2 research outputs found
DRUG UTILIZATION PATTERN AMONG THE PATIENTS OF LUNG CANCER IN TERTIARY CARE HOSPITAL OF NEPAL
No full textObjective: Lung cancer is one of the most common cancers in the Nepalese population. Due to the advancement of novel drug regimens and chemotherapeutic treatment guidelines, a proper evaluation of prescriptions is mandatory to prevent unnecessary drug use, which may lead to distress and harm on patient’s health financially and increases morbidity and mortality. Hence, drug utilization study has become an important criterion to implement during the evaluation of prescription and to study the trends of prescribing by prescribers.
Methods: From March 2023 to August 2023, we included 242 adult patients who had received chemotherapy in Bhaktapur Cancer Hospital. A retrospective cross-sectional study was done to evaluate socio-demographic profile of patients and medicines prescribed using the World Health Organization (WHO) prescribing indicators.
Results: The mean age was 58.21±13.22, with 57% (n=138) of the patients being male. The average number of drugs prescribed was 9.28, and 35.95% of the prescription was with antibiotics. Cisplatin (29.34%; n=260) and 5-fluorouracil (14.05; n=34) were among the most frequently prescribed chemotherapeutic agents, and antiulcer drugs (19.23%; n=260) and nutritional supplements (17.6%; n=238) were among the most commonly prescribed adjuvant drugs. 65.49% of the drugs prescribed belonged to the essential drug list, and only 21.228% drugs were prescribed by generic name.
Conclusion: Our study revealed the presence of polypharmacy in lung cancer patients. Prescribing medicines through generic names was found to be low. All WHO prescribing parameters were deviated from the optimal value. Hence, this study suggested that an effective intervention is needed for the rational use of drugs
Dedicated anticoagulation management protocols in fragility femoral fracture care – a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study
No full text\ua9 2024 The Author(s)Introduction: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. Methods: Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. Results: Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54–0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75–3.57, p=0.219). Conclusions: Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery
