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PubMed1998

Effects of Chinese herbal prescriptions on copulatory activity in aged male rats: a preliminary study.

Four herbal prescription medicines, Chi-Pao-Mei-Jan-Tan, Gui-Fu-Ba-Wei-Wan, Huan-Shao-Tan; and San Tsai-Feng-Sui-Tan, were tested for their effects on sexual behavior in aged rats. Crude liquid extracts of these herbs were administered to the rats daily through oral tubing for 14 days. All four herbal prescriptions showed some effects in restoration of mount and intromission behaviors, but there was no effect on restoration of ejaculation in 26 month old rats that had exhibited no copulatory activity (no mount, intromission and ejaculation) previously. The effects of Chi-Pao-Mei-Jan-Tan were further tested in 26 month old rats with low mount and intromission activities but without ejaculation behavior, and in 15 month old rats (middle-age group) that showed normal mount and intromission behavior but no ejaculation activity. Chi-Pao-Mei-Jan-Tan was effective in improving the frequency of both mount and intromission, but failed to restore the ejaculation activity of the old rats with low mount and intromission behaviors. It was, however, very effective in restoration of ejaculation activity in middle-aged rats that exhibited normal mount and intromission behaviors. Serum testosterone (T) levels of Chi-Pao-Mei-Jan-Tan in tested old and middle-aged rats were determined by radioimmunoassay, and showed no difference before and after treatment. Our findings demonstrated that the four herbal prescriptions had some effects in restoration of mount and intromission behaviors, but not ejaculation activity in old rats, and that Chi-Pao-Mei-Jan-Tan was very effective in restoration of ejaculation activity in middle-aged rats. The promotional effect of Chi-Pao-Mei-Jan-Tan on copulatory behavior was not correlated with serum T levels.

Aging↗
PubMed2002

Student critical thinking is enhanced by developing exercise prescriptions using online learning modules.

Developing the ability to think critically is an important element of undergraduate physiology education and is influenced by many factors, including the learning environment, the social context of the learning environment, and the instructor's approach to teaching. In this work, we describe online learning modules (OLM) that were designed to promote higher-order critical thinking skills in students enrolled in an upper-division Exercise Testing and Prescription course. The OLM provided students with an online learning environment in which to review clinical physiological details from authentic patient case data and develop exercise prescriptions (ExRx), by requiring students to critically analyze authentic patient case histories and collaborate on computer-based learning activities. On the basis of assessment data, we conclude that the OLM helped exercise science students develop the critical thinking skills necessary for development of effective exercise prescriptions by requiring them to think critically while concurrently reinforcing lecture-presented exercise science content.

Computer-Assisted Instruction↗
PubMed1995

Use of prescription psychotropic drugs among suicide victims in New York City.

OBJECTIVE: The authors examined the rate of prescription psychotropic drug use among suicide victims at the time of their death. METHOD: From a total of 1,970 suicides that occurred in New York City from 1990 to 1992, 1,635 cases that had a complete toxicologic analysis and an injury-death interval of 48 hours or less were assessed at autopsy for the presence of commonly prescribed antidepressants and neuroleptics. RESULTS: Prescription psychotropic medications were detected in only 16.4% (N = 268) of the suicide victims studied. Demographic factors associated with use of these drugs included female gender and white race. Poisoning accounted for 17.9% (N = 293) of all suicides studied, but antidepressants or neuroleptics were detected in less than half of these victims. Among all suicide victims in whom an antidepressant or neuroleptic was detected, almost half had used lethal methods other than poisoning. CONCLUSIONS: In this study, most individuals who committed suicide in New York City were not taking prescription psychotropic medications at the time of their death and either were not receiving pharmacotherapy or were noncompliant.

Adult↗
PubMed1993

Ill-health and social predictors of psychotropic drug prescription in general practice.

Prescriptions of psychotropic drugs among 505 consecutive attenders on a single day at 32 general practices were recorded. For 404 of them the results of a screening for psychiatric morbidity conducted by means of the General Health Questionnaire (GHQ) were available. Among attenders recognised as psychiatric cases by their general practitioners the presence of concurrent somatic problems exerted a significant effect in reducing the relative odds of prescription. A very strong and significant interaction effect between male sex and high GHQ score was detected: men scoring over the threshold on the questionnaire had a risk of receiving a psychotropic drug prescription 49 times higher than the general sample. Social problems-related factors did not show significant effects when included in multivariate models comprising ill-health risk factors.

Adult↗
PubMed2003

Prescription audit: experience in Garhwal (Uttaranchal), India.

