Game Analysis of Regulation for Online Prescription Drugs under Customer Feedback Mechanism

Objective To study the way to better regulate the online sales of prescription drugs,and to provide reference for the adjustment of relevant policies since the online sales of prescription drugs has become an inevitable trend.Methods A game model was constructed for the strategy choice of pharmaceutical e-commerce platform,customers and government departments based on differential game theory and Nash equilibrium game model to analyze the pure strategy Nash equilibrium,Nash equilibrium dominant strategy of each subject and the mixed strategy Nash equilibrium under different conditions.Besides,Matlab was used to carry out simulation analysis.Results and Conclusion The study shows that:(1)Improving the credibility of the government and reducing the cost of government regulation can not only make the pharmaceutical e-commerce platform operate with high quality,but also give greater play to government functions;(2)The greater the influence of social evaluation on pharmaceutical e-commerce platforms,the lower the cost of high-quality operation of pharmaceutical e-commerce platform,and the greater the probability of customer choosing real evaluation strategy;(3)The greater the customers’perception of potential risk,the greater the compensation,and the lower the cost of reporting.Then,the greater the probability that government departments will choose strict regulation.Finally,the model solution and simulation analysis are combined to provide countermeasures and suggestions for the safety regulation of online sales of prescription drugs.

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.

Study on Anti-diarrhea Effect of the Prescription of 4 Tibetan Veterinary Drugs

This study was conducted to investigate the effects of extracts of 4 Tibetan veterinary drugs on bacterial diarrhea, and to guide the clinical treatment of the disease. The inhibitory effects of the extracts of the 4 Tibetan veterinary drugs, Veronica ciliate Fisch, Usnea diffracta Vain, Sophoraflavescens var. flavescens, Lamiophlomis rotata （ Benth. ） Kudo on 14 common diarrheagenic bacteria were detected by K-B diffusion method and micro-broth dilution method. Optimization was performed on prescriptions of the 4 Tibetan veterinary drugs using orthogonal design software, and a mouse bacterial diarrhea model was established with a clinical isolate, Salmonella blegdam. According to the LD50 value of the optimal prescription of the 4 Tibetan veterinary drugs, the established mouse bacterial diarrhea model was treated in 3 dose groups, i. e. , the high, middle and low dose groups （0. 060, 0. 030 and 0. 020 g/ml, respectively）. The results showed that the 4 Tibetan veterinary drugs had very good inhibitory effects on most of the tested diarrheagenic bacteria, and among them, U. diffracta had better inhibitory effects on all the tested bacteria. The optimal prescription of the d Tibetan veterinary drugs （high dose, 0.06 g/ml） exhibited very good inhibitory effect on mouse diarrhea, indicating that the prescription has very good anti-diarrhea effect, which is beneficial to the clinical treatment of such disease and the development of Tibetan veterinary drugs.

Irrational drug use-a pilot prescription study from Calicut,Kerala

Objective:To describe the prescribing behavior of the physician in Kerala,and to describe types and number of medicine prescribed by doctors so as to rationalize the prescription writing habits of physician.Methods: A six month study was done to define the pattern of drug use in Medical college hospital,Calicut. The data and the other important aspects of study were collected by personal interview,questionnaires meant for doctors and prescription monitoring Performa for the patients issued by WHO. The findings of survey were critically analyzed.Results: The results indicated that majority of doctors prescribed on the basis of patient's history,patient's feed back report,drug availability,brand cost,quality of drug and ADRs. All the interviewed doctors looked upon the side effects. It was found that individual drugs were prescribed more than fixed dose combinations (85.6%). Out of these 71.5% were prescribed as branded and 28.5% as generic. The demographic data,like name,age,sex,disease diagnosis were available on all the patient health care cards and these constituted an essential part of the prescription particularly age and sex being an important in deciding the dose preference for patients. Socio economically most patients were found to be in the grade ⅡI (Population below poverty line). During the study of drug related parameters,doses were mentioned only in 80% of the prescription. But duration of the drug therapy was found to be only 30%.These indicated the irrational use of prescription. Branded drugs prescribed were found to be 71.5%,which showed a trend towards a good prescription habit. The results indicated the rational use of drug.Conclusion: The survey reveales that most of the doctors in Medical college hospital,Calicut are maintaining rational use of drugs and their prescription writing habits was found to be good.

