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Saudi Pharmaceutical Journal : SPJ :... Mar 2023The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year...
OBJECTIVE
The objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year period.
METHODOLOGY
The study period was of one year, i.e., October 2020 - September 2021. The venue of study was a tertiary care hospital. The narcotic medications included Fentanyl, Tramadol, Morphine, and Meperidine. The controlled medications included Midazolam, Phenobarbital, Diazepam, Ketamine and Lorazepam. The annual consumption and wastage of the narcotic and controlled medications were documented using data report generated by narcotics and controlled medication in-charge pharmacist through the hospital's online system. Data was reported using average, minimum and maximum values. Quantities of wastage is expressed in terms of ampoules. Costs per ampoule were calculated and expressed in both Saudi Riyal (SAR) and United States Dollar (USD). The study was approved by an ethics committee.
RESULTS
The annual wastage of narcotics was 3.19 % while the same for controlled medications was 21.3 %. An annual wastage of 3.81 % was reported for narcotics and controlled medications combined. The total wastage cost of narcotics and controlled medications was 15,443.1 SAR that was equivalent to USD 4085.5. Fentanyl 500mcg formulations had the highest consumption, i.e., 28,580 ampoules followed by Morphine 10 mg formulations, i.e., 27,122 ampoules. The highest ampoule wastage was observed for Morphine 10 mg formulations, i.e., 1956 ampoules. The highest % wastage was observed for Midazolam formulations, i.e., 29.3 %.
CONCLUSION
The overall wastage was less than 5% of the total consumption, however, midazolam was observed to have the highest wastage. Shifting to prefilled syringes supplied by pharmacies, making protocols, and safely pooling costly drugs could result in significant savings.
PubMed: 37026053
DOI: 10.1016/j.jsps.2022.12.012 -
European Archives of Paediatric... Feb 2024This study was conducted to explore the preference and experience of paediatric dentists based in Switzerland regarding the use of articaine and other local and topical...
PURPOSE
This study was conducted to explore the preference and experience of paediatric dentists based in Switzerland regarding the use of articaine and other local and topical anaesthesia.
METHODS
An 18-question survey was developed, piloted, and distributed to the members of the Swiss association of paediatric dentistry (n = 460). The following information were collected: most used local anaesthetic in different age groups, time needed to inject a full ampule, frequency of observed local and systemic side effects, application of topical anaesthetic prior to injection, time waited between application and the injection, and perceived effectiveness of topical anaesthetic. The dentists' responses were analysed with logistic regressions reporting odds ratios (OR) and 95% confidence intervals (CI) at 5%.
RESULTS
The response rate was 37% (n = 168) out of the 460 questionnaires sent, with the responders being predominantly female (67%) and 47-year-old on average. More than 80% of the dentists used articaine in all age groups. 45% of responders took longer than 60 s to inject a full ampule. Local and systemic side-effects were observed by 82% and 28% of respondents respectively, although the nature and the significance of those were not detailed due to the anonymous nature of the questionnaire. Significantly less local adverse effects were seen for older children (p = 0.04) and among dentists with more years of experience (p = 0.01). Most responders applied topical anaesthetic and half of them waited longer than 60 s before injection.
CONCLUSIONS
Articaine is a widely used local anaesthetic by the studied group of Swiss paediatric dentists regardless of patient's age. The use of topical anaesthetic before injection is a common practice with good perceived effectiveness.
Topics: Adolescent; Child; Female; Humans; Male; Anesthesia, Dental; Anesthetics, Local; Carticaine; Dentists; Switzerland; Middle Aged
PubMed: 38010573
DOI: 10.1007/s40368-023-00852-9 -
Turk Psikiyatri Dergisi = Turkish... 2021Given the very frequent prescription of non-opiod analgesics (NOA), their dependence potential has been a subject of research. Increased use of NOA in the last decade...
