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PubMed2002

[Textual research on Shi Kan and Shi zai zhi fang (Shi Zaizhi's Prescriptions)].

Shi Kan, also known as Zaizhi, was born in Emei, Sichuan, and Zaizhi was more popularly known. He lived in the Northern Song dynasty, and was a successful candidate in the highest imperial examinations. As a government official, he was promoted to the position of governor. When he cured the constipation of Cai Jing only with a single herb Aster root, people considered that he had excellent medical skill as famous doctor Xu Shuwei. He was one of the representatives who were doctors as well as government officials. His book Shi zai zhi fang (Shi Zaizhi's Prescriptions) was a typical formula work of the Song dynasty. In this book he emphasized the treatment principles on strengthening the vital and dispelling the evil. He also underlined the theory of yunqi (five elements' motion and six kinds of natural factors). He had many new ideas about the application of herbs and pulse - taking. According to the book, Zhi zhai shu lu jie ti (Zhizhai's Interpretation on Collected Books), Shi had a 2 - volume book titled Zhi nan fang (Guide Prescriptions). There were different views on whether Guide Prescriptions was the other name for Shi Zaizhi's Prescriptions. By studying the contents of citations from Shi's Guide Prescriptions quoted in Hong shi ji yan fang (Hong's Collections of Proved Recipes), Quan sheng zhi mi fang (A Guidebook of Recipes for Saving Lives), and by combining it with the textual research made by various scholars of the Qing dynasty, the author claims that Guide Prescriptions is another book rather than the other name of Shi Zaizhi's Prescriptions.

China↗
PubMed2003

Analysis of factors associated with increased prescription illegibility: results from the National Ambulatory Medical Care Survey, 1990-1998.

OBJECTIVE: To estimate the incidence of, and the variables affecting, illegible drug prescriptions in the United States. METHODS: Illegible notations of medications (ie, drug mentions) on the patient record form used for data collection in the National Ambulatory Medical Care Survey from 1990 to 1998 were used as a proxy for the incidence of illegible prescriptions in the United States. RESULTS: The average incidence of illegible mentions was 1.44%. Increased age of patient, female sex, urban practice setting, increased number of diagnoses and prescriptions written during the visit and seeing a family physician or internist were associated with an increased probability of at least 1 illegible drug mention. CONCLUSION: Distinct characteristics are associated with a higher incidence of illegible prescriptions. Multiple diagnoses and an increased number of prescriptions, both of which contribute to the complexity of a patient visit, are especially likely to be associated with at least 1 illegible prescription per visit. Physicians need to recognize factors contributing to illegible prescriptions to maintain high standards of care.

Adolescent↗
PubMedDate not supplied

[Prescription of drugs not appropriate for children in a Pediatric Intensive Care Unit].

OBJECTIVE: To assess the extent of use of drugs not appropriate for children in prescriptions issued in a tertiary pediatric intensive care unit (PICU), according to FDA standards. METHODS: Observational cross-sectional study. The prescriptions issued to all patients admitted to the PICU at Hospital de Clínicas de Porto Alegre, Brazil, over a six-week period were assessed. Patients' age, sex, weight, prior disease, reason for admission to the PICU and pediatric index of mortality (PIM) were recorded, as were all drugs prescribed, their indications, presentations, doses, frequencies and means of administration. Adequacy for prescription of drugs in three pediatric age ranges was defined according to USA Food and Drug Administration (FDA) approval classification, based on the USP DI 2001 drug reference database. RESULTS: Data were obtained in the months of July and August 2002, on different days, for six consecutive weeks, based on prescriptions issued to 51 patients in 54 admissions to the PICU. Median patient age was 10.5 months; 61% of patients were male. Two thirds of patients (65%) presented prior disease. 87% of admissions were due to clinical reasons, of which 57% were respiratory complaints. A total of 747 prescription items were registered, with prevalence of 10.5% for non-approved uses and 49.5% for off-label uses. No statistically significant difference was found in the distribution of prevalence of irregular prescription either by the three age ranges or by level of severity of disease at admission (according to PIM risk categories). CONCLUSIONS: The high prevalence of prescription of drugs not appropriate for children confirms, in the Brazilian context, the inadequate and inadvertent use of drugs either not approved or off-label for PICU use. This demonstrates the need to encourage further studies on the quality, efficacy and safety of drugs for pediatric use.

