Drug-Related Problems in Prescribing for Pediatric Outpatients in Vietnam

BACKGROUND: Our study was conducted to determine the prevalence of drug-related problems (DRPs) in outpatient prescriptions, the impact of DRPs on treatment efficacy, safety, and cost, and the determinants of DRPs in prescribing for pediatric outpatients in Vietnam. METHODS: A retrospective cross-sectional study was conducted on pediatric outpatients at a pediatric hospital in Can Tho, Vietnam. DRPs were classified according to the Pharmaceutical Care Network Europe classification (PCNE) of 2020. The study determined prevalence of DRPs and their impacts on efficacy, safety, and cost. Multivariate regression was used to identify the determinants of DRPs. RESULTS: The study included 4339 patients (mean age 4.3, 55.8% male), with a total of 3994 DRPs, averaging 0.92 DRP/prescription. The proportion of prescriptions with at least one DRP was 65.7%. DRPs included inappropriate drug selection (35.6%), wrong time of dosing relative to meals (35.6%), inappropriate dosage form (9.3%), inappropriate indication (7.1%), and drug-drug interactions (0.3%). The consensus of experts was average when evaluating each aspect of efficiency reduction, safety reduction, and treatment cost increase, with Fleiss' coefficients of 0.558, 0.511, and 0.541, respectively (p < 0.001). Regarding prescriptions, 50.1% were assessed as reducing safety. The figures for increased costs and decreased treatment effectiveness were 29.0% and 23.9%, respectively. Patients who were ≤2 years old were more likely to have DRPs than patients aged 2 to 6 years old (OR = 0.696; 95% CI = 0.599-0.809) and patients aged over 6 years old (OR = 0.801; 95% CI = 0.672-0.955). Patients who had respiratory system disease were more likely to have DRPs than patients suffering from other diseases (OR = 0.715; 95% CI = 0.607-0.843). Patients with comorbidities were less likely to have DRPs than patients with no comorbidities (OR = 1.421; 95% CI = 1.219-1.655). Patients prescribed ≥5 drugs were more likely to have DRPs than patients who took fewer drugs (OR = 3.677; 95% CI = 2.907-4.650). CONCLUSION: The proportion of prescriptions in at least one DRP was quite high. Further studies should evaluate clinical significance and appropriate interventions, such as providing drug information and consulting doctors about DRPs

Pneumonia: Drug-Related Problems and Hospital Readmissions

Pneumonia is one of the most common infectious diseases and the fourth leading cause of death globally. According to US statistics in 2019, pneumonia is the most common cause of sepsis and septic shock. In the US, inpatient pneumonia hospitalizations account for the top 10 highest medical costs, totaling $9.5 billion for 960,000 hospital stays. The emergence of antibiotic resistance in the treatment of infectious diseases, including the treatment of pneumonia, is a globally alarming problem. Antibiotic resistance increases the risk of death and re-hospitalization, prolongs hospital stays, and increases treatment costs, and is one of the greatest threats in modern medicine. Drug-related problems (DRPs) in pneumonia - such as suboptimal antibiotic indications, prolonged treatment duration, and drug interactions - increase the rate of antibiotic resistance and adverse effects, thereby leading to an increased burden in treatment. In a context in which novel and effective antibiotics are scarce, mitigating DRPs in order to reduce antibiotic resistance is currently a prime concern. A variety of interventions proven useful in reducing DRPs are antibiotic stewardship programs, the use of biomarkers, computerized physician order entries and clinical decision support systems, and community-acquired pneumonia scores

WHY ADIPOSITY NEGATIVELY INFLUENCES DYNAMIC BALANCE IN CHILDREN: A ROLE FOR MUSCULO-TENDON STIFFNESS?

BACKGROUND: Potential physiological mechanisms contributing to reduced physical activity in children with obesity or at risk for obesity include poor neuromuscular performance. Children with obesity demonstrate poorer neuromuscular performance, particularly in activities that involve simultaneous body movement and control (dynamic balance) compared to more static object-control tasks. However, the relationship between adiposity and dynamic balance in children is unknown. Emerging evidence in adults suggests that muscle stiffness positively contributes to dynamic balance, but whether this applies to children remains unclear. Understanding these factors can provide insights into the physiological mechanisms influencing a child\u27s level of physical activity. Therefore, the aim of this study was to examine the relationships between body composition, musculo-tendon stiffness, and dynamic balance in children. METHODS: Nine children aged 5 to 16, consisting of 2 males and 7 females, participated in the study. Height and weight were assessed using standard clinical procedures. Body mass index (BMI) percentile was determined using the CDC reference data. Measures of adiposity such as percent total body fat and leg fat (g) were estimated via a total body Dual energy X-ray absorptiometry (DXA) scan. A handheld device (Myoton) was used to assess musculo-tendon stiffness (N/m) in a relaxed state, at the gluteus maximus, vastus lateralis, lateral head of the gastrocnemius, quadriceps tendon, patellar tendon, and Achilles tendon. Dynamic balance was evaluated by the Four-square step test (FSST), which is a multi-directional, timed clinical test of balance, where a greater time taken to complete FSST depicts poor performance. RESULTS: FSST was positively related to percent total body fat (r=0.77, p=0.01), BMI percentile (r=0.78, p=0.01), and leg fat (r=0.75, p=0.02). Stiffness of the quadriceps tendon was negatively related to BMI percentile (r=-0.84, p \u3c 0.01) and leg fat (r=-0.72, p=0.03) while showing a negative trend with percent total body fat (r=-0.61, p=0.08). Additionally, the FSST was negatively related to the quadriceps tendon stiffness (r=-0.84, p=0.005) only. CONCLUSIONS: We provide preliminary evidence that adiposity is negatively related to dynamic balance and musculo-tendon stiffness in children. Specifically, our results suggest that poor dynamic balance in children may be partially explained by the negative relationship between adiposity and stiffness of the quadriceps tendon

Improving Efficacy of Endoscopic Diagnosis of Early Gastric Cancer: Gaps to Overcome from the Real-World Practice in Vietnam

Objective. To identify factors associated with increased proportion of early gastric cancer to total detected gastric cancer among patients undergoing diagnostic esophagogastroduodenoscopy. Methods. A nationwide survey was conducted across 6 central-type and 6 municipal-type Vietnamese hospitals. A questionnaire regarding annual esophagogastroduodenoscopy volume, esophagogastroduodenoscopy preparation, the use of image-enhanced endoscopy, and number of gastric cancer diagnosed in 2018 was sent to each hospital. Results. The total proportion of early gastric cancer was 4.0% (115/2857). Routine preparation with simethicone and the use of image-enhanced endoscopy were associated with higher proportion of early gastric cancer (OR 1.9, 95% CI: 1.1–3.2, p=0.016; OR 2.7, 95% CI: 1.8–4.0, p60.000–100.000 (OR 2.7, 95% CI: 1.7–4.2, p<0.001). Only four (33.3%) hospitals reported all endoscopic types of early gastric cancer. Conclusions. The detection of early gastric cancer is still challenging even for endoscopists working in regions with relatively high prevalence. The real-world evidence showed that endoscopic detection of early gastric cancer could potentially improve with simple adjustments of esophagogastroduodenoscopy protocols