Academic literature on the topic 'Oral medication'
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Journal articles on the topic "Oral medication"
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Given, BarbaraA, CharlesW Given, Alla Sikorskii, Eric Vachon, and Asish Banik. "Medication burden of treatment using oral cancer medications." Asia-Pacific Journal of Oncology Nursing 4, no. 4 (2017): 275. http://dx.doi.org/10.4103/apjon.apjon_7_17.
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Mekonnen, Gashaw Binega, and Dessalegn Asmelashe Gelayee. "Low Medication Knowledge and Adherence to Oral Chronic Medications among Patients Attending Community Pharmacies: A Cross-Sectional Study in a Low-Income Country." BioMed Research International 2020 (January 11, 2020): 1–8. http://dx.doi.org/10.1155/2020/4392058.
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Objective. To investigate the level of knowledge, medication adherence, and the relationship among patients taking chronic oral medication and attending community pharmacies in Gondar, Northwest Ethiopia. Methods. A cross-sectional study was conducted among adult chronic disease patients who were taking oral medications and getting service in 19 community pharmacies in Gondar City, Northwest Ethiopia. Patients’ medication knowledge and adherence were assessed using interviewer-administered validated questionnaires. Results. Of the 402 study participants (mean ± SD age = 44.7 ± 16.9 years, range = 18–86 years), 53.2% were males, 84.8% were aged <65 years, and 60.7% had high school education and above. About 348 (88.6%) respondents have used oral medications for more than one year. Less than half of respondents have good medication knowledge (n = 54, 38.3%) and were adherent to their medication (n = 158, 39.3%). Chronic disease patients with high school and above education are 5.35 times (95% CI: 3.231–8.857, p<0.001) more likely to have good knowledge of their medication and having good medication knowledge was linked to higher medication adherence (AOR, 95% CI = 10.300 [6.16517.209]; p<0.001). A statistically significant correlation was observed between the scores of medication knowledge and adherence (r = −0.471, p<0.001). Conclusion. The majority of patients on oral chronic medications and attending community pharmacies in Gondar town do not have good medication knowledge and were nonadherent. Community pharmacists need to engage in medication counseling to improve medication knowledge and adherence of chronic disease patients.
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Matzo, Marianne. "ORAL DIABETES MEDICATION." AJN, American Journal of Nursing 108, no. 3 (2008): 16. http://dx.doi.org/10.1097/01.naj.0000312238.21057.83.
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OSARENMWINDA, MONDAY IKPONMWOSA, and CHUKWUDI UZOWUIHE. "ASSESSMENT OF MEDICATION ADHERENCE TO ORAL ANTINEOPLASTIC DRUGS AMONG CANCER PATIENTS IN A TERTIARY HOSPITAL IN SOUTH-SOUTH, NIGERIA." African Journal of Pharmaceutical Research and Development 16, no. 2 (2024): 99–108. http://dx.doi.org/10.59493/ajopred/2024.2.10.
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The prevalence of cancer in developing countries is on the increase, and is associated with a high mortality rate. The study aimed to evaluate medication adherence to oral antineoplastic therapy in a tertiary health facility, in Benin City. A cross-sectional study was carried out among cancer patients at the oncology unit of the University of Benin Teaching Hospital, Benin City, using semi-structured and standardized Morisky Green Test instruments. The analysis was descriptive and inferential, and the results were considered significant at p < 0.05. Medication adherence to oral antineoplastic drugs was 74.4%. The patients had a significant (p < 0.05) Morisky Green Test score of 25.6%. Respondents using Bevacizumab, Docetaxel and Oxaliplastin, were totally (100%) compliant with their medications. Major reasons for medication non-adherence with oral cancer chemotherapy were forgetfulness (18.9%) and carelessness about time to take medications (14.1%). Significant (p < 0.05) factors and attitudes associated with medication adherence were gender, number of medications per day, forgetting to take medications, not knowing how and when to take medications, checking name and dosage before taking medication, and storing medications in an appropriate place. Overall, the patients had above-average adherence to their oral antineoplastic therapy, but experienced difficulty in treatment with a positive Morisky green Test score.
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Wakai, Eri, Kenji Ikemura, Chika Kato, and Masahiro Okuda. "Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension." PLOS ONE 16, no. 6 (2021): e0252944. http://dx.doi.org/10.1371/journal.pone.0252944.
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Introduction Good adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension. Methods According to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score. Results Among 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar. Conclusion Our study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.
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Dupade, Amol Balasaheb, Pramod Shivaji Hirave, and Vikas Bapurao Dadas. "Review of Oral Tablet." International Journal for Research in Applied Science and Engineering Technology 12, no. 5 (2024): 2820–22. http://dx.doi.org/10.22214/ijraset.2024.59315.
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Abstract: Oral drug delivery is noninvasive, has a high rate of patient compliance, is easy to handle, and doesn't require any special sterile settings, it is the most popular method of administration. Nevertheless, a number of physical, biological, and pharmacological obstacles that certain medications must overcome in order to be absorbed into the systemic circulation reduce their therapeutic efficiency. The use of nanocarriers to deliver drugs orally has proven to be an effective solution to the aforementioned problems and is being explored as a potential replacement for oral medication administration. This chapter provides an overview of the latest developments in the use of nanocarriers for oral medication delivery in the treatment of different disorders. The chapter also describes how diverse nanocarrier designs and technologies improve therapeutic potential by overcoming physical, biological, and biochemical obstacles. it is easy to produce, has few sterility limitations, is less expensive, has flexible dosage form design, and has high patient compliance, oral drug delivery (ODD) is the most convenient and favored method of drug administration. However, low medication bioavailability—which is influenced by three crucial factors—is one of the difficulties associated with oral drug delivery. The other is solubility. Many mathematical models that predict the medication's rate of solubility and dissolution have been developed in order to achieve efficient drug absorption in vivo. Similarly, models that are noncellular and cellular determine permeability. Furthermore, the medication's behavior in the gastrointestinal tract (GIT) is influenced by physiological parameters, such as pH, microbial colonization, and enzymes, as well as intrinsic drug properties. A drug's dosage form is a method of getting it into a living organism. The medicine must be administered to the site of action at a rate and concentration that will maximize therapeutic benefit and minimize side effects in order to provide the intended result. Although the oral method is still commonly used, swallowing tablets and capsules can be a regular problem. As a result, numerous studies on cutting-edge drug delivery methods have been conducted. This review focuses on oral dispersible tablets, a novel approach to drug delivery systems that are currently more focused on formulation and set a new course that not only helped patients increase their level of therapy compliance.
