Writing an appropriate prescription is one of the main competencies of medical doctors. Studies reveal that medication error is still a significant issue in health service, and many efforts have been done to minimise this through trainings. Integrative pharmacotherapy is a module delivered for medical students in clinical clerkship, which is adopted and developed from the World Health Organization Guide to Good Prescribing. The aim of the study was to examine the effect of the module on pre-test and post-test scores which consists of 17 clinical cases. The study was done in the Faculty of Medicine, Universitas Kristen Indonesia, East Jakarta from July to November 2018. Eighty one subjects were randomly selected from the data of 100 students who were screened from 200 students based on the exclusion criteria. There was an increase of post-test score which was statistically significant compared to pre-test score, from 42.07±12.45 to 58.47±8.54 (p=0.000, CI -19.36;-13.45). There were 69 (>85%) students having grade D and E in pre-test, but the number decreased to 18 (22,2%) out of 81 subjects in post-test. Both grade C and B students increased from 13.5% to 70.4% and 1% to 7%, respectively. Most of the students were first entries into clinical clerkship, thus, their pre-test scores were very low since they had not had the clinical experience yet. However, at the end of the clerkship, there was a significant increase on their knowledge on pharmacotherapy and prescription for particular diseases. An outcome study to measure the retention and to examine their success on the final competency examination should be done.Keywords: Medical education, OSCE, pharmacotherapy, prescribingPembelajaran Farmakoterapi Integratif dengan Objective Structured Pharmacotherapy ExaminationAbstrakMenulis resep yang benar merupakan salah satu kompetensi dokter. Penelitian menunjukkan kesalahan medikasi masih menjadi masalah besar di pelayanan kesehatan dan banyak upaya sudah dilakukan untuk mengurangi hal tersebut melalui pelatihan. Farmakoterapi integratif adalah sebuah modul yang diberikan kepada mahasiswa kedokteran saat kepaniteraan klinis. Modul ini merupakan hasil adopsi dan dikembangkan dari World Health Organization Guide to Good Prescribing. Tujuan studi ini adalah untuk melihat efek nilai pra-uji dan pasca-uji dengan 17 kasus klinis. Studi dilaksanakan di Fakultas Kedokteran Universitas Kristen Indonesia, Jakarta Timur pada Juli-November 2018. Delapan puluh satu subjek secara acak dipilih dari data 200 mahasiswa berdasarkan kriteria eksklusi. Terdapat peningkatan nilai pasca-uji yang signifikan dibandingkan nilai pra-uji dari 42,07±12,45 ke 58,47±8,54 (p=0,000; CI -19,36; -13,45). Terdapat 69 (>85%) mahasiswa yang memiliki nilai D dan E pada pra-uji, namun angka tersebut turun pada pasca-uji menjadi 18 orang (22,2%) dari jumlah total 81 mahasiswa. Mahasiswa dengan nilai C meningkat dari 13,5% menjadi 70,4%, dan mahasiswa dengan nilai B dari 1% menjadi 7%. Mayoritas mahasiswa pada penelitian ini baru pertama kali mengikuti kepaniteraan klinik sehingga nilai pra-uji yang diperoleh sangat rendah karena belum memiliki pengalaman klinis. Namun, di akhir kepaniteraan, terdapat peningkatan pengetahuan dan penulisan resep terhadap beberapa jenis penyakit yang signifikan. Perlu dilakukan studi jangka panjang untuk mengukur retensi dan keberhasilan mereka di ujian akhir kompetensi.Kata kunci: Farmakoterapi, OSCE, pendidikan kedokteran, penulisan resep

We investigate paper microfluidic devices for detection of pathogenic bacteria and their sensitivity towards β-lactamase and Extended Spectrum Beta Lactamases (ESBLs) in milk samples to enable appropriate prescription of antibiotics for mastitis.

Prescribing medications involves complex cognitive processes, and mistakes in prescription can cause serious adverse events. Deprescribing is one of the last opportunities to prevent patient harm from the use of drugs that should be avoided, especially among older patients. This viewpoint article aims to discuss the prescription process and some essential concepts, such as polypharmacy, prescription of potentially inappropriate medications, and, particularly, the relevance of deprescribing and its relationship with the appropriate prescription of medications in older people.

Abstract Background The emergency department (ED) is one of the most important settings where antimicrobials are frequently prescribed in developed countries, and at least 30% of antimicrobials prescribed at the ED are inappropriate. Some studies revealed that various factors, especially the physician-related factors were associated with inappropriate antimicrobial use. Implementing effective strategies to modify prescribing practice is needed to optimize antimicrobial therapy at the ED. Methods We implemented a multifaceted intervention to patients discharged with oral antimicrobial agents in the ED at a Japanese tertiary care center from October 2018 to March 2019. The intervention included (1) an educational didactic session to physicians, (2) an evidence-based tool book regarding antimicrobial use for common diagnoses, (3) antimicrobial order sets for common diagnoses, (4) monthly reports of the appropriateness of antimicrobial use, and (5) post-prescription review and feedback by an infectious diseases physician. The proportion of appropriate discharge antimicrobial prescription at ED, and changes in the prescription density, measured as the number of prescription per 1,000 patient visits between pre- and post-intervention were evaluated. Results The total number of patient visits at the ED during the study period was 52,274. With the intervention, the mean monthly discharge antimicrobial prescription decreased from 42.7 to 34.2 per 1,000 visits (proportional reduction 0.20; P < 0.01). Overall, appropriate prescription rate significantly increased from 47.7% (742/1,555) to 77.4% (421/544) (P < 0.01). The rate of unnecessary and inappropriate discharge antimicrobial prescription accounted from 27.5% (428/1,555) and 21.7% (337/1,555) to 8.5% (46/544) and 10.7% (58/544), respectively. A substantial improvement in discharge antimicrobial prescription against intra-abdominal infections and odontogenic infections during the intervention period was observed (changes in the proportion of appropriate prescription was 0.37 [P < 0.01] and 0.51 [P < 0.01], respectively. Conclusion An evidence-based, multifaceted intervention led to decreasing unnecessary prescription and optimizing physicians’ antimicrobial prescriptions at the ED. Disclosures All authors: No reported disclosures.

