暂无摘要。

UNASSIGNED: Inappropriate use of short-acting beta2-agonists (SABA) in asthma has been associated with undesired outcomes. This national expert consensus was developed to increase awareness of SABA overuse and provide recommendations on the ways to eliminate SABA overprescription and overreliance in Malaysia.
UNASSIGNED: This expert consensus was developed by searching the PubMed database, using index terms to identify SABA overuse-related burden and recommendations made in asthma guidelines. Consensus recommendations were made via the Delphi method, involving a Malaysian expert committee comprising 13 healthcare professionals (five pulmonologists, four family medicine specialists, two emergency medicine physicians and two pharmacists).
UNASSIGNED: The articles reviewed include randomized controlled trials, systematic reviews, meta-analyses, observational studies, guidelines, and surveys, with abstracts in English and published up until June 2023. Relevant recommendations were also sourced from verified websites of medical organizations and societies.
UNASSIGNED: Eleven consensus statements were developed, each statement achieving a priori agreement level of at least 70%. The statements reflect SABA overreliance in asthma care, as well as recommendations to eliminate SABA overprescription and overreliance in Malaysia. Supporting evidence in the literature as well as expert committee discussions leading to the development of the finalized statements were elaborated.
UNASSIGNED: This national expert consensus discussed the burden of SABA overreliance and made specific recommendations to eliminate SABA overprescription and overreliance in the Malaysian context. This consensus document is anticipated to impart better awareness among Malaysian healthcare providers and contribute to the continuous improvement of asthma care in the country.

BACKGROUND: Climate change as a consequence of anthropogenic greenhouse gas emissions (CO2e) favors weather extremes. This challenges the healthcare system to cope with negative consequences and to remain functional at the same time. Despite rising costs and shortage of staff, sick people in an aging society must be increasingly cared for in a resource-efficient and climate-neutral manner without compromising the quality of care.
OBJECTIVE: This article summarizes current challenges for practices and outpatient clinics due to climate change and societal transformation. In addition, steps to implement transformative interventions are discussed.
METHODS: Selective literature review in PubMed database was conducted on the impact of climate change on the healthcare system, crisis resilience, climate management, overprescription, and co-benefits.
RESULTS: Crisis-resilient practices are attuned to challenges resulting from climate change. Communicating co-benefits in the physician-patient conversation can accelerate the transformation to a sustainable society.
CONCLUSIONS: Rapidly changing environmental conditions require adaptation on the part of the healthcare system. Education and prevention are key to meet this challenge. Transformation to sustainable practices is an ongoing process and it represents a holistic concept that encompasses social, environmental, and economic aspects, which are interdependent and cannot be considered separately.
UNASSIGNED: HINTERGRUND: Der Klimawandel als Folge anthropogen verursachter Treibhausgasemissionen (Kohlendioxidäquivalente [CO2e]) löst häufiger Wetterextreme aus. Das Gesundheitssystem wird vor die Aufgabe gestellt, gesundheitliche Folgen des Klimawandels aufzufangen und zeitgleich funktionsfähig zu bleiben, aber auch eigene negative Einflüsse auf das Klima zu minimieren. Bei steigenden Kosten und fehlendem Personal müssen kranke Menschen in einer alternden Gesellschaft ressourcenschonend versorgt werden, ohne dass die Versorgungsqualität leidet.
UNASSIGNED: Diese Arbeit skizziert aktuelle Herausforderungen für Arztpraxen und ambulante Einrichtungen vor dem Hintergrund des Klimawandels und aktueller gesellschaftlicher Umbrüche und diskutiert Schritte zur Umsetzung transformativer Maßnahmen.
METHODS: Es erfolgte die Durchführung einer selektiven Literaturrecherche in der Datenbank PubMed zu den Auswirkungen des Klimawandels auf das Gesundheitssystem, Überverordnung, Co-Benefits, Klimamanagement und Krisenresilienz.
UNASSIGNED: Krisenresiliente Arztpraxen zeichnen sich durch ein hohes Maß an Anpassungsfähigkeit und Flexibilität aus. Sie bereiten sich auf die Herausforderungen vor, die durch den Klimawandel entstehen. Die Vermittlung von Co-Benefits kann im Arzt-Patienten-Gespräch zur nachhaltigen Transformation der Gesellschaft beitragen.
CONCLUSIONS: Veränderte Umweltbedingungen erfordern die Anpassung seitens des Gesundheitssystems. Fortbildung und Prävention sind zur Bewältigung dieser Herausforderungen ein wichtiger Schlüssel, die Transformation zur nachhaltigen Praxis ist ein kontinuierlicher Prozess. Hierbei handelt es sich um ein ganzheitliches Konzept, das soziale, ökologische und ökonomische Aspekte umfasst, welche voneinander abhängen und nicht getrennt voneinander betrachtet werden können.