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Downen, Julie, and Cassie Jaeger. "Quality improvement of intravenous to oral medication conversion using Lean Six Sigma methodologies." BMJ Open Quality 9, no. 1 (2020): e000804. http://dx.doi.org/10.1136/bmjoq-2019-000804.
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IntroductionLack of medication conversion from intravenous to oral contributes to increased risk of infection, delayed discharges and higher medication costs. At our institution, intravenous to oral medication conversion rate was 76% with missed opportunity for conversion of 37%. The goal of the project was to reduce the percent of missed opportunities for intravenous to oral conversion for applicable medications.MethodsA pharmacy-driven intravenous to oral policy and procedure was implemented. To identify potential opportunities, a patient worklist of applicable intravenous to oral medications was created for pharmacy review in real time. An intravenous to oral conversion order was implemented in the computerised provider order entry. ‘Convert to oral’ was added as an option in the electronic medication request and highlighted reminders were added to the electronic medication administration record for eligible medications.ResultsAfter improvements, the missed opportunity rate for intravenous to oral conversion decreased from 37% (19/51) to 21% (24/113) (p=0.04, two-proportion test), a 43% improvement. The trend in intravenous to oral conversion rate increased from 76% (39/51) to 85% (171/201) and severity adjusted length of stay was reduced from 8.1 days to 6.4 days post improvements (p<0.001, t-test).
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BOTASH, ANN S. "Syringe Caps: An Aspiration Hazard." Pediatrics 90, no. 1 (1992): 92–93. http://dx.doi.org/10.1542/peds.90.1.92.
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The accurate administration of medications to infants and young children is often a difficult task. Patient resistance to medications as well as parental compliance factors are best met by utilizing the most convenient means to deliver medication. For infants, the oral dosing syringe is considered the best device for delivery of liquid medications.1 When used properly, syringes provide the most accurate measured doses and reduce the risk of choking and of aspirating medication.2 Oral medication syringes may be dispensed by a pharmacist or may be available directly to the consumer. These syringes are dispensed with a plastic cap or "shield" to seal the end of the container.
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Malouh, Marwa A., Julie A. Y. Cichero, Yu Sun, Esther T. L. Lau, Lisa M. Nissen, and Kathryn J. Steadman. "Medication Lubricants for Oral Delivery of Drugs: Oral Processing Reduces Thickness, Changes Characteristics, and Improves Dissolution Profile." Pharmaceutics 16, no. 3 (2024): 417. http://dx.doi.org/10.3390/pharmaceutics16030417.
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Swallowing oral solid dosage forms is challenging for those who have medication swallowing difficulties, including patients with dysphagia. One option is to mix the drug (whole or crushed) with a thick vehicle (medication lubricant). Previous in vitro studies consistently suggest that thick vehicles could impact the dissolution of solid dosage forms, potentially influencing their therapeutic effectiveness, but do not account for changes that happen during oral processing and swallowing. This study aims to investigate the potential impact of medication lubricants on drug release and examine the effect of oral processing. In vitro dissolution of whole and crushed paracetamol tablets mixed with five commercially available medication lubricants (two IDDSI level 2, two IDDSI level 3, and one IDDSI level 4) were tested with and without oral processing; a medication lubricant with/without paracetamol was placed in the mouth (five healthy volunteers), prepared for swallowing, but then expectorated and assessed for physical characteristics and drug release. Medication lubricants, both alone and mixed with crushed paracetamol tablets, showed a significant decrease in viscosity after oral processing. Without oral processing, IDDSI level 3 and 4 lubricants significantly delayed the dissolution of paracetamol tablets. After oral processing, particularly with crushed tablets, there was a substantial increase in the dissolution rate. These findings suggest that dissolution testing overestimates the impact of medication lubricants on drug dissolution. Therefore, using in vitro dissolution tests to predict the dissolution rate of medications mixed with thick vehicles is discouraged. It is essential to consider ways to incorporate the effects of the oral environment and oral processing on thick vehicles used for oral medication administration.
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Nguyen, Bobbie K. H., Benjamin S. Wu, Hanna K. Sanoff, and Jennifer Elston Lafata. "Patient-Oncologist Communication Regarding Oral Chemotherapy During Routine Office Visits." JCO Oncology Practice 16, no. 8 (2020): e660-e667. http://dx.doi.org/10.1200/jop.19.00550.
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PURPOSE: Although studies in other clinical areas have shown that patient-clinician communication can positively influence adherence to medications, little is known about how oncologists address medication counseling during routine office visits. We describe patient-oncologist office-based discussions of oral chemotherapy treatment. METHODS: Transcripts of 24 patient-oncologist office visits were obtained from a national database. Patients were aged ≥ 19 years and prescribed capecitabine for colorectal cancer. We developed a structured coding worksheet using medication-counseling concepts previously identified as important to medication adherence and a grounded approach. Two coders reviewed transcripts for oncologists’ provision of medication information, assessment of patients’ adherence to medication, and the provision of self-management support for management of adverse effects. We assessed interrater reliability with Cohen κ statistics. We describe the counseling concepts present within patient-oncologist conversations and present illustrative quotes to describe how they were discussed. RESULTS: Oncologists generally provided patients who had yet to initiate therapy comprehensive medication information; those in the midst of treatment received less information. Oncologists discussed patients’ continued use of the medication (or discontinuation) among all patients who had initiated therapy (N = 18). How the patient was taking the medication (ie, therapy implementation) was less commonly discussed. Medication adverse effects were also discussed in all encounters. Self-management strategies were commonly provided, albeit mostly in response to a presenting symptom and not preemptively. Patients’ use of concurrent medications, financial access to therapy, and assessments of logistical arrangements were discussed more sporadically. CONCLUSION: Using audio recordings from a national sample of patient-oncologist office visits, we identified several potentially important opportunities to enhance medication counseling among patients prescribed capecitabine for the treatment of colorectal cancer.
Dissertations / Theses on the topic "Oral medication"
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Given, BarbaraA, CharlesW Given, Alla Sikorskii, Eric Vachon, and Asish Banik. "Medication burden of treatment using oral cancer medications." MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017. http://hdl.handle.net/10150/625510.