Given the very frequent prescription of non-opiod analgesics (NOA), their dependence potential has been a subject of research. Increased use of NOA in the last decade has led authors to publish case reports to describe the dependence potential of these agents. Metamizole (dipyrone) has become one of the most popular NOA agents, in being easily accessible and inexpensive. Its analgesic effect depends on the central inhibition of cyclo-oxigenase (COX-3) and activation of the opiodergic and cannabinoid systems. Recent research has also stressed its possible anxiolytic effects. Our Literature search indicated no previous reports regarding metamizole misuse. Case of a 41 year old female patient is presented. She had self administered increasing doses of i.v. metamizole reaching up to 10 ampules per day. Considering the risk of mortality due to the metamizole's side effect of agranulocytosis, we thought that it could be a significant contribution to the literature to present a case of a possible metamizole abuse.
Topics: Adult; Agranulocytosis; Anti-Anxiety Agents; Anti-Inflammatory Agents, Non-Steroidal; Dipyrone; Female; Humans
PubMed: 34181748
DOI: 10.5080/u25679 -
Respiratory Care Mar 2023Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the...
BACKGROUND
Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented. The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses. METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 g/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium.
RESULTS
A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, = .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, = .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 g/h or 1,200 g/d (2.2 ampules/d, < .001), and that of midazolam dose was 5.7 mg/h.
CONCLUSIONS
Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.
Topics: Humans; Midazolam; Analgesics, Opioid; Retrospective Studies; Pandemics; Respiration, Artificial; COVID-19; Hypnotics and Sedatives; Fentanyl; Delirium; Respiratory Distress Syndrome
PubMed: 36414277
DOI: 10.4187/respcare.10371 -
Diving and Hyperbaric Medicine Jun 2018It has been our institution's policy to not place glass medication ampoules inside our hyperbaric chamber for fear of rupture. There is only a small and conflicting...
INTRODUCTION
It has been our institution's policy to not place glass medication ampoules inside our hyperbaric chamber for fear of rupture. There is only a small and conflicting amount of data as to whether glass ampoules are safe for use under hyperbaric conditions.
OBJECTIVES
The primary objective of this study was to test the safety and usability of glass medication ampoules inside a hyperbaric chamber.
METHODS
Repetitive, rapidly staged compressions and decompressions were performed on multiple different glass medications ampoules inside the medical lock of a medical hyperbaric chamber. Medication ampoules of varying sizes (1 ml to 10 ml) of medication that may be required in a hyperbaric emergency were assessed. The ampoules were rapidly compressed 100 times to pressures of 142 kPa, 183 kPa, 300 kPa, 405 kPa and 507 kPa. They were then dropped from a height of 30 cm while compressed at 507 kPa and then half the ampoules were opened while pressurized at 507 kPa.
RESULTS
No ampoules were broken during compression or decompression. No ampoules broke when dropped from 30 cm onto the chamber floor. All ampoules opened at a pressure of 507 kPa functioned normally. No lids/ampoules shattered upon opening.
CONCLUSION
This study suggests that glass medication ampoules appear to be safe for use inside a medical hyperbaric chamber at routine treatment pressures.
Topics: Drug Packaging; Emergencies; Glass; Humans; Hyperbaric Oxygenation; Pressure
PubMed: 29888383
DOI: 10.28920/dhm48.2.107-109 -
Human Reproduction (Oxford, England) Jan 2017Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil?
STUDY QUESTION
Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil?
SUMMARY ANSWER
Contraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak.
WHAT IS KNOWN ALREADY
Transmission of ZIKV is primarily by Aedes aegypti mosquitoes; however, sexual transmission has also been described. The association of several birth defects and the ZIKV infection during pregnancy has been established, and it was estimated in Bahia, Brazil that the infection rate could range from 10% to 80%. The World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February 2016. The Brazilian government also made recommendations for women who were planning to become pregnant and who reside in ZIKV-affected areas to reconsider or postpone pregnancy.
STUDY DESIGN, SIZE, DURATION
The objective of this study was to assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak. We obtained information from all pharmaceutical companies based in Brazil and from the manufacturers of long-acting reversible contraceptives (LARCs), including the copper-intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants, about contraceptives sales in the public and private sectors between September 2014 and August 2016.
PARTICIPANTS/MATERIALS, SETTING, METHODS
We analyzed the data for: (i) oral contraceptives, i.e. combined oral contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives, (ii) injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate, (iii) LARCs and (iv) emergency contraceptive (EC) pills.
