Retrospective Analysis of Adult Patients Presenting to the Acute Care Setting Requesting Prescriptions

Introduction: Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value.  Methods: This was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-sized Canadian city between April 1, 2014–June 30, 2017. Recorded outcomes included patient demographic data and access to a family doctor, medication requested, whether or not a prescription was given, and ED length of stay. Medication street value was determined using a local police service listing.  Results: A total of 2,265 prescriptions were requested by 1,495 patients. The patient median [interquartile range] age was 43 [32-54] years. A family doctor was documented by 55.4% (939/1,694) of patients. The two most commonly requested categories of medications were opioid analgesics 21.2% (481/2,265) and benzodiazepine anxiolytics 11.7% (266/2,265). Of patients requesting medication, 50.5% (755/1,495) requested medications without street value including some with potential to cause serious adverse health effects if discontinued. The requested prescription was received by 19.9% (298/1,495) of patients; 15.3% (173/1,134) returned for further prescription requests. The 90th percentile length of stay was 3.2 and 5.6 hours at the UCC and ED, respectively.Conclusion: Patients who presented to the ED or UCC sought medications with and without street value in almost equal measure. A more robust understanding of these patients and their requests illustrates why a ‘one-size-fits-all’ response to these requests is inappropriate and signals some fault lines within our local healthcare system

Clinical and Diffusion Tensor MRI Findings in Congenital Homonymous Hemianopia

A 29-year-old woman underwent brain MRI for increasing frequency of migraine headaches. The MRI report recommended further evaluation for septo-optic dysplasia. The patient reported no visual deficits. Her examination showed normal visual acuities, color vision, pupillary function, and a normal optic disc in the right eye with mild temporal disc pallor in the left eye. Automated perimetry revealed an incongruous left homonymous hemianopia (Fig. 1). Optical coherence tomography (OCT) showed thinning of the retinal nerve fiber layer to 60 µm in the right eye and 54 µm in the left eye. There was ganglion cell layer thinning in a hemianopic pattern with temporal thinning in the right eye and nasal thinning in the left eye. This corresponded with the left homonymous hemianopia

A model to integrate patient preferences into delivery systems: the importance of end-user input into pulmonary delivery

Asthma is a public health problem estimated to affect approximately 334 million people worldwide. A significant amount of those affected with asthma are children. Asthma is a chronic disease that is characterized by inflammation and constriction of the airways, leading to breathing difficulties. It is estimated that in the USA alone, the direct cost for asthma in both adults and children was more than $56 billion annually in 2007 and is responsible for reduced quality of life. Asthma cannot be cured, but it can be controlled by medication. The most common and efficacious medications to treat asthma are delivered in aerosol form via nebulizer inhaler devices, which include pressurized metered-dose inhalers and dry-powder inhalers (DPIs). Unlike many oral dosage forms, inhaler compliance is composed of two independent components, temporal adherence and inhaler technique, of which much research has focused on temporal adherence due to limited methods available to monitor longitudinally. For this reason, the aim of this editorial is to describe problems with inhaler technique from published literature as well as propose a new method of integrating patients into the therapeutic delivery research process to reduce patient error, which may improve asthma outcomes