Share Videos, Not Pills: A Content Analysis of Prescription Drug Videos on YouTube for Presence of Behavior Change Theory

Objective: To identify the extent to which YouTube.com videos targeting prescription drug abuse include health behavior theory in their content and design. Methods: This study used a content analysis of 209 YouTube.com videos. Coders used an established theory-based instrument to rate each video’s inclusion of theoretical constructs from four prominent health behavior theories. Each YouTube.com video was coded for twenty-two theoretical items, which were summed to create a total theory score. Results: The mean theory score of videos was 3.26 out of a possible 22. Among the top 10% of videos with highest theory scores, social cognitive theory constructs were coded most often and transtheoretical constructs were coded least often. Conclusion: It is not unexpected that YouTube.com videos are largely void of theoretical content since these videos are made by a variety of organizations and sources that may not be trained in the application of health behavior theories. There is an opportunity for the organizations that create these videos to collaborate with health and behavior change experts in creating videos with more theoretical constructs, possibly resulting in better health outcomes.

Study of the Duration of Treatment in Drug Prescriptions Received in Pharmacies in Dakar

The prescription must include the name of the drugs or products prescribed, dosage form, dosage, directions for use and duration of treatment. However, sometimes errors can occur that can have consequences for the health of patients. Our study concerns the use of medical prescriptions received in pharmacies in the Dakar department. The survey was conducted in 90 pharmacies in these communes, which represent one third of the 270 pharmacies in the department of Dakar. This allowed us to study 2700 prescriptions. The study took place from 1 December 2016 to 30 June 2017, i.e. over a period of 7 months. Our results show that neurologists and urologists have a longer average treatment time than other specialists, with an average of 120 days and 90 days of treatment respectively. Then, the specialists who take a long time the drug represent more than 27%, and require renewal of the drug. In 63.90% of the cases, no notification on the duration of treatment was given by the prescriber. Only 5.39% were only given the mention “to be renewed”. At the end of our analysis, we can say that the prescription must be perfectly legible to avoid confusion by the patient or the pharmacist. The pharmacist then participates in the therapeutic education of the patient and thus helps him/her to live better with his/her disease. Therefore, socio-professional health associations and organisations must provide more continuous training on prescribing to ensure good compliance and above all avoid people buying medicines in the parallel circuit in order to better control health expenditure.

Does Direct-to-Consumer Prescription Drug Advertising Achieve a Mechanistic Fair Balance? A Critical Review of the Literature and Debate

The pharmaceutical industry is one of the most advertising-intensive industries.With the exponential growth of Direct-to-Consumer Prescription Drug Advertising(DTCA),there have been a large number of attempts to investigate the effectiveness of DTCA in various media,medications,and consumer groups.However,little attention has been paid to the history of the US Food and Drug Administration(FDA)regulations of DTCA and the status of DTCA practices in terms of regulatory compliance.Thus,this current study identifies a research gap in DTCA and highlights a new avenue that can be explored in future research.

Survey of Shanghai Residents’ Perceptions of Buying Prescription Drugs Online

Objective To investigate the willingness of Shanghai residents to buy prescription drugs online.Methods By using e-questionnaire,Shanghai residents’perceptions of online prescription drugs were investigated,and 206 valid questionnaires were collected.Results and Conclusion 96.1%of the respondents knew the correct definition of prescription drugs.46.6%knew they could buy prescription drugs online.67.7%,through social media,knew they could buy prescription drugs online.72.3%knew a medical prescription should be required when buying prescription drugs online.And 83.5%refused to buy prescription drugs online because they were concerned about the quality and safety of drugs.The publicity of online-pharmacies and prescription drugs should be increased in China.Besides,the government supervision should be strengthened in the whole process of service to protect consumers’rights and benefits.Then,the channels of online purchase must be optimized for customers.Lastly,a medical insurance payment system should be set up for buying prescription drugs online.