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Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.
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Aloudah, Nouf Mohammad. "Oral hypoglycaemic medication adherence in Saudi Arabia." Thesis, University of Aberdeen, 2016. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=231048.
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Diabetes has been labelled as one of the largest crises in the twenty-first century. Saudi Arabia is one of the top 10 countries for prevalence of diabetes and one in five people has the condition. Medication adherence assessment is vital to help clinicians reach therapy outcomes and identify gaps in patient management. The aim of this PhD was to explore oral hypoglycaemic medication (OHM) adherence in patients with Type 2 diabetes patients in Saudi Arabia and to identify factors associated with OHM adherence. The aim was addressed by: 1) Conducting a systematic review to identify which tools could be used to measure adherence to OHM as well as to quantify adherence levels across different countries; 2) Undertaking a cross-sectional study to quantify the prevalence of adherence to OHM in a group of patients in Saudi Arabia using a validated measure of adherence. An interview study on a subset of these patients then explored in detail Type 2 diabetic patients' beliefs and attitudes towards their OHM regimen, including factors which helped or hindered their medication taking behaviour. The systematic review included 37 studies. It showed that the level of OHM adherence varied widely across all measures: 36% to 95% when dispensing records were used, 37% to 98% with self-report, and 17% to 97% with pill counts. The term 'adherence' was most commonly used. There was no identified studies assessing OHM adherence in Saudi Arabia. The cross-sectional study showed that the level of OHM adherence was 40%, Lower adherence was associated with patients of younger age (OR, 1.084; 95% CI, 1.056-1.112), individual taking a higher number of non-OHM (OR, 0.848; 95% CI, 0.728-0.986) and having a higher HbA1c level (OR, 0.808; 95% CI, 0.691-0.943). The interview study identified several factors affecting OHM adherence using a validated theoretical framework. Facilitators of OHM adherence were OHM scheduling, knowledge about OHM, knowledge on other relevant behaviours such as diet and physical activity, knowing how to take OHM appropriately and how to manage hypoglycaemia. In addition, OHM adherence was facilitated by beliefs of preventing diabetic complications, avoiding insulin injections, achieving an improved quality of life, accepting diabetes, being optimistic about the future, and having high self-confidence. Conversely, barriers to OHM adherence were forgetfulness, cognitive overload, lack of knowledge of sexual health implications of OHM, and knowledge of OHM side effects or drug-drug interactions. Furthermore, side effects of OHM such as weight gain or hypoglycaemia, knowing how to measure blood sugar, feeling no symptoms, and having many medications to take were additional barriers to OHM adherence. The MASA study also showed that there are several social- and physical-related factors affecting OHM adherence such as the patient-physician relationship and perceived family support. The work in this PhD suggests that targeting suboptimal OHM adherence behaviour needs to be done in a comprehensive manner. The key benefit is to provide future researchers with a comprehensive range of factors that can be targeted when defining targets for an intervention(s). Further systematic intervention development and testing is required to choose and prioritise the most promising interventions to improve OHM adherence.
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Kam, Kin-wai, and 甘健威. "A systematic review of factors improving medication safety of oral medication via enteral feeding tubes in institutions." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206916.
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Objective: Medication safety is always having great concern in healthcare. Giving oral medication through enteral feeding tubes is not uncommon and is a well-known area that prone to error happening. These errors may lead to inadequate treatment or adverse drug reaction resulting in unnecessary health care cost and wastage of public health resources. This systematic review aims to identify contributing factors on medication errors associated with administration of oral medication via enteral feeding tubes. With better understanding of the factors, improvement measures applicable to Hong Kong situations will be suggested.
Methods: Pubmed, Medline and Embase databases were searched up to February 2014 by using relevant keywords. Prospective studies with researcher analyzing the drug administration process to observe the occurrence of errors and evaluate the contributing factors and case reports on medical error with review of the place of errors and their potential root causes were considered to be potential relevant literature. Studies meeting the inclusion criteria were included and evaluated in this review. Studies were excluded based on the exclusion criteria.
Results and Discussion: An initial search of medical literature by searching engines identified 682 references. After appraisal for inclusion, 11 of them were included in this systematic review. For the findings, lack of knowledge, lack of the presence or the awareness of protocol, environmental factors, inter-disciplinary communication among healthcare professionals and the ability of inadvertent connection of both IV catheter and enteral feeding system had been identified to be key contributing factors to drug administration error. Taken account with the findings, measures to improve the existing local practice through educational reinforcement, establishing guideline and inter-disciplinary communication were suggested.
Conclusion: With consideration of the local situation in Hong Kong and the findings identified in this review, suggestions of improvement measures on different aspects have been made in this review. Involvement of government policy, institutional management and the collaboration of multi-disciplinary healthcare professional are essential for the success of these improvement measures. Besides, this review also revealed the lack of research on medication safety issue concerning feeding tube, further research in this area is required.<br>published_or_final_version<br>Public Health<br>Master<br>Master of Public Health
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Malina, Kevin, Kathryn Matthias, and Kurt Weibel. "Evaluation of Oral Fluoroquinolone Administration Before and After Implementation of Electronic Prepared Medication Administration Record." The University of Arizona, 2012. http://hdl.handle.net/10150/614519.
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Class of 2012 Abstract<br>Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records.
Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May 2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded.
Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully (p=0.03).
Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went down even though the amount of scheduling errors did not decrease.
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Mahbubani, Krishnaa Trishna Ashok. "Vehicles for the oral delivery of live bacteria." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608290.
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Ettles, Violet Helen. "Oral medication administration : the effect of two instructional techniques on nursing student learning." Thesis, University of British Columbia, 1989. http://hdl.handle.net/2429/27334.
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This experimental study was designed to examine the effects of two selected instructional techniques on nursing student learning of oral medication administration. The research questions asked in this study concerned the effects of these selected Instructional techniques on cognitive learning, performance, and feeling of satisfaction toward the learning experience.
The study was conducted in a three-year diploma nursing program associated with a large metropolitan hospital. A total of 66 first-year students participated in the study. There were 32 students in the experimental group and 34 students in the control group.
