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PubMed1992

Low level of antidepressant prescription for people who later commit suicide: 15 years of experience from a population-based drug database in Sweden.

The use of antidepressants has been low in Jämtland County for many years, while the suicide rate has been among the highest in Sweden. A continuous outpatient prescription recording system has been in operation in Jämtland since 1970. Through this system we traced the prescription pattern of 80 individuals who committed suicide from 1970 to 1984. Suicide patients obtained 1.5 times more prescription drugs than 80 matched controls, mainly psychotropics and vitamins. During the 3 months prior to the suicide, half of the patients had received medical attention and 73% of the women and 40% of the men had obtained prescription drugs, in one-third from the psychiatric department. While 53% and 29%, respectively, obtained psychotropic drugs, only 13% and 9% respectively were prescribed antidepressants, often in low doses. People who will commit suicide often seek medical help. The low rate of antidepressant prescription in patients committing suicide probably reflects insufficient diagnosis and treatment of depressive disorders. It is urgent--for the individual as well as for society--that diagnostic and pharmacotherapeutic routines be improved.

Adolescent↗
PubMed2003

Therapeutic treatment plan optimization with probability density-based dose prescription.

The dose optimization in inverse planning is realized under the guidance of an objective function. The prescription doses in a conventional approach are usually rigid values, defining in most instances an ill-conditioned optimization problem. In this work, we propose a more general dose optimization scheme based on a statistical formalism [Xing et al., Med. Phys. 21, 2348-2358 (1999)]. Instead of a rigid dose, the prescription to a structure is specified by a preference function, which describes the user's preference over other doses in case the most desired dose is not attainable. The variation range of the prescription dose and the shape of the preference function are predesigned by the user based on prior clinical experience. Consequently, during the iterative optimization process, the prescription dose is allowed to deviate, with a certain preference level, from the most desired dose. By not restricting the prescription dose to a fixed value, the optimization problem becomes less ill-defined. The conventional inverse planning algorithm represents a special case of the new formalism. An iterative dose optimization algorithm is used to optimize the system. The performance of the proposed technique is systematically studied using a hypothetical C-shaped tumor with an abutting circular critical structure and a prostate case. It is shown that the final dose distribution can be manipulated flexibly by tuning the shape of the preference function and that using a preference function can lead to optimized dose distributions in accordance with the planner's specification. The proposed framework offers an effective mechanism to formalize the planner's priorities over different possible clinical scenarios and incorporate them into dose optimization. The enhanced control over the final plan may greatly facilitate the IMRT treatment planning process.

Algorithms↗
PubMed2006

Complementary and alternative medicines versus prescription drugs: perceptions of emergency department patients.

BACKGROUND: The perceptions of emergency department (ED) patients towards complementary and alternative medicines (CAM) are poorly understood. We assessed these perceptions and compared CAM users with non-users, particularly regarding CAM safety and efficacy. METHODS: This was an analytical, cross sectional survey of ED patients undertaken in a tertiary referral ED. A five point Likert scale evaluated patients' level of agreement with statements relating to CAM and prescription drugs. RESULTS: Of 404 patients who were enrolled (participation rate 97.1%), 275 (68.1%; 95% confidence interval (CI) 63.2 to 72.5) were CAM users (had taken a CAM within the previous 12 months). There were 178 patients (44.1%, 95% CI 39.2 to 49.1) who agreed or strongly agreed that CAM are drug free, and there was no significant difference between CAM users and non-users (p = 0.77). There were 115 patients (28.5%, 95% CI 24.2 to 33.2) who agreed or strongly agreed that CAM are always safe to take with prescription drugs, and there were no significant difference between CAM users and non-users (p = 0.39). Significantly more CAM users agreed or strongly agreed that CAM are safe to take, can prevent people from becoming ill, allow people to be in charge of their own health, can treat the mind, body, and spirit, and are more effective than prescription drugs (p<0.01). Significantly fewer CAM users agreed or strongly agreed that prescription drugs are safe to take (p<0.001). CONCLUSION: Considerable proportions of ED patients are CAM users yet are ignorant of the nature and potential toxicities of CAM. In addition, CAM users have significantly different perceptions of CAM and prescription drugs from non-users. The impact of these perceptions on clinical practice needs evaluation.

