactive hyperreninemia induced by diuretics. Furthermore, with coadministration, doses are lower than those required when the components are used as single agents. A once-daily dose formulation of the combination facilitates dosing and improves compliance.
We analyzed NAMCS 2000 to 2010 data to determine the annual rate of out- patient ARTI visits to pediatricians, general, and family practitioners and antimicrobial prescribing rates during ARTI visits. We used International Classi ﬁ cation of Diseases, Ninth Re- vision, Clinical Modi ﬁ cation (ICD-9-CM) diagnosis codes to identify subjects who had AOM, sinusitis, bronchitis, URI, and pharyngitis (Table 1). We de ﬁ ned these codes as restrictive, including just those codes for acute ARTIs, or permis- sive, including both the restrictive codes and additional ICD-9-CM codes for re- lated illnesses used in previous similar studies (eg, 473.9: unspeci ﬁ ed sinusitis [chronic]). 2,15 We identi ﬁ ed antimicrobial
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were means tested which results in an over-representation of lower socioeconomic groups [34, 35]. This may result in an over-inflation of the true prescription rates for Irish children; given that children from more socially deprived backgrounds are more likely to receive a psychostimulant prescription than their better off counter-parts . Analysis of prescribing data among children and ado- lescents with private healthcare insurance in Ireland would facilitate more robust conclusions regarding the role of socioeconomic status on prescribing pat- terns of psychostimulants in the Irish context. Cau- tion is also required when comparing findings with results from other countries, as in addition to meth- odological differences of studies, different licensing and reimbursement policies for medication may exist. Furthermore, no data was available on the clinical in- dication for treatment and professional details (spe- cialist versus generalist) of the doctor initiating the prescription.
Glaucoma is a condition in which distinctive changes occur in the optic nerve and visual field. In glaucoma intraocular pressure (IOP) is raised that compresses and damages the optic nerve. As the optic nerve is damaged, it fails to carry the visual information to the brain which induce clinically progressive loss of peripheral visual field and ultimately loss of vision. Aims and Objectives: To Evaluate the drug utilization and prescribing pattern of drugs used for treatment of glaucoma, to analyze current prescribing trends in anti-glaucoma drugs, to perform a drug utilization study, to identify drugs per prescription, category wise identification of drugs prescribed, mono therapy vs combination therapy. Materials and Methods: The present study was a prospective, observational study carried out in 105 patients at Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Results: Out of total 105 patients, 68 were males (64.76%) and 37 were females (35.24%). The most common age group was 46-60 years. Patients were mostly affected by primary open angle glaucoma (95.23%) then angle closer glaucoma (4.76%). Total 184 drugs were prescribed in the treatment of glaucoma. Average number of drugs per prescription was 1.75. Combination therapy was prescribed in 51.43% patients & most common used combination therapy was combination of Brimonidine+ timolol (81.48%) followed by Bimatoprost+ timolol (18.52%). Monotherapy was used in 48.57% patients in which drug dorzolamide (22.31%) was prescribed mostly which is belongs to the category of carbonic anhydrase inhibitors followed by timolol (19.23%) (β- blockers) which was second line choice of drug. Generic drugs were mostly prescribed in 77 patients (73.33%) followed by 28 patients (26.66%) were brand names. Conclusion: The prescription analysis of glaucoma patients concluded that monotherapy with dorzolamide was the first line choice for glaucoma therapy and timolol was found to be the second line choice. Timolol+ brimonidine was the mostly prescribed combination of drug. It also showed that all drugs were prescribed in their generic name instead of brand name.
cardiovascular society system, little walk shall be helpful in the Grade-I stable angina patients but in the case of Grade II, III, IV the symptoms of angina can be exacerbate. Initial treatment of stable angina includes A = Aspirin& anti-angina drugs, B= beta blockers and blood pressure, C= Cigarette smoking and cholesterol, D=diet and diabetes E=Education and exercise.  In Europe from euro heart survey, Aspirin is prescribe 78%, Statins 48%, 67%betablockers, and 37 % ACE inhibitors. The most prescribing drug by the cardiologist is Aspirin.  Gender Prevalence: Many studies were conducted to see the relation of stable angina with age and gender. The Euro Heart Survey of stable angina selected persons with stable angina and designed clinical trials within 4-week of diagnosis and collected follow up data within 1 year. In this survey, 3779 patients were included; (42%) were female. The chances of women to undergo an exercise ECG, coronary angiography, anti- platelet and Statins therapy were less than in men. The chances of revascularization in women with coronary diseases were also less than men ratio to suffer death or MI was double in them during 1-year follow-up period of data collection.  Gender is a significant variable to study trend, prevalence and prognosis of coronary artery disease with angina. In 2006, a designed study was conducted by taking less percentage of women than men in order to check trends of prevalence of Stable angina among them. The study revealed that such trend among genders is almost same with a moderate increase occurrence in females with angina i.e. (22.6%).Chest pain is twice likely to occur in females as compared to men and complexities are far more severe in females.  Given the current rise of angina in Pakistan, this study was designed to evaluate the prescribing trends of stable angina and to find out the most prescribed drug in a stable angina in public sector hospitals Multan, Pakistan and assessing its prevalence in both genders.