Adolescent↗
PubMed2003

Patients' responses to delayed antibiotic prescription for acute upper respiratory tract infections.

BACKGROUND: Upper respiratory tract infections (URTIs) account for approximately 50% of antibiotic prescriptions in the United Kingdom. General practitioners (GPs) frequently issue such prescriptions simply because they believe that the patient expects it. Deferred prescribing (issuing a prescription, but with instructions to wait for no spontaneous improvement before deciding whether to use it) might address patients' expectations, while minimising actual antibiotic consumption. Although the technique is quite widely practiced, patients' attitudes and responses to it are unclear. AIMS: To establish the proportion of recipients who claim to consume their delayed antibiotic prescriptions. To elicit factors associated with patients' decisions to consume their antibiotics, and patients' confidence in taking this decision. DESIGN OF STUDY: Postal questionnaire survey. SETTING: Patients from 13 group practices in the south of England. METHODS: Patients who had received a delayed antibiotic prescription for URTI from their GP were posted a questionnaire 2 days after their consultation. RESULTS: Three hundred and seventy-four subjects were recruited of whom 256 (68.4%) returned their questionnaires. Just over half (53.1%) of the responders claimed to have consumed their antibiotics. The majority of patients (87.1%) were confident about taking the decision as to whether to use their antibiotics, and 92.5% would choose to receive a delayed prescription again. Subjects were more likely to take their antibiotics if their presenting symptoms included a fever or sinus pain. CONCLUSION: Most patients are confident in making the decision about whether or not to take their antibiotics when receiving a delayed prescription for URTIs. Antibiotic consumption is associated with presenting symptoms, and this has implications for future practice.

Adolescent↗
PubMed2003

[Study of Chinese herbs and its compound prescription guided by traditional Chinese medical theory].

It is the key problem of TCM study in the new times to strengthen the research and application of Chinese herbs and its compound prescription directed by TCM theory by combining medicine and drugs, accelerating the creation and construction of modern the new system. In the study of compound, animal mode should be set up by the combination of modern experimental method according to TCM clinical requirements. A breakthrough in compound prescription needs to be found out from observation of pharmacodynamics and analysis of clinical therapy. Methodology and clarification of effective materials should be paid enough attention to in study the pharmacokinetics of the compounds. Since the therapeutic effects of compound prescriptions are different, or even opposite to itself under different Syndromes, it is so important to pay attention to Syndrome Differention. Multiple ways of TCM study have given active exploration on the developing of TCM academic level from different aspects. The aim of constructing a system of developing TCM and Syndrome-corresponding compound prescription is to build up a normalized standard of new and highly effective theory in treating disease clinically, designing methodology, Syndrome-corresponding prescription and monitor the compound prescription used. In this way, a new TCM clinical standard could be set up in Chinese medicine and its compound prescription in clinical experiments to raise the medical level continuously.

Animals↗
PubMedDate not supplied

[Induced drug prescription in oncology patients].

AIM: To study drug prescription generated by cancer patients treated at the Emergency Service (ES) of the Instituto Valenciano de Oncología (IVO) in their Primary Health Care Centre (PHCC). MATERIAL AND METHODS: A descriptive prospective study has been carried out with patients treated and discharged from the ES of the IVO in November (n=207) and December (n=239) of 2001. 446 patients were treated and discharged; one out of five patients was contacted by telephone 48 hours after discharge to confirm drug prescriptions from the ES. In November, drug prescription was based on brand-name products, while, in December, generic drugs were prescribed. All patients were discharged with a detailed report that included: patient's medical records, consultation reason, physical exploration performed, diagnostic test results, discharge diagnosis and prescribed treatment. When a brand-name drug was prescribed, the majority of patients received the same product at the PHCC (92.5%), while the rest of them received the same active drug with a different brand name. When a generic drug was prescribed, patients received a prescription for the same active substance at the PHCC in 98% of cases (46% generic drug and 54% brand-name). As to length of treatment, 96% were short treatments (less than 2 weeks), while the rest of them were on-going. 80% needed one prescription; 15%, two, and 5% three or more prescriptions. In terms of therapeutic groups, the most commonly prescribed drugs were anti-infectious, analgesics, digestive-metabolism, respiratory, cardiovascular, neurological and miscellaneous. CONCLUSIONS: 1. There is a high level of induced drug prescription at PHCC in cancer patients, since primary care physicians usually maintain active substances prescribed by the ES of IVO, with few variations. 2. Promoting a good relationship between Hospital Care and Primary Health Care Centres helps control and reduce pharmaceutical costs. 3. A high correlation can be found between most frequently prescribed drugs in oncological patients and non-oncological patients seen in Primary Health Care.

