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Antihypertensive prescribing patterns in non-dialysis dependent chronic kidney disease:Findings from the Salford Kidney Study

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World Journal of Nephrology 2023年第5期12卷 168-181页

作者： Rajkumar Chinnadurai Henry H L Wu Jones Abuomar Sharmilee Rengarajan David I New Darren Green Philip A Kalra Donal O’Donoghue Renal Research Centre&Department of Renal Medicine Northern Care Alliance NHS Foundation TrustSalford M68HDUnited Kingdom Department of Renal Research Kolling Institute of Medical ResearchRoyal North Shore Hospital&The University of SydneySt.Leonards(Sydney)2065New South WalesAustralia Faculty of Biology Medicine&HealthThe University of ManchesterManchester M17HRUnited Kingdom

BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and *** remains variability in antihypertensive treatment *** To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD *** The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since *** patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were *** between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression ***-Meier analysis demonstrated differences in survival *** Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were *** median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system *** pr

关键词： Hypertension Chronic kidney disease Antihypertensive agents prescribing patterns Cardiovascular complications Renin angiotensin system blockers

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Antibiotic prescribing patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

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Pharmacology & Pharmacy 2022年第10期13卷 379-392页

作者： Steward Mudenda Mary Chomba Billy Chabalenge Christabel Nang’andu Hikaambo Michelo Banda Victor Daka Annie Zulu Abraham Mukesela Maxwell Kasonde Peter Lukonde Enock Chikatula Lloyd Matowe Ronald Kampamba Mutati Tyson Lungwani Muungo Tobela Mudenda Shafiq Mohamed Scott Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Bell Pharmacy Kabulonga Centro Mall Lusaka Zambia Ministry of Health Headquarters Ndeke House Lusaka Zambia Department of Pharmacy Levy Mwanawasa University Teaching Hospital Lusaka Zambia Faculty of Pharmacy School of Pharmacy Eden University Lusaka Zambia Department of Pathology Ndola Teaching Hospital Ndola Zambia Remedium Pharmaceuticals Limited Lusaka Zambia Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.

关键词： Antibiotic prescribing Antimicrobial Resistance Antimicrobial Stewardship AWaRe Classification prescribing patterns Primary Healthcare Surveillance Zambia

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Herbal medicine prescribing patterns from contemporary famous old TCM doctors for treating coronary heart disease: an analysis based on data mining

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Medical Data Mining 2021年第2期4卷 1-8页

作者： Yong Chen Jie Wang Tong Yang De-Ying He Yi Ren Chongqing Traditional Chinese Medicine Hospital Chongqing 400021China

To analyze the herbal medicine prescribing patterns of contemporary famous old traditional Chinese medicine doctors in treating coronary heart disease,based on data mining technology,so as to provide useful insights into the clinical ***:Databases,including Medline(January 1966 to December 2019),Wanfang(January 1982 to December 2019),VIP Database(January 1989 to December 2019),CNKI(January 1979 to December 2019),CBMdisc(January 1978 to December 2019),and Classic Case Collection from Contemporary Famous Old Traditional Chinese Medicine Doctors were searched,and 224 eligible studies involving 416 patients were entered into the case study database after data *** analysis and association rule analysis were used to investigate the prescribing patterns of contemporary famous old traditional Chinese medicine doctors in treating coronary heart ***:In total 290 kinds of Chinese herbal drugs and 19 core drugs were used in the cases *** most commonly used categories were“Qi-Tonifying Drugs”,“Blood-Activating Drugs”,and“Phlegm-Eliminating Drugs”.The association rule analysis identified 14 commonly used herbal pairs,19 three-drug combinations,and 1 four-drug ***:Contemporary famous old traditional Chinese medicine doctors considered warming heart yang as an extremely important approach to treat coronary heart disease based on Zhang Zhongjing’s treatment for chest painful obstruction caused by“Inactivity of Chest Yang”(blockade of phlegm turbidity).Both symptoms and root causes were addressed in the formulas prescribed by these doctors.“Tonifying Qi,Nourishing Yin,Activating Blood,and Eliminating Phlegm”were the most commonly used therapeutic methods for patients with coronary heart disease.

关键词： Association rule analysis Coronary heart disease Old traditional Chinese medicine doctors prescribing patterns

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Management of erectile dysfunction: barriers faced by general practitioners

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Asian Journal of Andrology 2004年第2期6卷 99-104页

作者： Wah-YunLow Chirk-JennNg Ngiap-ChuanTan Wan-YuenChoo Hui-MengTan HealthResearchDevelopmentUnit DepartmentofPrimaryCareMedicine FacultyofMedicineUniversityofMalayaKualaLumpurMalaysia DepartmentofCommunity OccupationandFamilyMedicineFacultyofMedicineNationalUniversityofSingaporeSingapore AsiaPacificSocietyforImpotenceResearch c／oSubangJayaMedicalCenterSubangSelangorMalaysia

Aim: To explore the barriers faced by general practitioners (GPs) in the management of patients with erectile dysfunction (ED). Methods: This was a qualitative analysis of focus group discussions and in-depth inter views involving 28 Malaysian GPs. Results: GPs' perception of ED being not a serious condition was a major determinant of their prescribing practice. Doctor's age (younger), gender (female), short consultation time and lack of experience were cited as barriers. The GPs' prescribing habits were heavily influenced by the feedback from the first few patients under treatment, the uncertainty of etiology of ED without proper assessment and the profit margin with bulk purchase. Other barriers include Patients' coexisting medical conditions, older age, lower socio-economic status, unrealistic expectations and inappropriate use of the anti-impoteneet drugs. Cardiovascular side effects and cost were two most important drug barriers. Conclusion: The factors influencing the management of ED among the general practitioners were multiple and complex. An adequate understanding of how these factors (doctors, patients and drugs) interact can assist in the formulation and implementation of strategies that encourage GPs to identify and manage ED patients.

关键词： erectile dysfunction prescribing patterns general practitioners barriers Malaysia

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Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

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World Journal of Gastroenterology 2012年第24期18卷 3167-3172页

作者： Ling-Ling Zhu Ling-Cheng Xu Yan Chen Quan Zhou Su Zeng Geriatric Ward the 2nd Affiliated HospitalSchool of Medicine Zhejiang University Hangzhou 310009Zhejiang Province China Department of Pharmacy the2nd Affiliated Hospital School of Medicine Zhejiang Univer-sity Hangzhou 310009 Zhejiang Province China Department of Gastroenterology the 2nd AffiliatedHospital. School of Medicine Zhejiang University Hangzhou310009 Zhejiang Province China Department of Pharmaceutical Analysis and Drug Metabolism College of Pharmaceutical Sciences Zhejiang Uni- versity Hangzhou 310058 Zhejiang Province China

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective ***:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang *** hospital has 2300 beds and 2.5 million outpatient visits *** mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in *** use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring *** annual incidence of major GI bleeding due to low-dose aspirin was estimated for ***:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,*** statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or *** combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate

关键词： Low-dose aspirin Gastrointestinal injury Small bowel injury Drug utilization prescribing patterns Combined medications Proton-pump inhibitors Hista-mine 2-receptor antagonists IVlucoprotective drugs De-fined daily dose

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