All subjects were taught relevant content, prepared "drug cards", and completed a cognitive learning pretest prior to the oral medication administration laboratory. During the laboratory, the experimental subjects were taught by demonstration-return demonstration using simulation and the control subjects were taught by demonstration-return demonstration. Following the laboratory, all subjects were administered the pretest as a posttest, a feeling of satisfaction questionnaire, and a personal data questionnaire. Additionally, they were evaluated through the use of a performance checklist during their first administration of a medication(s) to a patient.
Data obtained from the cognitive learning tests and performance checklist were analyzed using independent t-tests, and data obtained from the feeling of satisfaction questionnaire were analyzed using the chi-square test. Study findings showed that the two groups were similar when compared on selected personal characteristics. Differences between the groups for cognitive learning, performance, and feeling of satisfaction toward the learning experience were revealed not to be significant at the established level of D. = .05. This finding suggests that demonstration-return demonstration using simulation is a viable alternate technique for teaching oral medication administration.<br>Applied Science, Faculty of<br>Nursing, School of<br>Graduate
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Ross, Benjamin Paul. "Lipoamino acid- and carbohydrate- based penetration enhancers for use in oral drug delivery /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18165.pdf.
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Malina, Kevin. "Evaluation of oral fluoroquinolone administration before and after implementation of electronic prepared medication administration record." The University of Arizona, 2012. http://hdl.handle.net/10150/623659.
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Class of 2012 Abstract<br>Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records.
Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May 2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded.
Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully (p=0.03).
Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went down even though the amount of scheduling errors did not decrease.
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Kaisaeng, Nantana. "Costs and Use of Oral Anti-cancer Medications among Senior Medicare Part D Beneficiaries." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/3055.
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Oral cancer drugs are branded and expensive medications that generally do not have generics available. The restrictions of the Medicare Part D program, including the coverage gap and high cost-sharing, and the high cost of oral chemotherapy may lead to patients’ non-adherence to medication. Few studies have examined the cost and utilization of oral anti-cancer medications. This study will be the first to examine the costs associated with the use of oral anti-cancer medications and the impact of cost-sharing and type of prescription drug subsidy on medication discontinuation in the Medicare Part D elderly population. Objectives: To determine the usage and costs of oral cancer treatment in elderly Medicare Part D beneficiaries and to examine the relationship between out of pocket costs and medication discontinuation or delay. Methods: A cross-sectional study of the spending and usage of oral cancer drugs in the Medicare Part D population was conducted. A 5% random sample of 2008 Medicare beneficiaries was used. The study sample included all members of this group who: 1) were 65 years of age and older and 2) filled at least one prescription for imatinib, erlotinib, anastrozole, letrozole, or thalidomide. We examined the average costs patients paid per day, the cost that the Part D plan paid per day, and the total cost that patients paid for the entire year for each drug. The demographic characteristics and type of prescription drug subsidy of Part D beneficiaries who used oral cancer drugs were reported in frequency counts and percentages. We also determined the percentage of enrollees who entered the Part D coverage gap, the time and duration that they fell into the coverage gap, the number of beneficiaries who discontinued treatment and the association between OOP costs and medication discontinuation or delay, controlling for polypharmacy, prescription coverage and socio-demographic factors. Results: Prescription drug subsidy was categorized in four groups: 1) Dual Eligible (DE), 2) full Low Income Subsidy (LIS), 3) partial LIS, and 4) no subsidy. Mean out-of-pocket (OOP) costs per day were between $0.03 and $0.09 for DE beneficiaries, between $0.04 and $0.23 for full LIS beneficiaries, between $1.17 and $6.34 for partial LIS beneficiaries and between $2.93 and $36.84 for beneficiaries who did not receive a subsidy. On average, the beneficiaries who used oral cancer medications were between 75 and 76 years of age. Over half of oral cancer medication users were Caucasian and female. Over two-thirds of oral cancer medication users received no subsidies for their prescription coverage. About 99% of users of the more expensive drugs - imatinib, erlotinib and thalidomide - entered the coverage gap and the majority of these entered the coverage gap at the time of their first fill. In contrast, beneficiaries who filled the less expensive drugs - anastrozole and letrozole - entered the coverage gap later. Less than 7% entered the coverage gap at the time of the first fill of their prescriptions. Beneficiaries who used imatinib, erlotinib, or thalidomide spent approximately a month in the coverage gap. Over the course of a year, the majority of their time was spent in the catastrophic phase. Approximately 33-60% of total oral cancer drug users discontinued their therapies. About 50% of these discontinued during the coverage gap for anastrozole and letrozole and about 80% discontinued during the catastrophic phase for imatinib, erloinib and thalidomide. OOP costs were associated with medication discontinuation for all five oral cancer drugs. The odds of discontinuation and delay increased 101%, 170%, and 264% for each $100 increase in OOP spending for imatinib, erlotinib and thalidomide users, respectively. The odds of discontinuation and delay increased 9%-10%, and 6-8% for every $10 increase in OOP spending for anastrozole and letrozole users, respectively. Conclusions: About 33-60% of all users discontinued their therapies. Beneficiaries receiving subsidies had low OOP costs, averaging between $0.03 and $6.34 per day. Beneficiaries on the more expensive drugs and not having subsidies had high OOP costs, averaging between $15.66 and 36.84 per day. Higher OOP costs were associated with an increased likelihood of discontinuation or delay.
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Istilli, Plinio Tadeu. "Adesão ao agente antidiabético oral de pessoas com Diabetes mellitus: uso do Brief Medication Questionnaire." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-03022015-164833/.