Adult↗
PubMed1995

Review of the prescription of domiciliary long term oxygen therapy in Scotland.

BACKGROUND: Since 1989 long term oxygen therapy (LTOT) in Scotland has been prescribable only by respiratory physicians, whereas in England and Wales general practitioners can also prescribe this treatment. The effect of this policy has been audited. METHOD: Six hundred and thirty patients were prescribed LTOT in Scotland between 1 October 1989 and 30 September 1991, of which 519 case notes were reviewed. RESULTS: In 79% of patients the diagnosis was chronic obstructive pulmonary disease (COPD), with a near equal male to female ratio. The mean (SD) age was 65 (13) years (range 0.2-90). Sixty percent of patients died during the study period. Compliance with treatment was 14.9 (6.0) hours daily (range 1-24) and in 44% was less than 15 hours daily. Sixty one percent were clinically unstable when assessed and 14% were still smoking. Only 14% of those with COPD fulfilled all of the relative criteria for the prescription of LTOT. Only 56% had a repeated arterial blood gas measurement within 12 months of prescription and 51% of these were taken during a period of clinical instability. Expenditure on oxygen cylinders was six times greater than on oxygen concentrators over this period. CONCLUSIONS: Compliance with LTOT in Scotland, where prescription is the responsibility of respiratory physicians, is similar to other studies and ranges widely. The greatest problem concerning adherence to the guidelines is assessment during clinical instability. The number of deaths suggest that prescription occurs late in the course of the disease. This study highlights the areas where the prescription of LTOT needs to be improved.

Aged↗
PubMed2000

Anti-hypercholesterolaemia, antioxidant activity and free radical scavenger effects of traditional Chinese medicine prescriptions used for stroke.

The generation of oxygen radicals and lipid peroxidation may be factors in the cerebral damage secondary to ischaemia of the cerebrovascular disease, as in stroke. Five traditional Chinese medicinal prescriptions were investigated for their antioxidant activity: Shiee Fuu Jwu Iu Tang (TCMP1), Oh Yaw Shuen Chin Saan (TCMP2), Buu Yang Hwan Wuu Tang (TCMP3), Sheau Shiuh Ming Tang (TCMP4), and Chir Hwu Jia Long Guu Muu Lih Tang (TCMP5). Anti-lipid peroxidation, anti-superoxide formation and free radical scavenger activity were determined by the FeCl2--ascorbic acid-induced lipid peroxidation effects on lipids in-vitro, xanthine oxidase inhibition, cytochrome C system and an electron spin resonance spectrometer, respectively. The results showed that TCMP5 had greater anti-lipid peroxidation and anti-superoxide formation activity than the other prescriptions. TCMP4 had the greatest free radical scavenging effect, TCMP5 showed the greatest superoxide radical scavenger activity and TCMP3 showed the greatest hydroxyl radical scavenger activity. Tests were also performed to evaluate the effects of the five prescriptions on blood lipid in-vivo. The test showed that the prescriptions decreased the level of total cholesterol and LDL-cholesterol in serum in high cholesterol-fed rats. From these results, it seems probable that these prescriptions may be effective in the prevention and therapy of stroke and ischaemia.

Animals↗
PubMed1992

[The study of Chinese herbal medicinal prescription with enzyme inhibitory activity. VII. The study of inchinko-to with adenosine 3',5'-cyclic monophosphate phosphodiesterase].

A Chinese herbal medicinal prescription, Inchinko-to, was studied for the inhibitory activity on adenosine 3',5'-cyclic monophosphate (cAMP) phosphodiesterase (PDE). The inhibitory activity on cAMP PDE of the extract of each constituent from the crude drug and of several compounds isolated from the drug was studied. By changing the combination ratio of two kinds of the crude drugs from 1:1 to 1:5, the inhibitory activity on cAMP PDE was estimated and it was found to be highest at the ratio of 1:3 in Rhubarb and Gardenia fruit, and at 1:4 in Rhubarb and Capillaris buds. These were the same ratio which is now commonly used for Chinese herbal medicinal prescription in Japan. Similar results were obtained in the combination test of the components of the crude drug such as emodin, geniposide, capillarisin and dimethylesculetin. The effects of Inchinko-to and its prescription which lacks one of the constituents of the crude drugs on carbon tetrachloride inducing liver injury in mice were also studied. Among the four prescriptions the antihepatotoxic activities were observed in the prescriptions containing Capillaris buds. Correlation between the administrated content of dimethylesculetin and antihepatotoxic activity was not recognized.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1982

A microcomputer system for prescription, calculation, verification and recording of radiotherapy treatments.