Analysis on the Medication Law of Drug Pair Acorus Tatarinowii-Polygala Tenuifolia Based on the Dictionary of Traditional Chinese Medicine Prescriptions

Objective:Using data mining method to dig and sort out the prescriptions with Acorus tatarinowiiPolygala tenuifolia drug pair,and summarize the medication characteristics and compatibility of their prescriptions after preliminary screening.Methods:By searching the Dictionary of Traditional Chinese Medicine Prescriptions,a standardized database of prescriptions was established,and the properties,tastes and meridian tropism of prescriptions were classified,and the indications of prescriptions and core combinations of traditional Chinese medicines were analyzed.Results:178 prescriptions were collected,of which 210 were related.Most of the drugs were warm in nature and sweet in taste,and mainly return to the heart and kidney meridians.Under the same confidence and different support,the core drug combination for treating brain diseases was Acorus tatarinowiiPolygala tenuifolia-Ginseng,and the core drug combination for treating asthenia was Acorus tatarinowii-Poria cocos-Rehmannia glutinosa-Polygala tenuifolia.Conclusion:The compatibility characteristics of the prescriptions containing Acorus Tatarinowii and Polygala tenuifolia in the Dictionary of Traditional Chinese Medicine Prescriptions are remarkable,which provides reference for scientific guidance of clinical rational drug use and basic research of prescriptions containing Acorus tatarinowii and Polygala tenuifolia.

Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong

BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice.METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included.RESULTS: Among the 162 cases, 141(87%) patients were prescribed one antihistamine of any group. Sixty(37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be signi? cantly(P<0.001) associated with multiple antihistamine prescription(OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription(OR=4.654, 95%CI=2.20 to 9.84, P<0.001).CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

Toxic epidermal necrolysis related to AP(pemetrexed plus cisplatin)and gefitinib combination therapy in a patient with metastatic non-small cell lung cancer

Toxic epidermal necrolysis(TEN) is a rare acute life-threatening mucocutaneous disorder that is mostly drug-related(80%-95%). It is clinically characterized as a widespread sloughing of the skin and mucosa. AP regimen(pemetrexed plus cisplatin) has been the preferred first-line chemotherapy for metastatic non-squamous non-small cell lung cancer(NSCLC). Gefitinib, a small-molecule epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor(TKI), has already been recommended as a first-line treatment in EGFR-mutant metastatic NSCLC. We report rare presentation of TEN involving adverse effects of AP and gefitinib combination treatment in a 42-year-old woman diagnosed with metastatic NSCLC harboring an EGFR mutation. On the 21 st day after administration of the first cycle of AP regimen and the 8th day after the initiation of gefitinib treatment, she developed an acne-like rash, oral ulcer, and conjunctivitis, which later became blisters and ultimately denuded. The characteristic clinical courses were decisive for the diagnosis of TEN. Treatment with systemic steroids and immunoglobulin as well as supportive treatment led to an improvement of her general condition and a remarkable recovery.

Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus:a cross-sectional study

OBJECTIVE To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 dia-betes mellitus(T2DM)and to evaluate the use of cardiovascular preventive medications among those diagnosed with atheroscler-otic cardiovascular disease(ASCVD).METHODS This cross-sectional,face-to-face interview study that comprised community-dwelling older adults(≥65 years)dia-gnosed with T2DM.The study questionnaire included the patients’demographics,clinical data,and current medication use.Pati-ents with established ASCVD were further classified into low(i.e.,not receiving evidence-based therapy or only one)and high(i.e.,receiving at least two evidence-based therapies)composite score groups.Bivariate analysis followed by multivariable logistic re-gression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic mo-notherapy/polytherapy and evidence-based pharmacotherapy.RESULTS A total of 500 older adults were enrolled.The mean age of included participants was 73±7 years,310 participants(62%)were males,and 385 participants(77.0%)had established ASCVD.Antidiabetic monotherapy was reported in 251 partici-pants(50.2%),with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy.The results of the multivariable analysis showed that age[odds ratio(OR)=0.89,95%CI:0.85-0.94,P<0.001],obesity(OR=4.18,95%CI:1.63-10.36,P=0.003),hypertension(OR=4.2,95%CI:1.22-7.66,P=0.04),and dyslipidemia(OR=4.1,95%CI:1.28-8.30,P=0.01),were significantly associated with the prescription of cardiovascular preventive medications.CONCLUSIONS Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommen-ded therapies,indicating a deficiency of utilization of cardiovascular preventive drugs.