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Trata-se de um estudo observacional transversal, com o objetivo avaliar a adesão aos agentes antidiabéticos orais de pessoas com Diabetes mellitus com o uso do Brief Medication Questionnaire. O estudo foi realizado no Centro de Saúde Escola Prof. Dr. Joel Domingos Machado. Participaram do estudo 60 pacientes que participavam do Programa de Apoio Telefônico em Diabetes mellitus e utilizavam o agente antidiabético oral no seu tratamento. A coleta de dados foi realizada de maio a outubro de 2013, e o trabalho foi aprovado pelo Comitê de Ética e Pesquisa em Humanos da Escola de Enfermagem de Ribeirão Preto, parecer número: 324.098. Para a coleta de dados foi utilizado um questionário contendo variáveis sociodemográficas e clínicas, e o Brief Medication Questionnaire. Para análise, utilizou-se estatística descritiva, Teste Exato de Fisher e a quantificação desta associação foi mensurada por meio de modelos de regressão logística. Os resultados mostraram que os pacientes tinham de 31 a 87 anos, com predomínio do sexo feminino (58,3%), a maioria era casada (75,0%), 53,3% eram aposentados e média de estudo era de 6,7 anos. Para as variáveis clínicas: o tempo de diagnóstico mais prevalente foi de 11 a 20 anos e entre as comorbidades referidas a hipertensão arterial sistêmica foi presente em 75,0% dos participantes, 40,6% apresentaram hipertensão arterial sistêmica grau I, 35,0% apresentaram obesidade grau 1, em relação à circunferência abdominal, 72,0% dos homens tem valores elevados de circunferência abdominal, em contrapartida 94,3% das mulheres também apresentam valores elevados de circunferência abdominal. Quanto aos valores da glicemia em jejum, 55,0% dos participantes apresentam valores maiores que 130 mg/dl. Em relação à hemoglobina glicada, 75,0% participantes estavam com valores alterados sendo que 33 são adultos com valores maiores que 7% e 12 idosos com valores maiores que 8%. Em relação aos outros exames laboratoriais, observa-se predomínio de 10,0% dos participantes apresentam valores menores de 60 mg/dl de HDL-C, 31,7% valores alto de triglicerídeos e 21,7% apresentavam valores limítrofes de colesterol total. Em relação aos agentes antidiabéticos orais, mostrou-se predomínio do uso da classe das biguanidas, com destaque para a metformina sendo utilizada por 80,0% participantes. Em relação à mensuração geral do BMQ, mostrou-se que 25,0% dos participantes aderem plenamente e 21,7% apresentam provável adesão ao uso de agentes antidiabéticos orais. Para os três domínios, observou-se que o Domínio Regime apresentou 81,7% de adesão, o Domínio Crença 55,0% de adesão e o Domínio Recordação 35,0% de adesão. Não houve relação estatística entre a adesão e as variáveis sociodemográficas e clínicas. No entanto, a importância deste estudo foi apresentar achados em Diabetes mellitus com uma nova ferramenta para mensuração da adesão ao tratamento medicamentoso. Os achados apresentam outros aspectos como crença e recordação do que apenas o uso do medicamento que podem subsidiar estudos de intervenção com proposta de melhorar a adesão ao tratamento medicamento oral em Diabetes mellitus<br>This is a cross-sectional study aimed to assess the adherence to oral antidiabetic agents in people with diabetes mellitus using the Brief Medication Questionnaire. The study was conducted at the School Health Center Prof. Dr. Joel Domingos Machado. The study included 60 patients participating in the Telephone Support Program for Diabetes mellitus who used the oral antidiabetic in its treatment. Data collection was conducted from May to October 2013, and the study was approved by the Ethics Committee of Human Research of the Nursing School of Ribeirão Preto, opinion number: 324 098. To collect data, a questionnaire containing sociodemographic and clinical variables was used, and the Brief Medication Questionnaire. For analysis, we used descriptive statistics, Fisher\'s Exact Test and quantify of this association was measured by means of logistic regression models. The results showed that the patients were 31-87 years old, with a predominance of females (58,3%), most were married (75,0%), 53,3% were retired, and the study average was 6,7 years. For clinical variables: the most prevalent diagnosis time was 11-20 years and among these referred comorbidities the hypertension was present in 75,0% of participants, 40,6% had grade hypertension I, 35,0% had grade obesity 1, compared to waist circumference, 72,0% of men have high values of waist circumference, and 94,3% of women also exhibit high values of waist circumference . On the values of unfed glycemia, 55,0% participants had higher values than 130 mg/dl. In relation to glycosylated hemoglobin, 75,0% participants were with altered values 33 adults with larger values than 7% and 12 elderly patients with values greater than 8%. In relation to other laboratory tests, it is observed predominance of 10,0% participants presented lower values of 60 mg/dl of HDL - C, 31,7% high triglyceride levels and 21,7% had borderline the values of total cholesterol. Regarding oral antidiabetic agents, it has proved predominance of the use of the biguanide class, especially metformin being used by 80,0% participants. Regarding the overall measurement of BMQ, it was shown that 25,0% of participants fully adhere and 21,7% are likely accession to the use of oral antidiabetic agents. For all three areas, it was observed that the Scheme Domain presented 81,7% adherence, Belief Domain 55,0% adherence and Remembrance Domain 35,0% adherence. There was no statistical relationship between adherence and sociodemographic and clinical variables. However, the importance of this study was to present findings in diabetes mellitus with a new tool to measure the drug treatment adherence. The findings show other aspects such as belief and recall than just the medication use that can aid intervention studies proposed to improve adherence to oral drug treatment in diabetes mellitus
Books on the topic "Oral medication"
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Harrigan, Jim. Safe medication practices: Oral and topical meds. Concept Media, 2008.
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Kurtzweil, Paula. Liquid medication and dosing devices. Food and Drug Administration, 1994.
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Kurtzweil, Paula. Liquid medication and dosing devices. Food and Drug Administration, 1994.
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Naylor, Michael J. V. Caloric and carbohydrate content of oral pharmaceutical products in Canada. 3rd ed. [s.n.], 1986.
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United States. Food and Drug Administration. Division of Field Investigations., ed. Guide to inspections of oral solutions and suspensions. Division of Field Investigations, Office of Regional Operations, Office of Regulatory Affairs, U.S. Food & Drug Administration, 1994.
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Dominique, Duchêne, Association de pharmacie galénique industrielle., and Swedish Academy of Pharmaceutical Sciences., eds. Buccal and nasal administration as an alternative to parenteral administration: European symposium, Paris, 10 and 11 December 1991. Editions de Santé., 1992.
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European, Symposium on the Formulation of Poorly-Available Drugs for Oral Administration (1995 Paris France). Minutes European Symposium Formulation of Poorly-Available Drugs for Oral Administration: Paris, 5 and 6 February 1996. Éditions de Santé, 1996.
Find full textBook chapters on the topic "Oral medication"
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Mangkorntongsakul, Varitsara, Alan J. Cooper, and Saxon D. Smith. "Oral Medication." In Scars. Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-24137-6_13.
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Russo, Teresa, and Gabriella Brancaccio. "Oral Medication in Hyperhidrosis." In Hyperhidrosis. Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-26923-8_5.