A total of 400 prescriptions were randomly audited from Govern Combined Hospital, Srinagar (Garhwal). Various prescribing specific indicators (recommended by World Health Organization and others) were studied and patient compliance was measured. All of the prescriptions were written for outpatients (males 59.25%; females 40.75%). The average number of drugs prescribed was 3.65 and about 51% of the drugs were prescribed by generic names. NSAIDs were the most widely prescribed (89.75%), antibiotics (77.25%), and vitamins (59.74%) in various clinical conditions. The diagnosis was mentioned only in 22.25% of the prescriptions. A total of 59% fixed dose combinations (FDCs) were prescribed. The patient compliance was 71.5%. The injection use was found to be 7% only. Our survey reveals increased drug exposure to the patients, indiscriminate use of NSAIDs, antibiotics and vitamins. Further studies in this area using a larger sample size should be carried out, and a well designed training programme should be conducted on rational drug use.

Drug Prescriptions↗
PubMed1983

FDA approval of comparative claims for prescription drugs--the Moxam case.

FDA allowance of comparative claims as part of the approved labeling for new prescription drugs creates special problems. Claims contained in prescription drug labeling are viewed by physicians as embodying not just the normal puffery of the manufacturer, but the considered views of government agency charged with protecting public health. Thus, labeling claims for prescription drugs have an impact and significance that promotional claims for other products do not. In the Moxam case--a dispute between Upjohn and Lilly over the FDA's approval of a comparative claim for a new Lilly antibiotic--the agency recognized this fundamental reality. Faced with the prospect of having to provide a procedure to permit competitors to challenge approval of comparative claims, the FDA has moved toward a policy of not permitting such claims in labeling, while allowing them in advertising.

Advertising↗
PubMed2006

Prescription errors in psychiatry - a multi-centre study.

Medication errors are an important cause of patient morbidity and mortality, of which there have been few reports in psychiatry, especially in the UK. Our aim was to examine the nature, frequency and potential severity of prescribing errors in UK mental health units in a prospective, 1 week survey of errors detected by pharmacy staff in nine NHS trusts. Pharmacists checked 22036 prescription items. In total, 523 errors meeting the study definition were detected (2.4% of prescription items checked). Prescription writing errors (77.4%) were most common, while decision-making errors accounted for 22.6% of errors. In 280 (53.5%) cases the prescribed drug had been administered before the error was detected. Most errors were of doubtful or minor importance but 22 (4.3%) were deemed likely to result in serious adverse effects or death. The error detection rate varied fourfold between trusts. Prescribing errors are fairly common in psychiatry. A small proportion of errors have the potential for serious harm. Pharmacy staff have an important role to play in their management.

Drug Prescriptions↗
PubMed2001

A green prescription study: does written exercise prescribed by a physician result in increased physical activity among older adults?

OBJECTIVE: To determine if a written exercise prescription increases physical activity when added to verbal advice. METHODS: Forty-nine community-dwelling older adults supplied their geriatricians with baseline data on their exercise levels using a questionnaire. Participants were randomly placed in a verbal advice only group or a verbal advice plus written prescription, "green" prescription, group. Outcomes were assessed after 6 weeks. RESULTS: Both groups showed a significant increase in time spent in physical activity. However, no significant differences between groups due to the effects of the different advice modalities were found. CONCLUSIONS: Geriatricians can effectively promote physical activity among sedentary older adults through goal-oriented physical activity advice.

Aged↗
PubMed1999

Physicians' perspectives on communicating prescription drug information.

Physician-patient communication has been identified as one factor that influences prescription drug compliance rates, even though the nature of such communication has not been well described. This study used a qualitative approach (in-depth interviews with 20 physicians representing a variety of medical areas) to better understand the process by which physicians communicate prescription drug information to their patients. A content analysis of interview transcripts indicated that two-way interactions focusing on the specific needs of the patients should be encouraged over simply disseminating more and more information about prescriptions. Information regarding unlikely outcomes was suggested to cause patient anxiety, which might be tied to decreased compliance rates. Physicians stressed the importance of "patient-directed communication" and expressed their concern over what they considered to be inappropriate sources of drug information. Other specific reasons cited for noncompliance included forgetfulness, ignoring medication when feeling better, and apprehensions about side effects.

Attitude of Health Personnel↗
PubMed1990

Assessment of the Florida Pharmacist Self-Care Consultant Law using patient profile and prescription audit methods.