Analysis on the Special Prescriptions from the Book of Chengfang Qieyong

The kinds of special prescriptions in the book of Chengfang Qieyong cover a wide range of subjects such as internal medicine,gynecology,pediatrics and surgery,etc.These prescriptions have gathered the original discussions of doctors of all ages,condensed the author's own in-depth insights,and displayed the profound connotation of traditional Chinese medicine prescriptions or clinical efficacy characteristics.Guided by the function and categories of the original monograph,26 prescriptions were integrated into seven categories,i.e.treating Qi and regulating Blood,nourishing and eliminating,exterior dispersing and dispelling cold,compromising and purging fire,drying dampness and expelling phlegm,fetal birth and baby,and carbuncle.Based on the characteristics of clinical efficacy,the connotation of legislative prescriptions,the modification of prescriptions and medicines,and the degree of decoction and prescription,etc,this paper analyzes the connotation of traditional Chinese medicine of these special prescriptions,and provides important reference for the research of modern prescriptions,the expansion of clinical application and the development of new drugs of traditional Chinese medicine.

基于癌毒理论的多发性骨髓瘤病机本质探源及方药体系构建

以国医大师周仲瑛教授癌毒理论为指导,吸纳仝小林院士态靶学说思想,总结多发性骨髓瘤的病机为正气亏虚,蚀骨伤髓,癌毒蓄积,痰瘀互结,正邪交争,动态演变;提出将补虚扶正、抗癌解毒、化痰祛瘀的思路贯穿治疗全程的多发性骨髓瘤的抗癌解毒全周期防治策略。并从蛋白质过载、肿瘤微环境等多环节阐释多发性骨髓瘤“正虚癌毒”病机理论的科学内涵,构建以宣痹消瘤方为核心的方药体系,为多发性骨髓瘤中西结合临床诊疗方案和全周期防控模式提供新的思路和科学依据。

赋能授权联合药物素养健康教育处方在心肌梗死患者中的应用研究

目的探讨赋能授权联合药物素养构建的健康教育处方对首发心肌梗死(myocardial infarction,MI)患者的药物素养、服药依从性及自我管理情况的影响。方法采用便利抽样法选取2023年6—12月江西省某三级甲等医院心内科首发MI入院治疗的70例患者为研究对象,按随机数字表法分为对照组35例和观察组35例。对照组采取常规健康教育处方,观察组实施赋能授权联合药物素养构建的健康教育处方,评估比较2组患者干预前后的药物素养、服药依从性及自我管理情况。结果干预后,观察组患者的药物素养、服药依从性得分分别为(5.29±0.93)分、(6.51±0.82)分,均优于对照组(4.69±0.96)分、(5.91±1.10)分,差异有统计学意义(P<0.05);观察组患者的自我管理情况总得分为(95.63±7.15)分,明显高于对照组(88.79±6.00)分,差异有统计学意义(P<0.05)。结论赋能授权联合药物素养构建的健康教育处方,有助于改善首发MI患者安全用药情况,提高自我管理水平。

基于审方中心信息化和药师同质化促进门急诊处方合理性的效果分析

目的探讨审方中心信息化和药师同质化对提高门急诊处方合理性的效果。方法基于合理用药管理系统的系统规则和人工设置的自定义规则,经过信息化和流程规范化管理,比较审方中心成立前(2023年2—7月)和成立后(2023年8月—2024年1月),药师审方质量、效率同质化和处方合理率的变化情况。结果与审方中心成立前比较,审方中心成立后审方药师审核通过率显著提高(P<0.05),平均耗时均延长(P<0.01):平均耗时、通过平均耗时和打回平均耗时分别由(4.50±0.58)、(4.50±0.58)、(4.75±0.96)s延长至(11.67±1.03)、(8.50±0.55)和(13.17±0.98)s。门急诊处方不合理率由2023年8月6.27%逐月下降至2024年1月0.93%(P<0.01)。审方中心成立以来干预系统规则数和门急诊处方不合理率具有显著相关性(P=0.0044)。结论利用审方中心平台,成立专职审方药师和信息药师团队,通过信息化和规范化管理流程,可助力提升审方质量与效率,提高处方合格率,提高医院管理水平和医疗质量。

医疗机构处方药品外配与使用管理专家共识

目的进一步规范我国医疗机构处方药品外配与使用的全过程管理,加强医疗机构药品供应保障,推动外配药品的临床合理使用与科学管理,贯彻医药行业作风建设要求,切实保护患者合法权益。方法通过收集调查问卷并广泛征求专家意见,编写组对处方药品外配的现状和问题进行了调研分析,形成共识意见。结果共识制定27条推荐意见,涵盖处方外配的定义、组织管理与制度建设、处方与审方权限管理、外配药品处方开具与使用管理、监测与评价、社会药房管理、培训与沟通及患者隐私保护等八个方面,明确处方药品外配全过程的规范化管理措施。结论该共识为处方药品外配的药学管理提供重要的参考依据,有助于提升外配药品服务的专业性和全面性,保障患者用药安全,并为整体医疗质量和安全的提升提供支持。

