Drug utilization evaluation of medications used in the management of neurological disorders

Background and object:The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition,with irrational drug use,which is also a global concern.Thus,drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings.The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders.Materials and methods:A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months.All legible prescriptions consisting neurological medications irrespective of patient's gender,aged≥18 years were included for the study.The World Health Organization(WHO)core drug use indicators were used to assess the drug prescribing and utilization patterns.Results:A total of 310 prescriptions were reviewed,where male predominance was found to be 56.45%.Out of 310 prescriptions,drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders.The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin(14.8%)and valproic acid(6.45%).By following the WHO core drug prescribing indicators,65.47%of drugs prescribed from the India National List of Essential Medicines,2022,followed by 29.83%of drugs prescribed in generic name and 10.86%of prescriptions including injections.Conclusion:The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators.But,the extent of polypharmacy prescriptions was very high.Therefore,interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety.

The role of drug utilization evaluation in medical sciences

Background:Drug utilization evaluation(DUE)is defined by the World Health Organization(WHO)and focuses on the medical,social,and economic consequences of pharmaceutical marketing,distribution,prescribing,and usage in society.The WHO recommends a physician to every 1000 people.According to the recent data from the Health Ministry in 2019,in which 1.16 million doctors are of active population with just 80%,or 0.9 million,practicing.As a result,a ratio of 0.68 doctors for every 1000 people,which is much below as per the WHO reports.This article describes history,types,WHO guidelines,need and purpose of DUE.Objective:The main aim of this paper is to provide information about the rational use of medication in outpa­tient and inpatient department with special emphasis of DUEs.It also provides awareness directly to healthcare professionals,researchers,academicians,pharmacist and nurses to reduce the irrationality of medicines.Methods:The method used to compile this review information gathered from websites,Google scholar,PubMed,Research gate,and studies published on DUE from July 20 to Oct 22 were included as source of information.Results:We studied more than 35 published study on DUE,that reveals most of the physicians prescribed branded drugs not generic drugs,but WHO prescribing indicator allows to prescribe generic drugs in the hospital pharmacy to maintain better inventory control.It may also help to prevent pharmacist misunderstanding during dispensing.Conclusion:The use of generic prescription names avoids the possibility of medication product duplication and lowers patient costs.It is important to remember that incorrect medication prescriptions have impact on both patients and their family members.WHO indicators identify irrational prescribing behaviours to make therapy more rational and cost-effective.

Evaluation of the Protection and Utilization of Great Sites:A Case Study of Zhengzhou City

The protection and utilization of great sites not only are related to the inheritance of historical and cultural heritage and academic research,but also directly affect local economic development and social and cultural dissemination.In this paper,five major great sites in Zhengzhou City(Dahe Village Site,Zhengzhou Shangcheng Site,Xiaoshuangqiao Site,the Capital of Zheng and Han States,and Mausoleum of Song Dynasty Tombs of Song Emperors)are taken as research objects,and a set of index system for evaluating the protection and utilization of great sites is constructed.A comprehensive evaluation is conducted from seven aspects:protection management,research value,site utilization,cultural value dissemination,socio-economic benefits,utilization effects,and regional development coordination.This paper provides a comprehensive and scientific evaluation perspective for the protection and utilization of great sites,which helps to better grasp the direction of site protection and utilization,and develop more practical and effective strategies for site protection and utilization.

Evaluation of Economical and Intensive Use of Construction Land in a County Town:A case study of Wan’an County,Ji’an City

Taking the changes of construction land in Wan’an County over the years as the research object,the quantity and spatial characteristics of construction land in Wan’an County were analyzed,and the overall situation and regional differences of construction land utilization in Wan’an County were revealed.From the aspects of main influencing factors such as land use structure,land use intensity,land input intensity and output benefit,an evaluation indicator system was established to evaluate the economical and intensive use level of construction land in Wan’an County.The results show that the score of the economical and intensive use level of construction land in Wan’an County was 56.92,which was the lowest among all the districts and counties in Ji’an City.Based on the evaluation results,the corresponding economizing and intensive strategies were put forward,and the safeguard measures for its implementation were explored.The purpose is to provide some support for the preparation of territorial spatial planning,the delineation of urban development boundaries,and the potential exploitation of construction land stock,hoping to improve the utilization efficiency and benefit of construction land in Wan’an County,and promote the economic growth of Wan’an County to the stage of high-quality development.