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Dmochowski, Roger, and Jill Danford. "Oral medication for overactive bladder." In Overactive Bladder. John Wiley & Sons, Ltd, 2015. http://dx.doi.org/10.1002/9781118640562.ch9.
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Costa Mendes, Leonor, and Bruno Courtois. "Medication-Related Osteonecrosis of the Jaws." In Drug-Induced Oral Complications. Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-66973-7_6.
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Rice, James. "Oral Medication Use in Cerebral Palsy." In Cerebral Palsy. Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-67858-0_24.
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Celentano, Antonio, and Elena Calabria. "Osteoporosis and Medication-Related Osteonecrosis of the Jaws." In Oral Medicine - A Clinical Guide. Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-36797-7_73.
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Vescovi, Paolo. "Laser Treatment of MEDICATION-Related Osteonecrosis of the Jaws." In Lasers in Oral and Maxillofacial Surgery. Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-29604-9_14.
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Walter, Christian, and Christoph Renné. "Osteomyelitis, Osteoradionecrosis, and Medication-Related Osteonecrosis of Jaws." In Oral and Maxillofacial Surgery for the Clinician. Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-15-1346-6_22.
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AbstractThe main function of the bones is the internal support and the storage of inorganic ions. Bones consist of the outer compact bone that harbors the inner cancellous bone and the bone marrow. Main cells are the bone-building osteoblasts, the bone-supporting osteocytes, and the bone-resorbing osteoclasts. All the cell lines communicate via the OPG RANK RANKL system.The term osteomyelitis describes inflammation of all bone structures. Depending on the clinical presentation and the cause triggering the osteomyelitis, it can be classified into acute osteomyelitis that is called secondary chronic osteomyelitis after a time span of more than 4 weeks. In general, an odontogenic infection is responsible whereas the trigger of the secondary chronic osteomyelitis is unknown. Symptoms of acute osteomyelitis are fever, listlessness, swelling, pain, reddishness, trismus, tooth mobility, pus, and paresthesia. In the secondary chronic stadium, the swelling is less prominent and a periosteal reaction, sequester formation, and fistulas can occur. The primary chronic osteomyelitis often has few and not very prominent symptoms with a nonsuppurative inflammation. Therapy consists of antibacterial mouth rinses and antibiotics to different surgical procedures.Osteoradionecrosis and medication-associated osteonecrosis are subentities where the radiation or a medication alters the bone biology and subsequently causes osteonecrosis of the affected bones.
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Budd, Siobhan C., and Jean-Christophe Egea. "Other Sports-Related Oral Health Risk Factors: Medication, Education and Access to Dental Care." In Sport and Oral Health. Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-53423-7_11.
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Diercks, Ronald L., and Francisco J. Vergara. "Oral Medication and Intra-articular Injection: Strategies and Results." In Shoulder Stiffness. Springer Berlin Heidelberg, 2015. http://dx.doi.org/10.1007/978-3-662-46370-3_17.
Full textConference papers on the topic "Oral medication"
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Nisse, Ye, S. Robert, J. Wicky, S. Henn-Ménétré, and B. Demoré. "4CPS-246 Palatability assessment of oral medication." In 24th EAHP Congress, 27th–29th March 2019, Barcelona, Spain. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/ejhpharm-2019-eahpconf.395.
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Khotimah, Purnomo Husnul, Yuichi Sugiyama, Masatoshi Yoshikawa, Akihiro Hamasaki, Kazuya Okamoto, and Tomohiro Kuroda. "Revealing oral medication patterns from reconstructed long-term medication history of type 2 diabetes." In 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). IEEE, 2016. http://dx.doi.org/10.1109/embc.2016.7591996.
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Ueda, Jun, Terese Martinez, Rohan Katoch, Kentaro Takemura, and Reay H. Brown. "Direct Illumination of Micro Stent Implants for the Treatment of Glaucoma." In 2019 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2019. http://dx.doi.org/10.1115/dmd2019-3251.
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Treatment of glaucoma involves lowering intraocular pressure, which can be achieved through several methods (e.g. topical medication, oral medication, surgery). This paper studies the use of stent implantations for pressure regulation, and proposes a direct illumination method to facilitate the insertion procedure. A proof-of-concept is demonstrated on a cadaver eye.
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Murphy, D., M. Kieran, and J. Brown. "4CPS-220 Patient satisfaction with pharmacist education on oral anticoagulant medication." In 25th Anniversary EAHP Congress, Hospital Pharmacy 5.0 – the future of patient care, 23–28 March 2021. British Medical Journal Publishing Group, 2021. http://dx.doi.org/10.1136/ejhpharm-2021-eahpconf.52.
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Ward, James, P. John Clarkson, Peter Buckle, and Wendy Harris. "The Packaging and Labelling of Solid Oral Medicine Using Oral Methotrexate as an Example." In ASME 7th Biennial Conference on Engineering Systems Design and Analysis. ASMEDC, 2004. http://dx.doi.org/10.1115/esda2004-58331.
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Solid oral Methotrexate (Methotrexate in tablet form) has been used for many years as an effective measure to treat severe rheumatoid arthritis and severe psoriasis. When taken at the right frequency and dose Methotrexate is a safe medication. However, in the community in the UK between 1993 and 2000, Methotrexate has been implicated in the deaths of some 25 patients and a further 26 cases of serious harm which have required hospitalisation [1,2]. In 2003 the National Patient Safety Agency (NPSA) began a programme of work to investigate the causes of errors with Methotrexate and to develop and implement solutions in response. Since then, three projects have been undertaken: • The development of a new patient treatment diary; • An investigation of IT systems in GP’s surgeries and community pharmacies; and • An assessment of the packaging and labelling of Methotrexate with patients and healthcare practitioners and the identification of changes which should improve patient safety. This paper describes the research and results from the third project.
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Adamovic, I., and U. Havemann-Reinecke. "Drug interaction of methadone with oral contraceptive medication. Clinic, treatment and TDM." In XIIIth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP. Georg Thieme Verlag KG, 2018. http://dx.doi.org/10.1055/s-0038-1649526.
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Molina, M., A. Rossignoli, S. de-Andrés, et al. "5PSQ-108 Reducing errors of oral medication administration in patients with dysphagia." In Abstract Book, 23rd EAHP Congress, 21st–23rd March 2018, Gothenburg, Sweden. British Medical Journal Publishing Group, 2018. http://dx.doi.org/10.1136/ejhpharm-2018-eahpconf.461.