The design of a microcomputer system for the reduction of mistakes in radiotherapy is described. The system covers prescription entry, prescription and treatment calculations, and verification and recording of the treatment set-up. A telecobalt unit was interfaced to the system and in the first 12 months 400 patients have been prescribed and 5000 treatment fields verified. The prescription is entered by the medical officer using an interactive program and this prescription provides the reference for verifying the treatment set-up. The program allows amendments to the prescription to be made easily during the treatment course. The treatment parameters verified are field size, wedge and treatment time. The system uses bar-codes for patient and field identification. A reduction in the number of mistakes has been achieved and future developments are discussed.

Computers↗
PubMed2006

Availability of Spanish prescription labels.

The research team conducted a cross-sectional telephone survey of all pharmacies in the Bronx, New York (99.4% participation rate) to determine availability of Spanish prescription labels. One hundred twenty five pharmacies (78%) were small independent pharmacies; 36 (22%) were large-chain pharmacies. Overall, 111 (69%) stated that they could provide prescription labels in Spanish. Overall, for all the pharmacy ZIP codes, the mean proportion of the population that was Spanish-speaking was 46.8% (range 11% to 71.6%). Seventy-eight (48%) pharmacies were located in areas where more than 50% of the population were Spanish-speaking, 48 (30%) were located in areas with 25.1-50% Spanish-speakers, and 35 (22%) were in areas with up to 25% Spanish-speakers. Small independent pharmacies were more likely than large chain pharmacies to provide prescription labels in Spanish (71% vs. 61%, p=0.25). All the pharmacists commented that a patient must specifically request a Spanish prescription label in order to receive one. Pharmacies located in areas with the highest proportion of Spanish speakers were more likely to provide prescription labels in Spanish (82% vs. 62% vs. 49%; p=.001). Of the 111 pharmacies that could provide Spanish labels, 95 (86%) used a computer program to perform the translation and 16(14%) used a lay employee. Of pharmacies using a computer program, only one had a Spanish-speaking pharmacist who could check and correct the computer translations.

Communication Barriers↗
PubMed1998

[Comparison between the prescription of physical training intensity based on the standard ergometric test and on the ergospirometric test].

PURPOSE: To compare the lower (LL) and upper limits (UL) of exercise intensity prescription based on standard exercise test (60-70% of estimated VO2max or 70-85% of HRmax measured) with exercise intensity prescription based on cardiopulmonary exercise test [anaerobic threshold (AT) and respiratory compensation point (RCP)]. METHODS: Fourty seven men (30 +/- 5 years) who were submitted to a progressive cardiopulmonary exercise test until exhaustion were divided in subgroups according to treadmill speed during exercise test (4 or 5 mph) and the physical capacity [lower (LPC) and moderate physical capacity (MPC)]. RESULTS: The LL of the indirect exercise intensity prescription showed VO2 and HR values significantly higher than VO2 and HR values measured at AT (4 mph = 34.4 +/- 4.5 vs 19.6 +/- 4.6 and 5 mph = 28.9 +/- 2 vs 18.9 +/- 5.4, and LPC = 32.0 +/- 4.1 vs 17.2 +/- 2.8 and MPC = 31.6 +/- 4.9 vs 21.1 +/- 5.7 mlO2.kg-1.min-1) and (4 mph = 128.9 +/- 7.8 vs 113.1 +/- 15.6 and 5 mph = 130.3 +/- 5.2 vs 114.1 +/- 18.9, and LPC = 127.6 +/- 7.2 vs 109.3 +/- 13.2 and MPC = 131.2 +/- 5.7 vs 117.4 +/- 19.2 bpm) The UL of the indirect exercise intensity prescription in 4 mph and LPC group showed VO2 values significantly higher than those measured at RCP (40.1 +/- 5.3 vs 32.2 +/- 4.3 and 37.4 +/- 4.8 vs 30.6 +/- 2.5 mlO2.kg-1.min-1, respectively), but similar HR values to those obtained at RCP. CONCLUSION: The LL of prescription based on standard exercise test overestimate the AT, whereas the UL seem adequate only for subjects with moderate physical capacity.