临床药师应用DDDs法联合DUE综合评价外科中成药的研究

目的:探讨临床药师应用用药频度(DDDs)法联合药物利用评估法(DUE)综合评价在外科中成药管理中的应用效果。方法:回顾性分析2022年1月—2022年10月外科患者203例的临床资料作为对照组,由医生或护士提供药物使用指导;2022年11月—2023年8月外科患者的临床资料203例作为观察组,临床药师采取DDDs法联合DUE进行药学干预。对比两组中成药DDDs、日均费用(DDDC)、药物利用指数(DUI)及排序比值、不合理用药情况、药品不良反应发生率。结果:观察组DDDs和DDDC最高的是丹参注射液,瓜蒌皮注射液次之;各中成药的DUI<1,排序比值均≥1;对照组DDDs最高的是注射用血栓通,瓜蒌皮注射液次之;DDDC最高为瓜蒌皮注射液,丹参注射液次之;丹参注射液、注射用血栓通、瓜蒌皮注射液、康莱特注射液的DUI>1;丹参注射液、瓜蒌注射液、康莱特注射液排序比值<1;观察组药物的选择、超医保限药、给药剂量、药物配伍不合理发生率及不良反应发生率低于对照组(P<0.05)。结论:DDDs法联合DUE综合评价中成药的使用,可以加强管理效果,改善DUI与排序比值,促进临床合理用药,减少不良反应。

DRUGDEX DRUG EVALUATIONS数据库介绍

DRUGDEX DRUG EVALUATIONS数据库主要收录基于实时证据,针对药品临床使用信息编撰而成的独立专论。本文简要介绍DRUGDEX数据库的数据开发流程、专论内容及组织结构、检索方法和获取途径等,目的是为医药专业人员提供一个药品评价信息的参考资源。

Drug utilization of clarithromycin for gastrointestinal disease treatment

AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release （IR） or sustained-release （SR） product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively. RESULTS： One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori （H pylori） therapy, triple therapy take the dominant position （91.8%）, followed by quadruple therapy （4.3%） and dual therapy （3.9%）. Amoxicillin was the most frequently co-prescribed antibiotic.Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating Hpy/ori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription （0.9%） of clarithromycin IR was prescribed for unapproved indication （i.e. gastro-oesophageal reflux disease）. 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified. CONCLUSION： There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.

Relative Efficiency Evaluation on Water Resource Utilization

Water resource allocation was defined as an input-output question in this paper, and a preliminary input-output index system was set up. Then GEM （group eigenvalue method）-MAUE （multi-attribute utility theory） model was applied to evaluate relative efficiency of water resource allocation plans. This model determined weights of indicators by GEM, and assessed the allocation schemes by MAUE. Compared with DEA （Data Envelopment Analysis） or ANN （Artificial Neural Networks）, the mode was more applicable in some cases where decision-makers had preference for certain indicators

Comprehensive evaluation of rural courtyard utilization efficiency:A case study in Shandong Province,Eastern China

