Pharmacotherapeutic audit meetings as a tool of improving prescribing practices

Background: Pharmacotherapeutic audit meeting (PTAM) is a good tool to review prescriptions for rationality and suggest measures for improving quality of prescriptions. To promote this, World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) provided drug prescribing and drug use indicators. To assess the impact of PTAMs as an intervention for improving quality and rationality of prescriptions.Methods: This was a single centre, prospective study conducted from December 2018-February 2020. Prescriptions from outpatient surgical departments were collected, screened using WHO/INRUD core indicators and discussed in PTAMs. The same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and Student’s t-test was used for statistical analysis.Results: The difference in proportions for antibiotic prescribing was 8.7% [95% CI (1.0%-16.7%), p=0.02]; injectable preparation use was 0.7% [95% CI (-0.4%-2.3%) p=0.23]; prescriptions with generic name drugs was 10.9% [95% CI (5.6-16.2%) p<0.0001] and prescriptions from Essential drug list (EDL) was 8.1% [95% CI (2.5%-13.5%) p=0.0046].Conclusions: Our research showed PTAM could be an effective tool to implement WHO/INRUD drug prescribing indicators robustly. Hence, it could be included in WHO/INRUD policies as an intricate part of institutional healthcare delivery system

On the Relation between a Nonlinear Elliptic Equation and Its Uniform Approximation

AbstractThe qualitative behavior of the solution set of nonlinear elliptic boundary value problems has in some instances been studied by reducing the partial differential equation to a related algebraic equation. Although this procedure often gives a good picture of the bifurcation diagram, it can be quite wrong. In this paper some relationships between the solutions of the two problems are investigated

Plasma cytokines do not reflect expression of pro- and anti-inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs

Background: Plasma concentrations of inflammatory markers are increased in response to the trauma of cardiac surgery and cardiopulmonary bypass (CPB). It is, however, unknown whether the plasma cytokine levels and cytokine mRNA expression at organ level reflect each other. Methods: Twenty-six piglets (17–19 days) were allocated to the sham-group (sternotomy only, n = 13) or to the CPB-group (sternotomy, 120 min CPB procedure with 60-min aortic cross-clamp, n = 13). The pigs were observed for 0.5 h or 4 h post-CPB. Plasma levels of IL-1β, IL-6, IL-8 and IL-10 and mRNA expression of TNF-α, IL-1β, IL-6, IL-8, IL-10 and iNOS in organs were registered with concomitant changes in oxygenation index (OI) and expiratory nitric oxide (NO). Results: In pigs killed 0.5 h post-CPB there was a significant increase in IL-10 mRNA in the lungs and kidneys compared with the sham-group. IL-1β mRNA was detectable in the kidneys and lungs of the CPB-pigs, while IL-6 mRNA was up regulated only in lungs. In pigs killed 4 h post-CPB a significantly higher IL-6 mRNA was found in heart tissue and a lower IL-10 mRNA was found in lungs of CPB pigs compared with the sham-group. There was a concomitant significant increase in OI and increased plasma IL-8 and IL-10 concentrations in the CPB-pigs compared with the sham-pigs. Conclusion: The cytokine mRNA expression pattern was very different for the pigs killed already 0.5 h after the CPB procedure compared with the pigs killed 4 h post-CPB. The plasma cytokine levels poorly reflected mRNA expression of the pro- and anti-inflammatory cytokines