Adult↗
PubMed2001

Impact of the cost of prescription drugs on clinical outcomes in indigent patients with heart disease.

STUDY OBJECTIVE: To measure the impact that economic relief for prescription drugs to indigent patients with cardiovascular disease has on indicators of disease control. DESIGN: Prospective cohort study. SETTING: University inner-city outpatient clinic. PATIENTS: One hundred sixty-three indigent patients with heart disease who were uninsured or whose insurance plan did not provide prescription drug coverage and who had baseline data. INTERVENTION: Patients were assisted in obtaining prescription drugs, free of charge, in an attempt to improve adherence to their drug regimens. MEASUREMENTS AND MAIN RESULTS: The primary end point was to determine if cardiovascular outcome measures (i.e., international normalized ratio [INR], blood pressure, low-density lipoprotein [LDL] cholesterol, and hospitalizations) and drug adherence improved in all patients after 6 months of prescription assistance compared with a 6-month baseline period. In patients receiving warfarin, mean INR increased from 2.44 +/- 0.64 at baseline to 2.61 +/- 0.53 at 6 months (p<0.05). In patients with hypertension, mean blood pressure decreased from 138 +/- 20/80 +/- 11 mm Hg at baseline to 138 +/- 19/78 +/- 12 mm Hg at 6 months (p<0.05 for diastolic blood pressure only). The mean LDL level for patients on lipid-lowering drugs significantly decreased from 126 +/- 39 mg/dl at baseline to 108 +/- 38 mg/dl at 6 months (p<0.001). For each disease measure, the improved disease control seen at 6 months persisted throughout 24 months of follow-up. Hospitalizations for the entire cohort decreased from 85 at baseline to 49 at 6 months. Patient drug adherence improved from 48.5% at baseline to 72.7% at 6 months (p<0.001). CONCLUSIONS: Drug adherence and clinical outcomes improved, and the number of hospitalizations declined when cardiovascular drugs were obtained for patients who could not afford to pay for them. Health care insurance plans that do not provide coverage for cardiovascular prescription drugs may be more costly secondary to poor disease control and increased hospitalizations.

Cholesterol, LDL↗
PubMedDate not supplied

Analysis of the movement of prescription drugs to over-the-counter status.

BACKGROUND: The transition of prescription drugs (Rx) to over-the-counter (OTC) status is a very complex and multifaceted process involving many parties and many issues. This article examines the regulatory history and process and presents a review of the issues involved, using recent Rx-to-OTC conversions as examples. FINDINGS: Data are presented on the growth of the OTC market and the impact recently switched products have had on this market growth. Drug product characteristics that make drug products amenable to OTC conversion are described. Reasons are presented for why more and more prescription drug products are being reviewed as candidates for OTC conversion. A list of high-profile Rx-to-OTC products is provided, along with a discussion of new proposals for OTC conversions and those products that have not been approved for OTC conversion. CONCLUSION: Conversion of prescription products to over-the-counter availability can have an impact on prescription-drug-benefit costs and on total health care costs. There are opportunities and limitations for managed care organizations in the coverage and promotion of OTC products as therapeutic alternatives to prescription-only drugs.

Journal Article↗
PubMedDate not supplied

Analysis of medication use patterns:apparent overuse of antibiotics and underuse of prescription drugs for asthma, depression, and CHF.