China is implementing the strategy of Rural Revitalization.Revitalizing idle and inefficient utilization courtyards is an important measure for rural revitalization.The evaluation of courtyard utilization efficiency is the basis of determining the idle and inefficient utilization courtyards in order to revitalizing it.This study provided a reference for the optimal use of rural courtyard utilization and revitalization through the quantitative comprehensive evaluation of courtyard utilization efficiency and the classification of courtyard utilization types.Taking Shandong Province in Eastern China as study area,we selected eight surveyed villages by stratified sampling method.According to the scale of the villages,full survey and sample survey were used,while middleaged men who familiar with the courtyards were selected as the respondents.Through a household questionnaire survey and face-to-face interviews from2017 to 2018,578 questionnaires of rural courtyardsin eight villages were obtained.Then based on the functions of rural courtyard and land resource conditions,16 comprehensive factors were formulated,involving land conditions,construction conditions and economic benefits,to build the comprehensive evaluation index system of rural courtyard utilization efficiency.Next the index weight was determined by analytic hierarchy process,and the linear weighted regression model was used to evaluate the utilization efficiency of rural courtyard.Finally,the K-means clustering analysis was used to classify the utilization efficiency of courtyards.The results showed that among the eight villages,the average utilization efficiency of courtyards was moderate(one village was low,five were moderate,and two were high).The proportions of both idle and inefficiently utilized courtyards were high.There were three vital factors leading to the idle and low efficiency of rural courtyards.They were declining rural industries,limited arable land per capita,and more farmer workers.In this case,the utilization efficiency of courtyards should be improved by transferring rural land,developing secondary and tertiary industries,evaluating the development potential of villages,classifying and optimizing courtyard utilization,so as to make full use of idle and inefficient courtyards,increase the income of farmers and collectives and promote the revitalization of rural areas.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India. METHODS： No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting （drug availability）-modified prescribing indicators and patient care indicators, based on World Health Organization＇s core drug use indicators. A cross- sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments （OPDs） for the first time at Mahesh Bhattacharyya Homeopathic Medical College ＆ Hospital, Howrah, West Bengal, India, using the developed indicators. RESULTS： Overall availability of prescribed drugs was quite satisfactory （92.28%）. Centesimal potencies accounted for the majority of prescriptions （74.76%）. There was a poor record of diagnosis （39.17%） except in the OPDs of Gynecology and Obstetrics （68.48%, P 〈 0.01） and Dermatology （64.58%, P 〈 0.01）. Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using ＇individualized homeopathy＇ predominated, there also existed the use of ＇polypharmacy＇. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible. CONCLUSION： This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.

A study on utilization of anti-asthmatic drugs at a medical college hospital in India

Objective:To study the usage of anti-asthmatic dugs and enumerate the patients’ noncompliance. Methods:The study was conducted from 5th Feb,2006 to 5th Mar,2006.The samples were from the general medicine ward.All patients with respiratory tract infection who received anti-asthmatic drugs were included in the study.Data were collected from clinical notes and structured patient’s data,and patient interview utilizing a piloted questionnaire data collection form.The questionnaire included patient demographics,anti-asthmatics prescribed, dose,frequency and previous treatment if any and its duration,concomitant medications etc. Results:26.31%of patients were 61-70 years old.Among 57 patients,91.23%of patients received multi-therapy,8.77%of patients received mono-therapy,59.65%of patients took over the counter(OTC) drugs and 57.89%of patients were non compliant.Anti-asthmatic drugs were prescribed to asthmatic patients as oral,inhalation and others(injections),and more than one route were used for administration of drugs.Conclusion:The anti-asthmatics are used to treat breathing difficulties such as allergy.Poor compliance to treatment is common among the patients,which makes it difficult to manage asthma and increases both morbidity and mortality.It is suggested that interventions have to be done by providing counseling and improving the current prescribing trend for better and rational utilization.

Quantitative characterization of cell physiological state based on dynamical cell mechanics for drug efficacy indication

Cell mechanics is essential to cell development and function,and its dynamics evolution reflects the physiological state of cells.Here,we investigate the dynamical mechanical properties of single cells under various drug conditions,and present two mathematical approaches to quantitatively characterizing the cell physiological state.It is demonstrated that the cellular mechanical properties upon the drug action increase over time and tend to saturate,and can be mathematically characterized by a linear timeinvariant dynamical model.It is shown that the transition matrices of dynamical cell systems significantly improve the classification accuracies of the cells under different drug actions.Furthermore,it is revealed that there exists a positive linear correlation between the cytoskeleton density and the cellular mechanical properties,and the physiological state of a cell in terms of its cytoskeleton density can be predicted from its mechanical properties by a linear regression model.This study builds a relationship between the cellular mechanical properties and the cellular physiological state,adding information for evaluating drug efficacy.

Utilization of Malaria Diagnostic Tests and Receipt of Anti-Malarial Drugs by Febrile Patients Attending Outpatient Clinics of Health Centre IV Facilities in Mukono District, Uganda