Costs and Cost Analysis↗
PubMedDate not supplied

[Cytostatic prescription errors: an analysis of causes, and proposals regarding their prevention].

OBJECTIVE: To collect and analyze prescription errors for parenterally-administered cytostatic drugs, to identify causes from results obtained, and to suggest feasible solutions to prevent them. METHOD: In our hospital, parenterally-administered cytotoxic drugs are prepared in the Pharmacy Department, where 100% of prescriptions are validated with the help of a software program. Prescription errors detected at validation over a 2-year period of time were recorded in a specific form to facilitate analysis. RESULTS: In all, 292 possible errors were detected and 183 were confirmed; most resulted from dosing errors, followed by incorrect treatment duration. Other errors detected included: dose or drug omitted, wrong administration route, wrong patient, and wrong medication. The following measures were suggested: improvement of the data processing system at the Pharmacy Department, implementation of an electronic prescription system, continuous updating of cytostatic therapy protocols, and inclusion of cytostatic prescription recommendations within Pharmacotherapeutic Guidelines. CONCLUSION: Most common errors included doses above or below the correct ones, with the primary cause being poor handwriting in manual prescriptions. Active recording of prescription errors is essential if an analysis of real causes in our setting is to be undertaken, as well as to making proposals and implementing definite solutions.

Antineoplastic Agents↗
PubMed2005

Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan.

OBJECTIVE: To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. METHODS: This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. RESULTS: The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86 mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription (p-value = 0.020). CONCLUSION: Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription.

Adult↗
PubMed2006

[Prescription errors--dimension and measures].

BACKGROUND: A prescription should contain sufficient information to dispense the right medicine with correct instructions for use. The information given on the prescription also forms the basis for reimbursement of drug expenses. Knowledge of prescription errors may improve the procedures of the prescribing physician and the pharmacy. MATERIAL AND METHOD: Prescriptions without information on the indication of the drug therapy were registered in ten Norwegian pharmacies during two days in the autumn of 2004. Other errors and omissions on prescriptions were registered in nine of the pharmacies during a five week period. RESULTS AND INTERPRETATION: A total of 1884 (39%) of the 4667 prescriptions included in the first part of the study contained no information on the indication. A total of 1696 other errors and omissions were registered on 1359 (2%) of the 69,315 prescriptions included in the second part of the study. The most common errors and omissions were incomplete instructions for use (26%), missing information about the patient (17%), and errors and omissions related to reimbursement of drug expenses. 294 (17%) of the errors were judged to have potential clinical significance if they had not been corrected. The most common intervention was to interview the patient or to contact the prescribing physician. The most common changes were to change or clarify drug and dose.

Drug Information Services↗
PubMed2006

Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation.

There has been intense interest in the problem of prescription drug abuse on the parts of health professionals, law enforcement, the media, and the general public. Clinicians not only need to know how to assess risk but also what drugs are being diverted most in their region. We conducted a prospective survey of prescription drug abusers entering a treatment facility in central Kentucky. Participants (n = 109) were enrolled and completed a structured clinical interview and prescription drug abuse survey. The prescription drug abusers assessed in the study had a mean age of 30.95 years (SD = 10.21), were comprised of 75 men (69%) and 34 women (31%), and were mostly Caucasian (98%). The majority (84%) stated that they had legitimately been given a prescription for opioids for pain at some point from a physician and 61% reported chronic pain concerns. The most commonly abused drugs were hydrocodone-containing formulations (78%) and oxycodone-containing products (69%), while products containing methadone (23%) or fentanyl (7%) were abused much less frequently. Most respondents (91%) stated that they had purchased prescription opioids from a street dealer at least once and the majority (80%) had altered the delivery system of the prescription drug by chewing, snorting, or using i.v. administration. Implications for pain management are discussed, focusing on the need for clinicians treating chronic pain to more thoroughly assess patients for their risk of abuse and addiction before starting an opioid regimen.

Adult↗
PubMedDate not supplied

Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia.

