There are multiple biases in using observational studies to examine treatment effects such as those from prevalent drug users, immortal time and drug indications. We used renin angiotensin system(RAS) inhibitors and s...There are multiple biases in using observational studies to examine treatment effects such as those from prevalent drug users, immortal time and drug indications. We used renin angiotensin system(RAS) inhibitors and statins as reference drugs with proven efficacies in randomized clinical trials(RCTs) and examined their effectiveness in the prospective Hong Kong Diabetes Registry using adjustment methods proposed in the literature. Using time-dependent exposures to drug treatments yielded greatly inflated hazard ratios(HR) regarding the treatment effects of these drugs for cardiovascular disease(CVD) in type 2 diabetes. These errors were probably due to changing indications to use these drugs during follow up periods, especially at the time of drug commencement making time-dependent analysis extremely problematic. Using time-fixed analysis with exclusion of immortal time and adjustment for confounders at baseline and/or during follow-up periods, the HR of RAS inhibitors for CVD was comparable to that in RCT. The result supported the use of the Registry for performing pharmacoepidemiological analysis which revealed an attenuated low low-density lipoprotein cholesterol related cancer risk with RAS inhibitors. On the other hand, time-fixed analysis with including immortal time and adjustment for confounders at baseline and/or during follow-up periods, the HR of statins for CVD was similar to that in the RCT. Our results highlight the complexity and difficulty in removing these biases. We call for validations of the methods to cope with immortal time and drug use indications before applying them to particular research questions, so to avoid making erroneous conclusions.展开更多
Objective:To evaluate the prescribing pattern of anti malarial drugs in a tertiary care hospital. Methods:A prospective cross-sectional study was conducted for 6 months of patients visiting in Basaveshwar Teaching and...Objective:To evaluate the prescribing pattern of anti malarial drugs in a tertiary care hospital. Methods:A prospective cross-sectional study was conducted for 6 months of patients visiting in Basaveshwar Teaching and General Hospital,Gulbarga.Data were analyzed for various drug use indicators.Results:A total of 212 prescriptions were collected,with 136(64.15%) male and 76(35.85%) female.There were 128(60.37%) Plasmodium vivax cases and 84(39.63%) Plasmodium falciparum cases.All Plasmodium vivax cases were treated with chloroquine alone and among these 16(12.5%) recieved radical treatment with primaquine along with chloroquine.Among 84 patients with Pasmodium falciparum,40 patients received single drug such as quinine/ mefloquinine/artesunate/arteether.Another 44 patients received multidrug regime like,quinine+artesunate(54.54%),quinine+mefloquine(27.27%) and quinine+arteether (18.18%).Chloroquine was not administered to any of the patients with Plasmodium falciparum malaria.The most common adverse effects with chloroquine were anorexia,nausea,vomiting and tinnitus in 9.37% of the cases.With quinine it was nausea and vomiting in 17.64% ,tinnitus in 11.76% and hypoglycemia in 2.1% of cases.Conclusions:Our study found the perennial favorites like chloroquine for Plasmodium vivax and quinine for Plasmodium falciparum were the most effective drug.In the severe Plasmodium falciparum cases the artesunate derivatives and combination of artesunate with quinine/mefloquine were most effective with fewer incidences of side effects.展开更多
<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappro...<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappropriate use of medicines is a global concern with serious con</span><span style="font-family:Verdana;">sequences related to prescribing, dispensing, and use. WHO estimate</span><span style="font-family:Verdana;">d that 50% of medicines are not used correctly on their journey from the facility to home. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: To assess medicines use using WHO drug core indicators rega</span><span><span style="font-family:Verdana;">rding prescribing, patient, and facilities. </span><b><span style="font-family:Verdana;">Setting</span></b><span style="font-family:Verdana;">: Outpatients, Hea</span></span><span style="font-family:Verdana;">lth centers in Wadmadani locality (Urban area) in Gezira State, Sudan. </span><b><span style="font-family:Verdana;">Method</span></b><span style="font-family:Verdana;">: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dos展开更多
文摘There are multiple biases in using observational studies to examine treatment effects such as those from prevalent drug users, immortal time and drug indications. We used renin angiotensin system(RAS) inhibitors and statins as reference drugs with proven efficacies in randomized clinical trials(RCTs) and examined their effectiveness in the prospective Hong Kong Diabetes Registry using adjustment methods proposed in the literature. Using time-dependent exposures to drug treatments yielded greatly inflated hazard ratios(HR) regarding the treatment effects of these drugs for cardiovascular disease(CVD) in type 2 diabetes. These errors were probably due to changing indications to use these drugs during follow up periods, especially at the time of drug commencement making time-dependent analysis extremely problematic. Using time-fixed analysis with exclusion of immortal time and adjustment for confounders at baseline and/or during follow-up periods, the HR of RAS inhibitors for CVD was comparable to that in RCT. The result supported the use of the Registry for performing pharmacoepidemiological analysis which revealed an attenuated low low-density lipoprotein cholesterol related cancer risk with RAS inhibitors. On the other hand, time-fixed analysis with including immortal time and adjustment for confounders at baseline and/or during follow-up periods, the HR of statins for CVD was similar to that in the RCT. Our results highlight the complexity and difficulty in removing these biases. We call for validations of the methods to cope with immortal time and drug use indications before applying them to particular research questions, so to avoid making erroneous conclusions.
文摘Objective:To evaluate the prescribing pattern of anti malarial drugs in a tertiary care hospital. Methods:A prospective cross-sectional study was conducted for 6 months of patients visiting in Basaveshwar Teaching and General Hospital,Gulbarga.Data were analyzed for various drug use indicators.Results:A total of 212 prescriptions were collected,with 136(64.15%) male and 76(35.85%) female.There were 128(60.37%) Plasmodium vivax cases and 84(39.63%) Plasmodium falciparum cases.All Plasmodium vivax cases were treated with chloroquine alone and among these 16(12.5%) recieved radical treatment with primaquine along with chloroquine.Among 84 patients with Pasmodium falciparum,40 patients received single drug such as quinine/ mefloquinine/artesunate/arteether.Another 44 patients received multidrug regime like,quinine+artesunate(54.54%),quinine+mefloquine(27.27%) and quinine+arteether (18.18%).Chloroquine was not administered to any of the patients with Plasmodium falciparum malaria.The most common adverse effects with chloroquine were anorexia,nausea,vomiting and tinnitus in 9.37% of the cases.With quinine it was nausea and vomiting in 17.64% ,tinnitus in 11.76% and hypoglycemia in 2.1% of cases.Conclusions:Our study found the perennial favorites like chloroquine for Plasmodium vivax and quinine for Plasmodium falciparum were the most effective drug.In the severe Plasmodium falciparum cases the artesunate derivatives and combination of artesunate with quinine/mefloquine were most effective with fewer incidences of side effects.
文摘<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappropriate use of medicines is a global concern with serious con</span><span style="font-family:Verdana;">sequences related to prescribing, dispensing, and use. WHO estimate</span><span style="font-family:Verdana;">d that 50% of medicines are not used correctly on their journey from the facility to home. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: To assess medicines use using WHO drug core indicators rega</span><span><span style="font-family:Verdana;">rding prescribing, patient, and facilities. </span><b><span style="font-family:Verdana;">Setting</span></b><span style="font-family:Verdana;">: Outpatients, Hea</span></span><span style="font-family:Verdana;">lth centers in Wadmadani locality (Urban area) in Gezira State, Sudan. </span><b><span style="font-family:Verdana;">Method</span></b><span style="font-family:Verdana;">: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dos