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Adamovic, I., and U. Havemann-Reinecke. "Drug interaction of methadone with oral contraceptive medication. Clinic, treatment and therapeutic drug monitoring." In Abstracts of the 1st Symposium of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) and Deutsche Gesellschaft für Biologische Psychiatrie (DGBP). Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1679177.
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Jasim, Marie, and Richard Pollok. "PWE-027 Self-medication with oral corticosteroids in amongst patients with inflammatory bowel disease." In British Society of Gastroenterology, Annual General Meeting, 4–7 June 2018, Abstracts. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2018. http://dx.doi.org/10.1136/gutjnl-2018-bsgabstracts.159.
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Nishikawa, Hisashi, Takahiro Yamanaka, Hirofumi Yoshioka, Ami Tanaka, and Takakuni Douseki. "Metal-length sensor with antenna resonant detector for prescription guidance of oral pill medication." In 2013 IEEE Sensors. IEEE, 2013. http://dx.doi.org/10.1109/icsens.2013.6688435.
Full textReports on the topic "Oral medication"
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McPheeters, Melissa, Elizabeth A. O'Connor, Sean Riley, et al. Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2023. http://dx.doi.org/10.23970/ahrqepccer262.
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Background. Unhealthy alcohol use is the third leading preventable cause of death in the United States, accounting for more than 140,000 deaths annually. Only 0.9 percent of Americans who reported having alcohol use disorder (AUD) in the past year indicated they received medication-assisted AUD treatment. Methods. We updated a 2014 Agency for Healthcare Research and Quality (AHRQ) report on pharmacotherapy for AUD treatment, following AHRQ Evidence-based Practice Center Guidance. We assessed efficacy and comparative effectiveness of specific medications for improving consumption outcomes (Key Question [KQ] 1) and health outcomes (KQ 2). We assessed harms (KQ 3) and sought to identify evidence for the use of pharmacotherapy to treat AUD in primary care (KQ 4) and among subgroups (KQ 5). When possible, we conducted quantitative analyses using random-effects models to estimate pooled effects. When quantitative analyses could not be conducted, we used qualitative approaches. Results. We included 118 studies (156 articles) in our review, which included 81 studies (106 articles) from the 2014 review and 37 studies (50 articles) published since then. Studies generally included counseling co-interventions in all study groups, and the benefits observed reflect the added benefit of medications beyond those of counseling and placebo. Oral naltrexone at the 50 mg dosage had moderate strength of evidence (SOE) for reducing return to any drinking, return to heavy drinking, percent drinking days, and percent heavy drinking days. The addition of a new randomized controlled trial of injectable naltrexone conducted in a population experiencing homelessness resulted in positive outcomes for a reduction in drinking days and heavy drinking days with low SOE. Acamprosate had moderate SOE for a significant reduction in return to any drinking and reduction in drinking days. Topiramate had moderate SOE for several outcomes as well, but with greater side effects. Two other medications demonstrated low SOE for benefit in at least one consumption outcome—baclofen (reduced return to any drinking) and gabapentin (reduced return to drinking and to heavy drinking). With no new studies on disulfiram, there remains inadequate evidence for efficacy compared to placebo for preventing return to any drinking or for other alcohol consumption outcomes. No new eligible studies provided head-to-head comparisons. Conclusions. Oral naltrexone at the 50 mg dose had moderate strength of evidence across multiple outcomes and relative ease of use as a once-daily oral medication. Acamprosate and topiramate also have moderate evidence of benefit with a less desirable side effect profile (topiramate) and a higher pill burden (acamprosate). Clinicians and patients may want to consider which treatment outcomes are most important when choosing among the medications. Current data are largely insufficient for understanding health outcomes. Finally, there is relatively little research to assess the use of medications for AUD among subgroups (9 studies) or in primary care settings (1 study).
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Yuan, Yu, Linjia Wang, Yuan Chen, Mengdi Zhou, Bingyu Hu, and Ling Zhao. Acupuncture therapy for subacute and chronic cough in adults: a systematic review and meta analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.7.0110.
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Review question / Objective: The effectiveness of acupuncture in the treatment of subacute and chronic cough. Eligibility criteria: In the literature, the intervention measures of the treatment group were acupuncture or acupuncture combined with other therapies agent, while the control group was placebo or oral non-acupuncture therapy such as western medicine and Chinese medicine; In the same study, when the treatment group was acupuncture combined with other treatment methods, the intervention measures adopted by the control group, except no acupuncture intervention, must be the same as the experimental group .We excluded trials comparing one acupuncture therapy with another, or trials comparing the use of other non- acupuncture related therapy in this review, and trials where acupuncture therapy were not the main intervention were excluded. No limitations were imposed concerning the duration of the application, dosage, or the form of the acupuncture therapy used. We included trials that allowed concurrent use of other medications such as analgesics, antitussives, antipyretics, or mucolytics if they allowed equal access to such medication.
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Kwak, Sang Gyu, Yoo Jin Choo, Soyoung Kwak, and Min Cheol Chang. Efficacy of Transforaminal, Interlaminar, and Caudal Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Network Meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.8.0091.
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Review question / Objective: Epidural injection (EI) has been used to manage lower back or radicular leg pain from herniation of lumbar disc (HLD). Three types of EI techniques, including transforaminal (TFEI) interlaminar (ILEI), and caudal epidural injections (CEI), are being applied. We aimed to evaluate the comparative effect of TFESI, ILEI, and CEI for reducing pain or improving function in patients with HLD. Condition being studied: For controlling inflammation by the HLD, various oral medications and procedures are used. Among these therapeutic methods, EI of the drugs is frequently used in clinical practice. Its positive HLD-induced pain reducing effect was reported in several previous studies. Three types of techniques, including TFEI, ILEI, and CEI, have been utilized in clinical practice. conflicting outcomes as to which technique is superior were reported in previous studies. So far, some meta-analysis studies for comparing the effects of different EI techniques on HLD were conducted. However, these previous studies conducted comparison between two procedures among TFEI, ILEI, and CEI. In the current study, using network meta-analysis, we synthesize and compare the effects of TFEI, ILEI, and CEI on pain from HLD, together.