We performed a retrospective analysis of outpatient antibiotic prescribing from 2000 to 2010. In the MEPS, survey respondents are asked to report health conditions which are then coded by professional coders using the International Classification of Diseases, 9th Revision, Cli- nical Modification (ICD-9-CM) diagnoses codes. These conditions are recorded at the person-level in conjunc- tion with medical events, including outpatient visits and antibiotic purchases. We assessed antibiotic prescribing trends in overall antibiotic use, broad-spectrum antibi- otics, outpatient visits, and for common ARTIs that infre- quently necessitate an antibiotic: acute nasopharyngitis and upper respiratory tract infection (ICD-9-CM diagno- sis codes 460 and 465), bronchitis (466 and 490), influenza (480, 487 and 488), pharyngitis (034, 462 and 463), and si- nusitis (461 and 473) [18,21,22]. Outpatient visits included visits with medical providers in office-based settings and clinics, hospital outpatient departments and phone con- tacts with office-based medical providers.
Writing prescriptions using generic name is an important drug-use quality to avoid undesirable drug interactions, adverse drug reactions, and medication errors. The average percentage of drugs prescribed by generic name in the four hospitals was 95.8. DSMGH and TZH exhibited the accept- able values in terms of the WHO criteria with regard to prescribing by generic names (almost 100%), whereas it was found to be lower in SCH and WSUTRH. Private pharmacies might have influenced the prescribing patterns in later cases as they are relatively located in main city (Wolaita Sodo) where there are alternative private pharmacies, whereas the former are located in small towns. This can be explained by a reason given by a doctor from WSUTRH for a question, “why not all drugs are prescribed by generic name?” which was answered as “Some physicians who are working as part-time in private health facilities are more familiar with brand name than generic name”.
for both adolescents and young adults, whereas approximately half of adolescents with a clavicle fracture were prescribed an opioid. These ﬁndings serve to inform initiatives aiming to reduce excessive opioid prescribing, especially as we seek to further deﬁne and address the opioid epidemic in our younger patients. Although the focus of opioid- prescribing guidelines and educational campaigns has been primarily on pain management in adult patients and those with chronic conditions, 11,22 adolescents and young adults are at high risk for opioid misuse and abuse after exposure from medical treatment, and a number of studies indicate
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We have developed a novel process for extracting APP information from mental health electronic patient re- cords. We have demonstrated that the combination of natural language processing and a bespoke algorithm can be an effective approach to extracting APP data. We were able to detect APP with high precision and modest recall. Once extracted these data can be used to allow researchers to characterize patterns of polypharmacy over time including different drug combinations, trends in polypharmacy prescribing, predictors of polypharmacy prescribing and the impact of polypharmacy on patient outcomes (such as mortality and physical health conse- quences). The use of NLP combined with a bespoke al- gorithm is likely to be applicable to similarly structured clinical datasets where medications data is held in free- text. Essentially we have provided an example of an ap- proach which other researchers may trial in their own datasets with some modification to suit their specific needs and source data.
model, time period, gender, race, phy- sician specialty, and age were at least nominally associated (P ⬍ .2) with the dependent variable of amoxicillin pre- scribing. In a model including age and excluding specialty, time period and age were each found to be indepen- dently associated with amoxicillin prescribing. On average, each 2-year increase after 1998 –1999 was inde- pendently associated with a 49% in- crease in the odds of amoxicillin pre- scribing (odds ratio [OR] per 2 years: 1.49 [95% CI: 1.16 –1.92]). In addition, children 0 to 5 years of age were more likely to receive amoxicillin than were children 12 to 17 years of age (OR: 2.51 [95% CI: 1.15–5.47]). When physician specialty was included and patient age excluded, family practitioners were less likely than pediatricians to pre- scribe amoxicillin (OR: 0.38 [95% CI: 0.16 – 0.88]).
In a few cases, the algorithm detects a change in a some- what arbitrary place (e.g. high-cost ACE inhibitors for CCG 05Y in Additional file 1: Appendix A). This is possible when the level of noise within the percentiles changes over time. For example, if the level of noise is low initially, a low trig- ger threshold will be set, if the noise then increases (per- haps due to a reduction in overall prescribing for that measure), this may occasionally trigger an alert when there is no underlying shift in the measure. This also occurs where prescribing numbers are especially small (low single figure denominators. This is more common in small prac- tices and can cause the percentile to change very erratically. Though this does not always trigger an inappropriate alert, there may be some utility in filtering out alerts where changes are detected based on very small numbers; we will consider and respond to user-feedback on this issue.
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