经典名方导痰汤的古代文献分析与考证

通过文献溯源,梳理导痰汤的历史源流、药物组成、基原、炮制、剂量、煎服法、主治病证等关键问题,为经典名方导痰汤的开发与临床运用提供文献支撑。经分析与考证,导痰汤出自吴彦夔《传信适用方》,其组方为半夏、天南星、枳实、橘红、赤茯苓五味药。除赤茯苓外,其余药物基原皆遵循2020年版《中国药典》。赤茯苓、橘红用生品,半夏为清半夏,枳实为麸炒枳实,天南星为制南星。药物剂量建议半夏18.59 g,天南星4.65 g,枳实4.65 g,橘红4.65 g,赤茯苓4.65g。导痰汤煎煮时须将药物锉碎,过一号筛,加入生姜10 g,加水600 mL,煎至300 mL,滤去药渣,食后服用。该方燥湿祛痰,行气开郁,主要用于治疗痰厥,或胸膈痞塞、胁肋胀满、食少纳呆等多种病证。

基于PCNE分类系统的儿科前置审核医嘱分析

目的 采用欧洲药学监护联盟(PCNE)分类系统分析儿科医院门诊前置审核医嘱中的药物相关问题(DRPs),为改进前置审核系统、减少用药错误的发生提供参考依据。方法 回顾性收集2022年7月至2023年6月上海交通大学医学院附属上海儿童医学中心的门诊前置审核医嘱数据,通过PCNE分类系统(V 9.1版)对医嘱中存在的DRPs进行分类汇总,分析DRPs医嘱产生的问题类型、问题的产生原因、介入被接受情况。结果 本研究共纳入门诊前置审核DRPs医嘱66 017条,涉及患者41 165例。其中≤5岁患儿的DRPs医嘱占比最高(58.25%),其次为6~12岁患儿(33.52%);DRPs医嘱占比最高的科室为儿内科(71.41%);DRPs医嘱发生率最高的科室为胸外科(9.73%);发生DRPs医嘱的药品种类前3名为全身用抗感染药(25.26%)、中成药(24.74%)和呼吸系统药物(22.38%)。参照PCNE分类系统,DRPs医嘱中问题类型占比最高为治疗安全性问题(64.86%);DRPs医嘱产生的原因主要为剂量选择(82.09%),其中药物剂量过高占41.26%;92.13%的介入都能被临床医生接受并完全执行。结论 使用PCNE分类系统,能够有效分析前置审核系统识别的DRPs医嘱。药师应重点关注≤5岁儿童的用药情况,及时更新和制定个性化的审核规则,满足儿童临床用药的合理性需求。

某院合理用药前置审方系统智能化刚性拦截处方分析

目的分析中山大学附属第七医院合理用药前置审方系统智能化刚性拦截的4600张问题处方,总结常见问题处方及临床用药错误的原因,探讨提高临床安全合理用药的方法。方法整理2019年5月~2023年7月合理用药监测系统构建的药品数据规则库对门急诊处方进行实时审核的结果,统计分析系统刚性拦截处方的问题类型、每种问题类型中从高到低排名靠前的问题药品、问题科室。结果合理用药前置审方系统智能化刚性拦截处方4600张,排名前六位的问题处方集中出现在无特殊理由超疗程用药(1717/4600,37.33%),药控相关的审核问题(1485/4600,32.28%),遴选药品不适宜(978/4600,21.26%),用药监测问题(186/4600,4.04%),药品浓度和溶媒选择不适宜(89/4600,1.93%)和用药频次不适宜(51/4600,1.11%)。涉及问题药品有303个,问题科室53个。结论合理用药前置审方系统智能化刚性拦截功能可有效杜绝各种类型的严重用药错误,保障患者用药安全。药品基础规则是合理用药前置审方系统正常运作的根基,药师应定期加强维护。临床科室应重视系统提示内容,不断加强药学专业知识的学习。