MAIN RESULTS AND THE ROLE OF CHANCE
Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7-13.8 million cycles/units per month (90%). The second largest group of sales was injectables, representing 0.8-1.5 million ampoules per month (9.5%). Following this, are LARC methods with sales of 37 000-41 000 devices per month (0.5%). It is important to note that although the peak months of sales were different for each group of contraceptives, there were no significant differences overall between the months of observation. The EC pill sales were between 1.0 million and 1.3 million of pills per month.
LIMITATIONS, REASONS FOR CAUTION
Although the use of contraceptive methods was already high and no change was noted, the ZIKV outbreak may have changed the pregnancy intentions of Brazilian women. Consequently, the number of women planning pregnancy may be lower than that recorded. The contraceptive sales figures did not include condoms. Since condoms might not only prevent pregnancies, but also sexual transmission of ZIKV, this lack of information is a limitation.
WIDER IMPLICATIONS OF THE FINDINGS
The results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil. Furthermore, it is possible that access to LARC methods was limited. Although we did not investigate the reason for low LARC uptake, we suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women. Projections estimate millions of additional cases of ZIKV transmission. Thus, a coordinated response is needed to ensure access to a wide range of contraceptive methods for women during the ZIKV outbreak. In conclusion, this assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and represents an alternative source of data to help us understand the trends in demand for contraception in ZIKV-affected areas.
STUDY FUNDING/COMPETING INTERESTS
This study received partial financial support from Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504-9 and from an anonymous donor. The funding sources did not play a role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The authors declare no conflict of interest associated with this study.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Adult; Brazil; Commerce; Contraception; Contraceptive Agents; Female; Humans; Pregnancy; Zika Virus; Zika Virus Infection
PubMed: 27932442
DOI: 10.1093/humrep/dew310 -
Asian Journal of Surgery Apr 2024
PubMed: 38212223
DOI: 10.1016/j.asjsur.2023.12.084 -
Chemical Science Dec 2019A temperature induced valence phase transition from Yb at higher temperatures to Yb at lower temperatures was observed at = 110(1) K for intermetallic YbPdAl. The title...
A temperature induced valence phase transition from Yb at higher temperatures to Yb at lower temperatures was observed at = 110(1) K for intermetallic YbPdAl. The title compound has been prepared from the elements in sealed tantalum ampoules. The structure was refined from single-crystal data and the title compound was found to crystallize in the hexagonal YNiAl type structure with space group 6/ and lattice parameters of = 929.56(7) and = 420.16(3) pm (300 K data). Full ordering of the Pd and Al atoms within the [PdAl] polyanion was observed. Magnetic measurements revealed an anomaly in the dc susceptibility data and intermediate valent Yb at higher temperature, as observed from the effective magnetic moment. The proposed valence phase transition was also observed as a -type anomaly in heat capacity measurements ( = 108.4(1) K), however, no systematic shift of the -peak was observed in field dependent heat capacity measurements. An antiferromagnetic ordering at this temperature, however, could be excluded, based on field-dependent susceptibility measurements and magnetization isotherms. No dynamic phenomenon was observed in ac susceptibility measurements, excluding spin-glass behavior. Subsequent temperature dependent single-crystal and powder X-ray diffraction experiments indicated a steep increase in the length of the axis around = 110 K upon cooling. However, no structural phase transition was found single-crystal diffraction experiments conducted at 90 K. The anomaly was also observed in other physical measurements of the electrical resistivity, indicating a clear change in the electronic structure of the material. X-ray photoelectron spectroscopy conducted at room temperature shows the presence of both, Yb and Yb, underlining the mixed-valent state. Members of the solid solution Yb Ca PdAl ( = 0.33, 0.67, 1) were finally used to further study the charge ordering and the present temperature induced valence phase transition.
PubMed: 32206257
DOI: 10.1039/c9sc04437j -
NPJ Microgravity 2019Directional solidification experiment was carried out with Al-Bi-Sn immiscible alloy under microgravity environment onboard the Tiangong 2 space laboratory of China....