Objective Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention. Methods Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention. Results Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription. Conclusion Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

Objective: This study aimed to investigate the factors affecting the sale of non-prescribed antibiotics in Jakarta, Indonesia.Methods: A cross-sectional, observational study was conducted across 190 randomly selected pharmacies in five administrative districts of Jakarta,Indonesia. Data regarding pharmacies were obtained from the Facility of Pharmaceutical Services Ministry of Health Data, in 2014, which includes allpharmacies in Jakarta. Further data were obtained using structured questionnaires.Results: Among the 190 respondents, 15 pharmacies (9.7%) never provided antibiotics without prescription, whereas 44 (23.6%), 60 (31.6%), and71 pharmacies (36.3%) provided antibiotic services without prescription rarely, sometimes, and always, respectively. Factors considerably associatedwith the increased sale of antibiotics without a prescription included the attitude and age of pharmacists, the type of pharmacy (independent or chainstore), and the presence of pharmacist assistants. Attitude was the most common variable related to providing antibiotics without a prescription.Conclusion: Antibiotics are frequently dispensed by community pharmacies in Jakarta without an appropriate prescription. These findings supportthe need for strict enforcement of pharmacy laws through improved inspections, and they highlight the need for evidence-based guidelines andeducational interventions to improve practices regarding antibiotic provision.

  Background and Purpose: To the best of our knowledge, no information is available regarding the treatment of vulvovaginal candidiasis in gynecological practices. The goal of this study was to analyze the prevalence of vulvovaginal candidiasis (VVC) and the drugs prescribed for the treatment of this condition in women followed in gynecological practices in Germany. Materials and Methods: All the women followed in 262 gynecological practices between November 2014 and October 2016 were included in this study. The first outcome was the prevalence of patients diagnosed with VVC during this period. The second outcome was the prevalence of women with VVC who received an appropriate vaginal or systemic antimycotic prescription within 30 days after their first VVC diagnosis. Covariables included the use of gynecological/systemic antibiotics, consumption of oral/vaginal contraceptives, cancer, pregnancy, diabetes, and psychiatric diseases including depression, anxiety, and adjustment and somatoform disorders. Results: Between 2014 and 2016, 954,186 women were followed in gynecological practices, and 50,279 (5.3%) women were diagnosed with VVC during the same period. The use of gynecological antibiotics (OR=2.88), systemic antibiotics (OR=1.45), oral contraceptives (OR=1.74), and vaginal contraceptives (OR=1.84) were associated with an increase in the risk of VVC diagnosis. Cancer (OR=1.20) and pregnancy (OR=1.59) were additional risk factors. Approximately 75% of women diagnosed with VVC received an antimycotic prescription. The three most frequently prescribed drugs were clotrimazole (72%), fluconazole (14%), and nystatin (6%). Conclusion: More than 5% of women were diagnosed with VVC and the majority of them received an appropriate prescription.

  Background and Purpose: To the best of our knowledge, no information is available regarding the treatment of vulvovaginal candidiasis in gynecological practices. The goal of this study was to analyze the prevalence of vulvovaginal candidiasis (VVC) and the drugs prescribed for the treatment of this condition in women followed in gynecological practices in Germany. Materials and Methods: All the women followed in 262 gynecological practices between November 2014 and October 2016 were included in this study. The first outcome was the prevalence of patients diagnosed with VVC during this period. The second outcome was the prevalence of women with VVC who received an appropriate vaginal or systemic antimycotic prescription within 30 days after their first VVC diagnosis. Covariables included the use of gynecological/systemic antibiotics, consumption of oral/vaginal contraceptives, cancer, pregnancy, diabetes, and psychiatric diseases including depression, anxiety, and adjustment and somatoform disorders. Results: Between 2014 and 2016, 954,186 women were followed in gynecological practices, and 50,279 (5.3%) women were diagnosed with VVC during the same period. The use of gynecological antibiotics (OR=2.88), systemic antibiotics (OR=1.45), oral contraceptives (OR=1.74), and vaginal contraceptives (OR=1.84) were associated with an increase in the risk of VVC diagnosis. Cancer (OR=1.20) and pregnancy (OR=1.59) were additional risk factors. Approximately 75% of women diagnosed with VVC received an antimycotic prescription. The three most frequently prescribed drugs were clotrimazole (72%), fluconazole (14%), and nystatin (6%). Conclusion: More than 5% of women were diagnosed with VVC and the majority of them received an appropriate prescription.