A sample of prescription orders received from outpatient departments by a hospital pharmacy in Asir, Saudi Arabia, were analysed over 1 year for the essential elements of prescriptions. The prescriber's name, address and signature were on 83.3%, 9.6% and 81.9% of prescriptions respecti-vely. The patient's name, age and sex were on 94.6%, 77.3% and 51.3%. No prescription contained the patient's address and weight. Generic drug names were used in only 15.1% and strength of medication and dose units were included in 26.6% and 55.6% of prescriptions. Most prescriptions (94.0%) had no quantity indicated and had only partial instructions for patient use (90.7%); the diagnosis was included in about two-thirds. The prescriber's handwriting was illegible in 64.3% of prescriptions. Measures to improve the situation are suggested.

Ambulatory Care↗
PubMed1991

Information systems for the analysis of drug prescriptions in Spain.

The Spanish National Health Service, largely represented by INSALUD, covers at present over 98% of the Spanish population. Services are free at the point of delivery with exception of prescription charges. The patients contribution towards the price of their medicines is approximately 40% of the cost of the drug for most ethical preparations. Non-prescription drugs are not reimbursed by the National Health Service. Pensioners and the disabled are exempt from prescription charges. Prescription analysis or monitoring is possible within INSALUD because of the necessity to reimburse pharmacists for the prescriptions they dispense, monthly batches of prescriptions are processed. The Drug Data Bank possesses three databases that may be used for prescription analysis, these are ESPES, ECOM and PACTIV. Information from these databases is used by external workers in: drug Monitoring Centres for Adverse Drug Reactions; the Spanish Collaborative Study on drug-induced birth effects; drug utilization research workers; INSALUD also produces reports on drug prescribing and these have a particular emphasis on expenditure; the General Directorate of Pharmacy also use these databases for their policy making on issues related to, and derived from prescribing.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Outpatient use of prescription sedative-hypnotic drugs in the United States, 1970 through 1989.

Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study outpatient use of prescription sedative-hypnotic drugs in the United States from 1970 through 1989. Retail pharmacies dispensed an estimated 62.5 million prescriptions for sedative-hypnotic drugs in 1970. This number declined by half to 31.6 million in 1978. This decline has continued, so that in 1989 there were 20.8 million dispensed prescriptions. From 1970 to 1989, barbiturate and nonbarbiturate-nonbenzodiazepine prescriptions decreased 24-fold and 18-fold, respectively, and benzodiazepine prescriptions increased 26-fold. By 1989, the ultrashort-acting benzodiazepine drug triazolam was the leading sedative hypnotic, with about 40% of the total sedative-hypnotic market in the 6 years since its marketing. Data also indicate shifts from longer to shorter acting, and from higher to lower dose, benzodiazepine prescriptions, increasing use of antidepressant drugs for insomnia, female predominance of use, and increasing use with age.

Ambulatory Care↗
PubMed1990

[Prescription of benzodiazepine sedatives in general practice].

A review of the prescriptions dispensed by all pharmacists in the County of Arhus during a week in January 1989 resulted in information about 3,212 prescriptions for benzodiazepine hypnotics sedatives by the general practitioners in the county. The majority of prescriptions were for men in the age group 60-69 years and women in the age group 70-79 years. After age standardization, the extent of prescription was found to increase with age to reach extent of 267.1 and 347.9 defined daily dosages (DDD)/1,000 inhabitants/day for men and women, respectively in the age group of 90 years or more. A total of 70.8% of the prescriptions and 81.6% of the prescribed DDD were for preparations with prolonged effects. More of the elderly women than the middle-aged and younger women were prescribed preparations with prolonged effects (p less than 0.01). Prescription of tablets with double doses (2 DDD per tablet) were responsible for 40.4% of the prescribed DDD of hypnotics/sedatives with prolonged effect and 33.0% of the total quantity of medicine calculated in DDD. It is concluded that general practitioners should attempt to reduce the extent of prescription of benzodiazepine hypnotics sedatives and that the registering authorities should investigate the justification of continued registration of preparations with prolonged effects and that ths general public should be informed about how unsuitable employment of sleeping pills can be, except for very brief periods.

Adolescent↗
PubMed1984

Effect of a triplicate prescription law on prescribing of Schedule II drugs.