OBJECTIVE: To assess the appropriateness of prescription medication use based upon widely accepted treatment guidelines. METHODS: We analyzed administrative claims for the period October 1, 1998, through September 20, 1999, supplied by 3 California health plans to determine medication use patterns for outpatient prescriptions. We compared these patterns to those expected in the presence of adherence to treatment guidelines. RESULTS: During the study period, only 27.5% of antidepressant users received the recommended 6 months of continuous therapy, only 49.0% of diagnosed asthma patients received at least one inhaled corticosteroid prescription (compared to 67.1% who received at least one inhaled beta-agonist prescription), and only 54.5% of patients diagnosed with congestive heart failure (CHF) received an angiotensin-converting enzyme (ACE) inhibitor. Of patients who had a diagnosis of common cold or upper respiratory tract infection, 35.7% received antibiotics. CONCLUSION: There is a remarkable degree of apparent overuse and underuse of prescription medications despite the existence of clinical guidelines to support appropriate use in the conditions studied. Effective medications appear to be underused for patients with asthma, CHF, and depression. Antibiotics appear to be overused for the common cold and upper respiratory infections. More effective efforts must be made to address appropriate use of medications. Without these efforts, improved quality of care and decreased total health system costs are unlikely to be realized.

Adolescent↗
PubMed1998

The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners.

OBJECTIVES: The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone. METHODS: Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. RESULTS: The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. CONCLUSIONS: A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their parents to increase physical activity.

Adult↗
PubMed2003

Stimulating adverse drug reaction reporting: effect of a drug safety bulletin and of including yellow cards in prescription pads.

BACKGROUND: The effectiveness of voluntary reporting systems in pharmacovigilance highly depends on the number of assembled reports. AIM: The aim of this study was to measure the effect of the periodical distribution of a bulletin on drug safety issues and of including yellow cards in prescription pads on the rate of adverse drug reaction (ADR) reporting. STUDY DESIGN AND METHODS: The Catalan Centre of Pharmacovigilance began its activities at the end of 1982. Since 1985, an ADR bulletin (ADRB) has been mailed approximately quarterly to all physicians in its catchment area, with one yellow card enclosed. Additionally, from 1991-1994, a yellow card was included in the prescription pads of the Catalan Health Service. Time series methodology, with adjustment of the monthly number of reports to an Auto-Regressive Integrated Moving Average (ARIMA) model, was used to evaluate the effect of these two measures. RESULTS: From January 1983-October 1995, 6240 spontaneous ADR reports were received, and 41 issues of the ADRB were sent out. Initially, the mean monthly spontaneous ADR reporting rate was 34.4 (SD = 14.1; n = 106 months). After the inclusion of yellow cards in prescription pads, the mean monthly spontaneous ADR reporting rate increased to 53.9 (SD = 14.4; n = 48 months). According to an ARIMA model, when a bulletin was send out (MONTH1), a mean increase of 9.4 reports was produced in that month, plus 12.3 additional reports in the following month (MONTH2), and 6.3 in the second month after sending the ADRB (MONTH3). A yellow card in the prescription pads elicits a monthly mean increase of 19.8 in the number of reports. CONCLUSIONS: The present study suggests that ADRBs elicit a temporal increase of the ADR reporting rate. Including a yellow card in prescription pads was followed by an even greater increase in the reporting rate, possibly because it guarantees that yellow cards are available at the workplace.

Adverse Drug Reaction Reporting Systems↗
PubMed1996

Exercise testing and prescription. Practical recommendations for the sedentary.

A sedentary lifestyle is prevalent in most industrialised societies. Persuasive evidence allows us to demonstrate that a physically active lifestyle protects against the development and progression of many chronic diseases. The assessment of sedentary individuals for the purpose of exercise testing and or exercise prescription should always culminate in the determination of the relative risk of the individual for traumatic events which may be precipitated by participation in moderate physical activity. Sedentary individuals may be categorised in a low to high risk stratification as apparently healthy (Class I), higher risk (Class II), or known coronary heart disease and/or symptomatic of chronic disease (Class III). An expanded role for allied health professionals, such as a clinical exercise physiologist, may enhance and extend the services of physicians and nurses as they relate to exercise testing, exercise prescription and preventative healthcare in general. Risk stratification will determine the type of exercise test, the exercise prescription and the exercise environment (low to high levels of supervision). The exercise prescription may include a determination of mode, duration, frequency, intensity, and progression of activity. Although target heart rate remains one of the most effective instruments for monitoring exercise intensity, the rate of perceived exertion should be incorporated especially in the titration of exercise prescriptions for those on beta-blockade therapy. Finally the benefits of an exercise programme, derived from a foundation of proper assessment, are numerous and include improvements in cardiovascular fitness, body composition, blood lipid profile and retention of essential muscle mass during the course of the life-cycle. A considerable public health benefit will result if sedentary individuals become regularly more physically active.