Background: Failure to demonstrate the presence of malaria parasites prior to treatment with anti-malarial drugs remains a challenge in Uganda, often resulting into over-prescription of anti-malarial drugs to febrile patients suspected of malaria. The aim of this study was to describe the role of utilization of malaria diagnostic tests and associated factors in the receipt of anti-malarial drugs among febrile patients suspected of malaria. Methods: In a cross-sectional study design, client-exit interviews with febrile patients and key-informant interviews with purposively selected health workers were conducted at outpatient clinics of health centre IV facilities in Mukono district. Data entry and analysis were done using EpiData 3.2 and STATA 10 respectively. Data were described using frequency distributions and proportions. Chi square was used in two by two tables, odds ratios as the measure of association and an alpha level of 0.05 was used in all significance tests. Results: Out of 408 respondents, the majority were female (252, 61.8%) and a third of the samples were aged five years and below. The mean age in years was 3.3 with a standard deviation of 2.1. More than half of the respondents (359, 88%) utilized malaria diagnostic tests and about half (241, 59%) received anti-malarial drugs. There were no statistically significant differences between utilizers and non-utilizers in most characteristics except age, history of indoor residual spraying and perceived satisfaction with services at outpatient clinics. Utilizers were 75% less likely to receive anti-malarial drugs than non-utilizers after controlling for age, sex and residence (OR: 0.25, 95%CI: 0.09, 0.66). Frequent power cut-offs as well as limited knowledge on malaria treatment guidelines amongst laboratory personnel were some of the major limitations to microscopic diagnosis of malaria. Conclusion: Utilizers were 75% less likely to receive anti-malarial drugs as opposed to non-utilizers. This implies that increasing utilization of malaria diagnostic tests can reduce the problem of over-prescription of anti-malarial drugs by 75% among those tested for malaria, since anti-malarial drugs would be received by only those with a parasi- tologically-confirmed diagnosis of malaria. Policy implications: To overcome the problem of over-prescription of anti-malarial drugs, there must be a policy that ensures a consistent power supply in all public health laboratories. Training of health workers should encompass all cadres and work-shifts for laboratory personnel should be established to enhance utilization of malaria diagnostic tests especially at night.

Evaluation of Intensive Land Utilization based on Anti-planning Concept

Based on the gist of anti-planning,evaluation standards and methods of intensive land utilization were re-examined according to the inverse planning procedures.Significant role of compulsory non-development zone(similar to the traditional"non-construction land")among the planning fruits in the intensive utilization of urban land resources and relevant index weights in the evaluation system were re-weighed.In land evaluation,relevant control indexes of compulsory non-development zone were first calculated and evaluated,healthy and sustainable development coefficients of land were obtained and regarded as the core content of the whole evaluation system.

A Few Specialized Issues That Should Be Focused on Anti-HIV Drug Evaluation In Vitro

Since the introduction of antiretroviral therapy (ART), the lifespan and quality of life of patients infected with HIV have been significantly improved. But treatment efficacy was compromised eventually by the development of resistance to antiretroviral drugs, and more new anti-HIV drugs with lower toxicity and higher activity were needed. Based on the experience and lessons learned from the treatment in the developed countries, US FDA suggested that more pharmacodynamical researches should be considered ahead of the clinical trials. To facilitate the anti-HIV drug research and development, we reviewed a few specialized issues that should be focused on drug evaluations in vitro, including: 1) Mechanism of action studies, demonstrating the candidate drug's efficacy to specifically inhibit viral replication or a virus-specific function and confirm the drug target. 2) Drug resistance studies, selecting the drug-resistant variants in vitro and determining the activities inhibiting HIV isolates resistant to approved antiretroviral drugs of the same class. 3) Antiviral activity in vitro in the presence of serum proteins, ascertaining whether an investigational product is significantly bound by serum proteins. 4) Combination activity analysis, evaluating in vitro antiviral activity of an investigational product in two-drug combinations with other drugs approved.

Drug Utilization in Homes for the Aged in Brasilia, Brazil

This paper aims to describe the socioeconomic and epidemiological profile, as well as the standards of medicine consumption in a group of 154 elderly people from five homes for the aged in Brasilia, in order to expand the understanding about some characteristics and individual needs of this population and its influence on the quality of drug’s therapy. Data were collected between January and December of 2007, it was used a questionnaire adapted from Dader’s method (2002) and a pharmacotherapeutic follow up method and it was responded by the elders and caregivers. Data were supplemented with information from medical records and prescriptions available in the institutions. The studied group has an average age of 74.6 years, living in their current homes for about 5.4 years and the group consists mainly of men with preserved cognitive status. The members of the group have low monthly income, low education level and are sedentary. They consume 4 - 5 drugs and are affected mainly by cardiovascular and psychiatric diseases. Results suggest that low monthly income, low education level, the prevalence of sedentary lifestyle, elders with compromised cognitive status, the increasing number of chronic diseases and the high consumption of drugs in the researched group may be important factors for the emergence or injury drugs-related problems (DRP) as non-adherence to treatment, medication errors, drug interactions and adverse drug reactions compromising the quality of medication therapy. This study points out the necessity of including a pharmacotherapeutic follow-up for the elderly people in order to minimize such problems and provide better quality of life for patients.