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Steele, Dale W., Gaelen P. Adam, Ian J. Saldanha, et al. Management of Postpartum Hypertensive Disorders of Pregnancy. Agency for Healthcare Research and Quality (AHRQ), 2023. http://dx.doi.org/10.23970/ahrqepccer263.
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Background. Hypertensive disorders of pregnancy (HDP) are increasingly common and have important implications for maternal health, healthcare utilization, and health disparities. There is limited evidence to support best management of postpartum individuals with HDP, including home blood pressure (BP) monitoring (HBPM) and choice of antihypertensive agents. For patients experiencing preeclampsia with severe features, there is robust evidence supporting delivery of the infant and treatment with magnesium sulfate (MgSO4). However, MgSO4 may cause unpleasant side effects and, less commonly, toxicity. Patients receiving MgSO4 require additional monitoring (e.g., urinary catheterization) and often have activity restrictions, which impact their postpartum experience. Evidence regarding the optimal (lowest effective) dose and (shortest effective) duration of MgSO4 treatment is needed. Methods. We searched Medline®, Cochrane, Embase®, CINAHL®, and ClinicalTrials.gov from inception to December 1, 2022. After double screening, we extracted study data and risk of bias assessments into the Systematic Review Data Repository Plus (SRDR+; https://srdrplus.ahrq.gov). We evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42022313075). Results. We found 13 eligible studies (3 randomized controlled trials [RCTs], 2 nonrandomized comparative studies [NRCSs], 8 single-arm studies) evaluating postpartum HBPM, 17 RCTs evaluating pharmacological treatment of postpartum HDP, and 43 studies (41 RCTs and 2 NRCSs) that compared alternative MgSO4 regimens. HBPM programs probably increase submission of any BP measurements during recommended time intervals (moderate SoE) and may increase the number of BP measurements obtained overall (low SoE). Studies have not found that HBPM affects the rate of BP treatment initiation (low SoE), but HBPM may reduce unplanned hypertension-related hospital admissions (low SoE). Most patients were satisfied with management related to HBPM (low SoE), and HBPM probably compensates for racial disparities in office-based follow-up (moderate SoE). In patients with preeclampsia or gestational hypertension (HTN), oral furosemide may shorten the duration of postpartum hypertension (low SoE). There was insufficient evidence regarding the comparative benefits and harms of other antihypertensive medications. Compared with 24-hour treatments, shorter duration MgSO4 regimens shorten the urinary catheterization time (high SoE), time to ambulation (high SoE), and time to breastfeeding (moderate SoE); and may shorten time from delivery to contact with the infant and decrease toxicity as manifested by lost deep tendon reflexes (both low SoE). Loading dose only regimens increase the risk of a recurrent seizure in patients with eclampsia (moderate SoE). Lower dose MgSO4 regimens, compared to standard dose regimens, reduce early signs of magnesium toxicity (high SoE), may approximately double the risk of recurrent seizure in patients with eclampsia (low SoE), but may not affect 5-minute Apgar scores in infants of patients with preeclampsia with severe features (low SoE). There is insufficient evidence regarding potential harms of concomitant use of nifedipine or other antihypertensive medications. Conclusion. HBPM probably improves ascertainment of BP, allowing early recognition of hypertension in postpartum patients, and probably compensates for racial disparities in office based follow-up. The evidence suggests furosemide may shorten the duration of postpartum HTN. However, further evidence is needed regarding the comparative benefits and harms of the antihypertensive medications used to treat postpartum HTN. Large pragmatic trials, augmented by analysis of real-world data, are needed to evaluate the effect of postpartum HBPM on clinical event outcomes (not only process outcomes) and on the comparative effectiveness of alternative antihypertensive treatments. Given that lower dose MgSO4 regimens reduce Mg toxicity, and shorter regimens decrease urinary catheterization time, time to ambulation, time to breastfeeding, and time from delivery to contact with the infant, evidence is needed to identify MgSO4 regimens with the lowest effective dose and shortest effective duration that minimize side effects and toxicity but still prevent seizures among patients with preeclampsia with severe features.
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Lubowa, Nasser, Zita Ekeocha, Stephen Robert Byrn, and Kari L. Clase. Pharmaceutical Industry in Uganda: A Review of the Common GMP Non-conformances during Regulatory Inspections. Purdue University, 2021. http://dx.doi.org/10.5703/1288284317442.
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The prevalence of substandard medicines in Africa is high but not well documented. Low and Middle-Income Countries (LMICs) are likely to face considerable challenges with substandard medications. Africa faces inadequate drug regulatory practices, and in general, compliance with Good Manufacturing Practices (GMP) in most of the pharmaceutical industries is lacking. The majority of pharmaceutical manufacturers in developing countries are often overwhelmed by the GMP requirements and therefore are unable to operate in line with internationally acceptable standards. Non-conformances observed during regulatory inspections provide the status of the compliance to GMP requirements. The study aimed to identify the GMP non-conformances during regulatory inspections and gaps in the production of pharmaceuticals locally manufactured in Uganda by review of the available 50 GMP reports of 21 local pharmaceutical companies in Uganda from 2016. The binary logistic generalized estimating equations (GEE) model was applied to estimate the association between odds of a company failing to comply with the GMP requirements and non-conformances under each GMP inspection parameter. Analysis using dummy estimation to linear regression included determination of the relationship that existed between the selected variables (GMP inspection parameters) and the production capacity of the local pharmaceutical industry. Oral liquids, external liquid preparations, powders, creams, and ointments were the main categories of products manufactured locally. The results indicated that 86% of the non-conformances were major, 11% were minor, and 3% critical. The majority of the non-conformances were related to production (30.1%), documentation (24.5%), and quality control (17.6%). Regression results indicated that for every non-conformance under premises, equipment, and utilities, there was a 7-fold likelihood of the manufacturer failing to comply with the GMP standards (aOR=6.81, P=0.001). The results showed that major non-conformances were significantly higher in industries of small scale (B=6.77, P=0.02) and medium scale (B=8.40, P=0.04), as compared to those of large scale. This study highlights the failures in quality assurance systems and stagnated GMP improvements in these industries that need to be addressed by the manufacturers with support from the regulator. The addition of risk assessment to critical production and quality control operations and establishment of appropriate corrective and preventive actions as part of quality management systems are required to ensure that quality pharmaceuticals are manufactured locally.