In the last 30 years, pain control in the United States has undergone several evolutions impacting the care of surgical patients. More recently, safe pain control has been a subject of quality improvement efforts by otolaryngologists focusing on minimizing opioid consumption. This article discusses the rising overprescription of opioids, influenced by legislation and governmental agencies, and the steps taken to correct and reform policies to decrease the amount of opioids prescribed. Lastly, specific institutional examples of quality improvement protocols implemented to help decrease opioid consumption and prescription are discussed.

UNASSIGNED: Physicians frequently prescribe allopurinol for uric acid deposition disorders. However, reports have emerged of the inappropriate use and overprescription of allopurinol. We conducted this study to determine the rate of inappropriate prescription of allopurinol in a Saudi institution.
UNASSIGNED: This cross-sectional descriptive study was conducted on all adult patients who had been prescribed allopurinol in Doctor Soliman Fakeeh Hospital Jeddah KSA. Demographic data and laboratory results were retrieved from patients\' electronic health records (EHR). We considered valid indications of allopurinol as significant hyperuricemia (>13 mg/dL in men and >10 mg/dL in women), confirmed gout, hyperuricosuria of more than 1100 mg/day, uric acid stones or recurrent calcium oxalate kidney stones, malignancy, and haemolysis. The possible valid indications were unconfirmed gout and unconfirmed type of kidney stones, whereas no documented indication or insignificant hyperuricemia was considered as an invalid indication.
UNASSIGNED: We included 1978 patients in this study. The cohort was composed of 76.4% men and 23.6% women. The mean ± standard deviation of age of this patient cohort was 53 and 4 months ± 15 years. The mean ± standard deviation of duration since the first prescription was 1.53 ± 2.2 years. Physicians prescribed allopurinol without a valid indication in 1539 patients (77.8%). More than a third of the patients (39%) did not have a documented indication and 38.8% were prescribed allopurinol for insignificant hyperuricemia.
UNASSIGNED: This study revealed a markedly high number of allopurinol prescriptions without a clear indication in our centre. This approach may potentially expose patients to serious side effects of allopurinol without added benefits.
UNASSIGNED: يستخدم الأطباء عقار الوبيورينول في كثير من الأحيان لاضطرابات ترسب حمض اليوريك. ومع ذلك، هناك تقارير عن استخدام غير مناسب ويعتقد أنه قد يوصف بغير حاجة. تهدف هذه الدراسة لتحديد معدل الوصف غير المناسب للألوبيرينول في مركز سعودي واحد.
UNASSIGNED: كانت هذه دراسة وصفية مستعرضة لجميع المرضى البالغين الذين وُصف لهم الوبيورينول في مستشفى الدكتور سليمان فقيه بجدة، بالمملكة العربية السعودية، خلال الفترة من ١/١/٢٠١٦ حتى ١/١/٢٠١٧. تم استرداد البيانات الديموغرافية ونتائج المختبر من الملفات الإلكترونية للمرضى. تم تقييم أسباب الوصفة الطبية من سجلات الحالة الإلكترونية. اعتبرنا الأسباب الصحيحة ما يلي: فرط حمض اليوريك في الدم لأكثر من ١٣مغ/دل عند الرجال وأكثر من ١٠مغ/دل عند النساء، والنقرس المؤكد، وفرط حمض اليوريك في البول لأكثر من ١١٠٠مغ في اليوم، وحصوات حمض اليوريك أو حصوات الكلى المتكررة بسبب أكسالات الكالسيوم، والسرطانات وانحلال الدم. واعتبرنا الأسباب التالية أنها صحيحة للوصف: النقرس غير المؤكد، والأنواع غير المؤكدة من حصوات الكلى. اعتبرنا المؤشرات التالية غير صالحة للوصف: لا يوجد سبب موثق في الملف الإلكتروني، زيادة حمض اليوريك في الدم بنسبة غير ذات أهمية.
UNASSIGNED: شُمل ما مجموعه ١٩٧٨ مريضا في هذه الدراسة: ٧٦.٤٪ كانوا من الذكور و٢٣.٦٪ من الإناث. ومتوسط الانحراف المعياري: العمر ٥٣ سنة و٤ أشهر ± ١٥ سنة. كان متوسط الانحراف المعياري لسنوات مدة الوصفة الأولى ١.٥٣ ± ٢.٢ سنة. تم وصف الوبيورينول دون وجود سبب صحيح ل ١٥٣٩ مريضا (٧٧.٨ ٪). أكثر من ٣٩٪ من جميع الوصفات الطبية لم تكن بوجود سبب موثق في الملف الإلكتروني و٣٨.٨٪ كانت لزيادة حمض يوريك الدم بنسبة غير ذات أهمية.
UNASSIGNED: كانت النسبة لوصف الوبيورينول بدون سبب صحيح في مركزنا مرتفعة بشكل ملحوظ. هذا النهج هو تعريض المرضى لآثار جانبية خطيرة دون فائدة إضافية.