<i>In Vitro</i>Evaluation of Anticancer Drugs with Kinetic and Static Alternating Cell Culture System

Variable bioreactors have been developed for the evaluation of anti-cancer drug efficacy. The Kinetic and Static Alternating Cell Culture System (KSACCS) combines the advantages of kinetic bioreactors and static cultures to improve cell growth by providing adequate metabolic support while minimizing shear-stress. In the current studies, the KSACCS in the ZYX Bioreactor could significantly increase the sensitivity of lung cancer cells (PLS008) and leukemia cells (HL60) to anticancer drugs Cisplatin and 5-FU by accelerating the apoptosis of cancer cells. It was also shown that excessive agitation of the cells could lead to severe cell damage, which resulted in a diminished sensitivity of anticancer drug evaluation, and co-culture systems tend to reduce the sensitivity of anticancer drug evaluation although it might better mimic in vivo conditions.

An Evaluation Synthesis of US AIDS Drug Assistance Program Policy

US Congress passed the CARE Act in 1990 in response to a dramatically growing need for resources to combat the AIDS epidemic. One of the programs contained in the Act was the AIDS Drug Assistance Program (ADAP), a federally-funded but state-maintained and managed program primarily concerned with providing medication for low-income HIV/AIDS patients. While ADAP programs across the country reached one-third of all patients in 2007, these programs are now in budgetary danger due to the economic recession, state budgetary constraints, the rising cost of healthcare generally, and longer life expectancies associated with current highly active antiretroviral therapy (HAART). This paper first evaluates the current state of ADAP, its strengths and weaknesses, and examines its sustainability in the short term if short-term measures are taken. Concluding that such measures would not lead to long-term sustainability, this paper then argues for a long-term solution to ADAP’s current problems, namely a national, centralized ADAP standard for budgetary and administrative matters. Such a program would increase the long-term sustainability and effectiveness of current ADAP programs by employing more efficient, standard policies and allowing larger, wholesale purchases of costly HAART medications. Moreover, a national policy would address the disparity that currently exists in ADAP programs today with regard to both minorities and those on the waiting lists for treatment. The institution of a national ADAP program would certainly face many political hurdles. Consequently, this paper also looks to a recent political dispute, the enactment of the Affordable Care Act (ACA), for guidance. Using the passage of the ACA as an example could light the path for passage of a national ADAP standard. Ultimately, this would lead to a more effective and sustainable program for HIV/AIDS patients in the United States.

Evaluation on Diseases Resistance of Cotton Material and Its Utilization

Fusarium wilt and Verticillium wilt are important worldwide fungal diseases on cotton that cause damage to yield and quality.The pathogens survive in soil as microsclerotia for many years,and

Tourists' Demand for Heritage Utilization Based on Fuzzy Comprehensive Evaluation:A Case Study of the Summer Palace

Under the background of whole-region tourism,heritage is utilized in a more diversified and various way.With the continuous deepening of the experience economy,the integration of various technical means such as VR and AR,and the construction of Internet platforms,it is more necessary to integrate various utilization methods,so that tourists can get more humanized and personalized experience in addition to traditional displays,and more intuitively feel the space,history,allusions,handicrafts and other aspects of Chinese heritage,showing the charm of Chinese traditional culture.In this paper,based on literature analysis,the utilization methods of heritage were sorted out,and the survey questionnaires were analyzed by analytic hierarchy process (AHP).A model was established to obtain the weight of various utilization methods,and the fuzzy comprehensive evaluation method was used to conduct empirical research with the Summer Palace as an example.It is concluded that in the future utilization of heritage,on the basis of heritage protection as much as possible,combining traditional festivals,special themes,etc.to carry out various forms of activity and experience utilization will more effectively improve the satisfaction of tourists and achieve the purpose of inheriting culture.