This article examines pharmacist nd physician prescribing patterns during the first two years of the Florida Pharmacist Self-Care Consultant Law. Nineteen pharmacies were audited. The mandatory patient profiles were audited for a two-year period, and the prescription files were audited for a five-year period. For the nine pharmacies maintaining patient profiles, the prescribing activities of the pharmacists almost double from the first year to the second year. However, these prescriptions made up a very small portion of the total. Pharmacist prescribing appeared to be limited to three primary drug categories: topical pediculicides (lindane shampoo), oral analgesics, and otic analgesics; these comprised 82 percent of all pharmacist-generated prescriptions.

Drug Prescriptions↗
PubMed1992

Impact of triplicate prescription program on psychotropic prescribing patterns in long-term care facilities.

OBJECTIVE: To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period. DESIGN: Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program. SETTING: Eight private and two public long-term care facilities in the western New York area. PATIENTS: All residents in the long-term care facilities with complete medical records for a one-year period were reviewed. OUTCOME MEASUREMENTS: Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst. MAIN RESULTS: BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program. CONCLUSIONS: This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.

Drug Prescriptions↗
PubMed2006

Patient-reported underuse of prescription medications: a comparison of nine surveys.

Nine national surveys documenting patient underuse of prescription medications were examined to describe the variation and trends in that underuse and identify possible reasons for the substantially different rates that were reported. Underuse includes unfilled prescriptions, delayed therapy, reduced frequency, and lowered dosage. Rates of cost-related patient underuse in the studies ranged from 1.6 to 22 percent. Insurance coverage, level of wealth, age, and health status were the sociodemographic variables most strongly related to underuse. Seven additional factors in the design and administration of the surveys were identified as providing plausible explanations for the variance across surveys. The most conspicuous variation was between three government-sponsored periodic surveys and six generally one-time assessments, with the latter yielding higher rates and greater variance in underuse. Understanding the factors contributing to the variation in reported rates of underuse of medications is an important prerequisite for the design of effective prescription-drug benefit programs.

Adolescent↗
PubMedDate not supplied

ELISA D-dimer measurement for the clinical suspicion of pulmonary embolism in the emergency department: one-year observational study of the safety profile and physician's prescription.

OBJECTIVES: To validate the safety profile of a rapid ELISA D-dimer as the first diagnostic step in the clinical suspicion of pulmonary embolism (PE) in outpatients admitted to an emergency department (ED), and to retrospectively evaluate the appropriateness of the physician's prescription. DESIGN AND SETTING: An observational study of all patients admitted to the ED of an urban university teaching hospital with signs and symptoms justifying the prescription of a rapid ELISA D-dimer measurement (Vidas; Biomerieux; France) as the first line diagnostic test for PE. Acute PE was established or excluded according to an appropriate combination of the D-dimer concentration, the lung scintigraphy, the spiral computerized tomography (spiral CT), the venous ultrasonography, and the arteriography in case of uncertain results. All patients with D-dimer values under the cut-off point of 500 ng/ml were followed up after 6 months. RESULTS: 395 patients were studied. A normal D-dimer concentration < 500 ng/ml was found in 179 patients (45% of the cohort). The retrospective analysis showed that none of these patients were found to have a high pre-test clinical probability. None of these 179 patients received anticoagulation nor displayed a PE event during a 6-month period (negative predictive value 100%; 95% CI, 98.0 to 100%; sensitivity 100%; 95% CI, 90.3 to 100%). Among the 216 patients (55%) with D-dimer values above 500 ng/ml, PE was confirmed in 32 cases, for a prevalence of the disease of 8.1%. Eighty-six patients (22%) had no additional testing in spite of positive D dimer values > 500 ng/ml, pointing out a 22% rate of inappropriate use of the D-dimer measurement. CONCLUSION: This observational study confirms that a normal rapid ELISA D-dimer value (< 500 ng/ml) used as a first diagnostic step in ruling out the diagnosis of PE is a safe clinical practice when the pre-test clinical probability is low or intermediate. Nevertheless, the low prevalence rate of the disease (8.1%) suggests a potential overused and inappropriate prescription.

Adolescent↗
PubMed2005

Prescription channeling of COX-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs: a population-based case-control study.