Prescribing of Schedule II drugs for outpatients before and after enactment of a triplicate prescription law (TPL) was examined at a 1200-bed teaching hospital in Texas. Four pharmacists reviewed all prescriptions for Schedule II drugs during 1981 (before TPL) and 1982 (after TPL). The name of the drug product, quantity, and prescriber's training classification were recorded. Prescribing of non-Schedule II analgesics was also analyzed. Finally, prescribing by 280 resident physicians was examined for six months before and six months after enactment of TPL. The total number of prescriptions received for Schedule II drugs decreased by 60.4% from 1981 to 1982 (total outpatient prescriptions increased by 12.7%). The number of Schedule II prescriptions received from first-year residents decreased by 44.5%, more than for any other category of prescribers. In each year, nine of the ten most frequently prescribed Schedule II medications were analgesics. The numbers of prescriptions for several non-Schedule II analgesics increased in 1982 at a rate greater than that for all outpatient drugs. The medical residents wrote 2958 Schedule II prescriptions in 1981 and 834 in 1982. At this hospital, a TPL discouraged prescribing of Schedule II drugs.

Drug Prescriptions↗
PubMed1981

Prescription writing in a pediatric clinic.

A prescription monitoring system was established in our pediatric outpatient clinic. The system was used to monitor prescriptions written by members of our pediatric housestaff and faculty. A total of 884 consecutive prescriptions written during a six-week period were reviewed for the presence of the components of a complete prescription as well as certain prescribing errors. Numerous prescription writing errors were identified. Errors were especially common in prescriptions for controlled substances. The number and types of errors raise important questions about the quality of prescriptions written in our clinic and about the cost of these errors in terms of patient, physician, or pharmacist time as well as drug cost and potential therapeutic mishaps.

Child, Preschool↗
PubMed1995

[Drug prescriptions in general medicine practice].

OBJECTIVE: To find the origin of pharmacological prescriptions written in the primary care ambit, the effect of training on the prescribers and the influence of the organisational structure of the centres where they work on the quality of the drugs prescribed. DESIGN: Observational study of a crossover type. SETTING: Two health centres and two consulting-rooms in Areas 11 and 12, Valencia. MEASUREMENTS AND MAIN RESULTS: The sample calculated corresponded to 664 prescriptions per centre. The origin of the prescription differed, depending on the model, so that in the consulting-rooms the origin of 55% of prescriptions was specialist care, whereas in the health centres this percentage went down to 31%. There were significant differences (p < 0.0001) in the quality of prescription in different organisational structures, but there were no significant differences among professionals with different training. CONCLUSIONS: A high percentage of pharmacological prescriptions have their origin in specialist care. Prescription quality is conditioned basically by the organisational model and is appreciably better in health centres.

Cross-Over Studies↗
PubMed1995

Correlations between prescriptions and drugs taken in self-poisoning. Implications for prescribers and drug regulation.

OBJECTIVE: To compare prescription data for Australia with drugs ingested in self-poisoning and suicide, to determine which drugs are over-represented. DESIGN: Comparison of data on drugs taken in self-poisoning admissions and suicides with Australian prescription drug dispensing data from the Drug Utilization SubCommittee (DUSC). SETTING: Newcastle and Lake Macquarie, Australia, 1989-1992. SUBJECTS: Between July 1989 and June 1992, 1159 prescription drugs were taken in overdose. Eighty-three drug-related deaths were investigated by the coroner between 1987 and 1992. On 48 occasions a prescription drug was the primary cause of death. RESULTS: Drugs over-represented in self-poisoning (relative to Australian prescriptions) included not only those prescribed for psychiatric conditions (antidepressants, neuroleptics and lithium), but also benzodiazepines, barbiturates and other anticonvulsants. The highest odds ratios for death when adjusted for prescription numbers were for short-acting barbiturates (523.7; 95% confidence interval [CI], 207-1322), chloral hydrate (58.1; 95% CI, 18.1-187), colchicine (27.9; 95% CI, 3.8-202), dextropropoxyphene (20.8; 95% CI, 8.8-48.9), tricyclic antidepressants (13.3; 95% CI, 7.2-24.5) and anticonvulsants (11.6; 95% CI, 4.1-32.2). CONCLUSIONS: Short-acting barbiturates, chloral hydrate and dextropropoxyphene have little or no clinical advantage over alternatives and excessive toxicity in overdose. They should be removed from the market. The toxicity of anticonvulsants and colchicine should be considered when they are prescribed, and smaller amounts per prescription may be advisable for high risk patients using these and other toxic drugs.

Drug Prescriptions↗