BACKGROUND: The introduction of proton pump inhibitors (PPIs) into clinical practice has greatly improved our therapeutic approach to acid-related diseases for their efficacy and safety. Areas Covered: The following evidence-based indications for PPI use are acknowledged by many scientific societies: treatment of the various forms and complications of gastroesophageal reflux disease, eradication of H. pylori infection in combination with two or more antibiotics, short- and long-term therapy of H. pylori-negative peptic ulcers, healing, and prevention of NSAID/COXIB-associated gastric ulcers, co-therapy with endoscopic procedures to control upper digestive bleeding and medical treatment of Zollinger Ellison syndrome. Expert Commentary: Despite the above well-defined indications, however, the use of PPIs continues to grow every year in both western and eastern countries and the endless expansion of the PPI market has created important problems for many regulatory authorities for two relevant features: the progressive increase of the costs of therapy and the greater potential harms for the patients. The major reasons for the misuse of PPIs are the prevention of gastro-duodenal ulcers in patients without risk factors and the stress ulcer prophylaxis in non-intensive care units, steroid therapy alone, anti-platelet or anti-coagulant treatment in patients without risk of gastric injury and the overtreatment of functional dyspepsia.

OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs.
METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23® statistic software.
RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%.
CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole.
UNASSIGNED: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacológicos más prescritos en atención primaria. El objetivo del trabajo fue conocer la prescripción de IBP en el Área de Atención Primaria de la Comarca Araba de Osakidetza para sensibilizar a los médicos de familia sobre su correcta utilización, así como fomentar la prescripción de los IBP más eficientes.
UNASSIGNED: Estudio descriptivo de la prescripción de IBP de 200 médicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los años 2009-2014. Se analizó el importe del consumo y las Dosis por 1000 habitantes/día (DHD) de IBP, así como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapéutico. El análisis estadístico se realizó mediante el programa IBM SPSS v23®.
UNASSIGNED: La prescripción de IBP se incrementó un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilización muy superior a la de otros países europeos. En el mismo periodo, el porcentaje de prescripción relativa de omeprazol frente al resto de IBP disminuyó un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol pasó del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyó un 17,60%.
UNASSIGNED: Existe un incremento global en el número de prescripciones de IBP, aunque ha disminuido el gasto por la reducción de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripción de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevención de gastropatías aumenta el riesgo de prescripciones inadecuadas. El antiulceroso más recomendado continua siendo el omeprazol.

Background: The use of antibiotics prophylactically and therapeutically in dentistry has become common practice. Inappropriate prescription may lead to adverse side effects and bacterial resistance. During clinical training, dental students in Saudi Arabia are authorized to prescribe antibiotics. Aim: To evaluate dental students’ knowledge and attitudes regarding antibiotic prescription in Riyadh, Saudi Arabia. Methods: A cross-sectional study based on a validated questionnaire consisting of 34 questions focusing on antibiotic indications in dentistry, antibiotic regimens, and knowledge regarding resistance was distributed amongst dental students in five leading dental colleges in Riyadh. Results: A large proportion of students (71.7%) were familiar with the concept of antibiotic resistance. When comparing junior and senior dental students’ knowledge with regards to indications of antibiotic use in commonly encountered conditions, it was found that there was no significant difference in antibiotic prescription frequency between these groups. Most dental students choose to prescribe amoxicillin as their first-choice of antibiotic (88.4%), and most also chose to use it for a duration of 3⁻5 days (69.2%). Conclusions: This study concludes that dental students may prescribe antibiotics inappropriately to manage various conditions when not indicated. This may indicate a defect in education of students with regards to current antibiotic guidelines.

OBJECTIVE: To test the potential association between time spent with a doctor and antibiotic overprescriptions in case of the common cold, runny nose, bronchitis, chest colds, flu, sore throats, and fluid in the middle ear.
METHODS: Cross-sectional study.
METHODS: Office-based physicians in the US.
METHODS: A total of 261,623 patient visits recorded to office-based physicians in the US.
METHODS: The interest outcome was unnecessary antibiotic prescription.
RESULTS: The analysis revealed five significant predictors of antibiotic prescriptions for suspected viral infections: length of doctor-patient encounter time, patient gender, spending time with a family medicine doctor, type of insurance, and the rate of antibiotic prescriptions per physician. For every additional minute a patient spent with a physician during a visit, the mean predicted probability of receiving unnecessary antibiotics decreased by 2.4%.
CONCLUSIONS: This study provided evidence that physicians continue to prescribe antibiotics in avoidable cases. Policies that would monitor antibiotic prescription in office-based settings should be considered in order to control spreading of antibiotic resistance and eventually improve population health.

BACKGROUND: Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available.
OBJECTIVE: The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs.
METHODS: This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined.
RESULTS: The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients\' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in <4% of the consultations without a prescription.
CONCLUSIONS: Awareness of indications and patient groups provoking antibiotic overprescribing can help in the development of targeted strategies to improve GPs\' prescribing routines for RTIs.