This pharmacoepidemiologic study was conducted to determine whether risk factors for upper gastrointestinal bleeding influenced the prescription of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) at the time when COX-2 inhibitors were first included in the formulary of reimbursed medications. A population-based case-control study was conducted in which the prevalence of risk factors and the medical histories of patients prescribed COX-2 inhibitors and traditional nonselective NSAIDs were compared. The study population consisted of a random sample of members of the Quebec drug plan (age 18 years or older) who received at least one dispensation of celecoxib (n = 42,422; cases), rofecoxib (n = 25,674; cases), or traditional nonselective NSAIDs (n = 12,418; controls) during the year 2000. All study data were obtained from the Quebec health care databases. Adjusting for income level, Chronic Disease Score, prior use of low-dose acetylsalicylic acid, acetaminophen, antidepressants, benzodiazepines, prescriber specialty, and time period, the following factors were significantly associated with the prescription of COX-2 inhibitors: age 75 years or older (odds ratio [OR] 4.22, 95% confidence interval [CI] 3.95-4.51), age 55-74 years (OR 3.23, 95% CI 3.06-3.40), female sex (OR 1.52, 95% CI 1.45-1.58), prior diagnosis of gastropathy (OR 1.21, 95% CI 1.08-1.36) and prior dispensation of gastroprotective agents (OR 1.57, 95% CI 1.47-1.67). Patients who received a traditional nonselective NSAID recently were more likely to switch to a coxib, especially first-time users (OR 2.17, 95% CI 1.93-2.43). Associations were significantly greater for celecoxib than rofecoxib for age, chronic NSAID use, and last NSAID use between 1 and 3 months before the index date. At the time of introduction of COX-2 inhibitors into the formulary, prescription channeling could confound risk comparisons across products.

Adolescent↗
PubMed2003

[Area distribution of out-issued prescriptions from Saiseikai Kurihashi Hospital and behavior patterns of outpatients for selection of pharmacy].

The area distribution of out-issued prescriptions for outpatients in Saiseikai Kurihashi Hospital was surveyed over 6 months from the first day of out-issue. Behavior patterns of outpatients in the selection of pharmacy were also investigated. Our survey included the out-issued prescriptions in eight surrounding newly established pharmacies together with the first out-issue. Computer simulation indicated that 70% of the outpatients selected the surrounding pharmacies when they received their out-issued prescriptions the first time. However, the percentage of surrounding pharmacies selected by the patients decreased to 60% the second time, and then again increased to 80% the third time. The results suggest that most outpatients use surrounding pharmacies, although they try to use the pharmacies near their homes for a time.

Choice Behavior↗
PubMed2005

A drug dosage table is a useful tool to facilitate prescriptions of antiretroviral drugs for children in Thailand.

Scaling up of antiretroviral treatment (ART) for children in countries like Thailand will require decentralization and management by non-specialist doctors. We describe (a) the formulation of a standardized drug dosage table to facilitate antiretroviral drug (ARV) prescriptions for children, (b) the acceptability of such a table among doctors and (c) the safety and efficacy of drug doses in the table. Acceptability was assessed using a questionnaire. Safety and efficacy were assessed on the basis of incidence of adverse effects and virological response to treatment, respectively. Of all doctors (n=18), 17 (94%) found that the table was practical to use, avoided miscalculations and made them more confident with prescriptions. Of 49 children prescribed ARVs, less than 5% had adverse side-effects. All ARV-naïve children achieved undetectable viral loads within six months of ART. In our setting, a standardized drug dosage table provided a simple and reliable tool that facilitated ARV prescriptions for children.

Anti-HIV Agents↗
PubMed1993

An investigation of promotional mix considerations for mail-order prescriptions: facilitating the market's acceptance of a partial health care-cost remedy.

While the U.S. health care system is confronted by a daunting assortment of problems, the foremost crisis almost certainly involves the excessive costs of health care. Mail-order prescriptions offer a modest, albeit worthwhile, measure of relief from high health care costs. This study investigates the information search behaviors and product perceptions that characterize current users and nonusers of mail-order prescriptions. Implications and recommendations concerned with the development of promotional strategies for mail-order prescriptions are derived from the findings.

Aged↗
PubMed2002

Trust in online prescription drug information among internet users: the impact on information search behavior after exposure to direct-to-consumer advertising.

The proliferation of both manufacturer-controlled and independent medication-related websites has aroused concern among consumers and policy-makers concerning the trustworthiness of Web-based drug information. The authors examine consumers' trust in on-line prescription drug information and its influence on information search behavior. The study design involves a retrospective analysis of data from a 1998 national survey. The findings reveal that trust in drug information from traditional media sources such as television and newspapers transfers to the domain of the Internet. Furthermore, a greater trust in on-line prescription drug information stimulates utilization of the Internet for information search after exposure to prescription drug advertising.

Adolescent↗