Directional solidification experiment was carried out with Al-Bi-Sn immiscible alloy under microgravity environment onboard the Tiangong 2 space laboratory of China. Sample with a well-dispersed microstructure was obtained by properly designing the experimental scheme, the matrix shows equiaxed morphology, and there is no visible gas cavity or pinhole in the sample. In contrast, the reference samples solidified on earth show phase-segregated structure and contain some gas cavities or pinholes. The grain morphology of the terrestrial sample depends on the solidification direction, it is equiaxed when the sample ampoule was withdrawn against the gravity direction, while it is columnar when the sample ampoule was withdrawn along the gravity direction. The solidification process and affecting mechanisms of microgravity on the microstructure formation are discussed. The results indicate that the microgravity conditions can effectively diminish the convective flow of the melt and the Stokes motions of the minority phase droplets and gas bubbles, which are helpful for suppressing the occurrence of macro-segregation and preventing the formation of porosity. The results also demonstrate that the microgravity conditions favor the detachment between the melt and the wall of crucible, thus increasing the nucleation undercooling of α-Al nuclei and promoting the formation of equiaxed grain.
PubMed: 31754626
DOI: 10.1038/s41526-019-0086-z -
Lancet (London, England) Jul 2021Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and...
BACKGROUND
Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and postpartum depression, and delayed functional recovery. We investigated the role of nurse-supported care in acute pain management after caesarean delivery, which as far as we know has not previously been investigated in Gaza.
METHODS
This was a comparative study done from March, 2018, to October, 2018, among women assigned to undergo caesarean delivery. Research nurses at the Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, were trained to give supportive pain management care to women after caesarean delivery, including individualised care and educational sessions on pain, nutrition, exercise, and wound care. Women were randomly assigned to receive nurse-supported care or usual care. Pain assessment scales (range 1-5, where 1=no pain and 5=pain as bad as it could be) were used to record pain at 1, 6, 12, 18, and 24 h after caesarean delivery. The time from the end of the caesarean delivery to the first request for analgesia and the total amounts and types of analgesics (pethidine ampules, diclofenac ampules, or indometacin suppositories) used in the first 24 h were recorded as primary outcomes. Secondary outcomes were nausea and vomiting scores (0-3, where 0=no nausea or vomiting and 3=severe and unresponsive to antiemetic drugs), sedation scores (0-3, where 0=patient awake and 3=severe sedation and patient difficult to rouse), and pruritis scores (0-2, where 0=no pruritis and 2=severe pruritis needing treatment). Data were analysed with SPSS (version 22.0). Groups were compared by using the Student's t-test and χ. P values less than 0·05 were significant. The study was approved by the Ministry of Health and Helsinki Committee, Gaza Strip. Women provided verbal informed consent for inclusion in the study when they were assigned to the caesarean delivery.
FINDINGS
108 women participated, with a mean age of 29·2 years (SD 5·50). 49 women were randomly assigned to nurse-supported care and 59 to usual care. Pain was reduced in the nurse-supported care group compared with in the usual care group at 12 h (mean score 1·15 [SD 0·25] vs 1·60 [0·67], p=0·002) and at 18 h (1·08 [0·22] vs 1·26 [0·21], p=0·049) but did not differ significantly at other times. The time to first requesting analgesia was shorter in the nurse-supported care group than in the usual care group (mean 3·38 h [SD 1·01] vs 6·16 h [2·01], p=0·038). The proportions of women who asked for a first analgesic were similar in the two groups (30 [61%] and 36 [61%]), whereas seven (14%) women in the nurse-supported care group requested a second analgesic compared with 13 (22%) in the usual care group (p=0·045). There were no significant differences between the two groups for nausea and vomiting, sedation, or pruritis.
INTERPRETATION
Nurse-supported care provided better analgesia than usual care in women who had undergone caesarean delivery. A multicentre study is needed to explore the types, duration, and repeatability of the effects of nurse supportive care on pain perception and duration of hospital stay after caesarean delivery.
FUNDING
None.
PubMed: 34227956
DOI: 10.1016/S0140-6736(21)01510-5