Adrenergic beta-Antagonists↗
PubMed1999

Poverty, health care, and problems of prescription medication: a case study.

Through the use of ethnographic research methods the authors examine the relationship between poverty, limited access to health care, and prescription medication use/misuse in rural eastern Kentucky. Four patterns of prescription drug misuse are documented in this study: 1) overuse of medications, often by means of multiple prescriptions obtained from different physicians; 2) the acquisition of prescription drugs for the purpose of resale through illegal channels; 3) borrowing or "swapping" medications through informal exchange; and 4) under- or nonuse of prescription drugs. Of the four patterns, the last is the one reported as having the highest prevalence due to residents' inability to afford the costs of medications prescribed by physicians. The public health implications of these findings are briefly discussed.

Appalachian Region↗
PubMedDate not supplied

Fitting hearing aids to adults using prescriptive methods: an evidence-based review of effectiveness.

The use of a prescriptive fitting approach for hearing aid selection has been a common practice for the past 60-70 years. While there are prescriptive approaches that have been validated, in recent years it has become popular to deviate from these validated methods and use manufacturers' proprietary algorithms, which in many cases are significantly different. This research review was designed to examine if there was evidence supporting the use of specific gain requirements for hearing aid fitting. Specifically, the question that was asked was "Are there real-world outcome measures from adult patients that show a preference for the gain prescribed by a specific prescriptive fitting procedure?" Inclusion criteria were as follows: adult subjects, consistent technology (e.g., different prescriptive methods compared using same hearing aids), real-ear verification of gain, and real-world outcome measures. For this review, in addition to subjective responses, preferred use gain was considered a real-world outcome measure. The National Acoustic Laboratories' revised (NAL-R), revised for severe/profound (NAL-RP), and the National Acoustic Laboratories-Non-Linear 1 (NAL-NL1) prescriptive methods were used as a common reference, as they have been the most commonly studied methods with adults. Eleven studies were identified that met the inclusion criteria. Eight of the studies supported gain similar to that prescribed by the NAL-R or NAL-RP methods; three studies supported prescribed gain less than the NAL-R or NAL-RP. There was no evidence that gain greater than that prescribed by the NAL methods should be used. The level of evidence was moderate, as the supporting studies were either Level 2 or Level 4, and the statistical power of the studies was low.

Adult↗
PubMed2005

[Antibiotic prescription quality at a hospital emergency service].

INTRODUCTION AND AIM: Many patients receive an antibiotic prescription at hospital emergency departments. It could be considered adequate if it is effective against an appropriate bacteria spectrum and the dosage prescribed is correct. The aim was to evaluate the antibiotic prescriptions quality at an hospital emergency department. METHOD: Retrospective study of patients attended because an infectious disease at an emergency department during a 12 days period analyzing the antibiotic prescription quality. RESULTS: One hundred eighty nine patients were included (48+/-23 years; 52% women). More frequent diseases attended were respiratory infections (58 patients 31%), urinary tract infections (33 patients, 17%) and gastroenteritis (22 patients, 12%). Most frequent prescribed antibiotic was amoxicillin with clavulanic acid (54%). In 82 cases (43%) prescription was considered incorrect. More frequent reason were having a disease that does not need antibiotics (40%), excessive dosage(27%), treatment period inappropriate prolonged (26%), short dosage(10%) and wrong antibiotic selection (5%). CONCLUSIONS: A huge proportion of patients attended at an hospital emergency department received an inadequate antibiotic treatment. Some important measures should be undertaken in order to improve the antibiotic prescription quality.

Adult↗