A new analysis of antibiotics doled out during US ambulatory care visits in 2015 indicates that more than 40% were inappropriate, and nearly 1 in 5 prescriptions had no documented reason for being written.In a study published yesterday in the British Medical Journal (BMJ), researchers looking at survey data on more than 28,000 sample visits to office-based healthcare providers in 2015—a sampling that represents 990.9 million visits nationwide—found that antibiotics were prescribed in 13.2% of visits. Of the 130.5 million antibiotic prescriptions given out during these visits, only 57% were for a bacterial infection or other condition for which antibiotics are commonly, and appropriately, prescribed.Twenty-five percent of the antibiotic prescriptions analyzed were deemed inappropriate because they were written for conditions, like upper respiratory infection, for which antibiotics aren’t indicated but are commonly prescribed. But 18%—representing roughly 24 million prescriptions—lacked either an appropriate or inappropriate indication.”When there’s no indication documented, it’s reasonable to think that at least some of the time, the prescription was written without an appropriate indication present,” lead study author Michael J. Ray, MPH, a researcher at Oregon State University’s College of Pharmacy, said in a university press release.The problem of undercodingTo determine whether the prescriptions were appropriate or inappropriate, Ray and his colleagues looked at the ICD-9-CM codes associated with each visit in which an antibiotic was prescribed. Only five of these codes, which are used by physicians to classify a diagnosis in a patient’s medical record for billing purposes, were included in the data from the 2015 National Ambulatory Medical Care Survey (NAMCS), a survey describing a sample of patients’ visits.The researchers note that even if more ICD-9-CM codes had been available to analyze, at best, 15% of the visits would have still lacked a documented indication for an antibiotic.The most common diagnoses reported among the “no indication” group were unspecified essential hypertension (11%), diabetes mellitus without mention of complication (8%), and other specified aftercare (7%).In analyzing additional patient data from the NAMCS records, the researchers determined that adult men (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.02 to 5.3), patients who spent more than 17 minutes with providers (aOR, 1.6; 95% CI, 1.1 to 2.5), and patients who saw non-primary care specialists (aOR, 2.1; 95% CI, 1.2 to 3.7) were more likely to receive an antibiotic without an indication.The analysis also found that sulfanomides (aOR, 4.9; 95% CI, 1.5 to 15.7) and urinary anti-infectives (aOR, 3.1; 95% CI, 1.3 to 7.6) were the antibiotics most likely to be prescribed without an indication.The study adds to a well-established body of research illustrating the problem of inappropriate outpatient antibiotic prescribing in the United States. The most widely cited study is a 2016 paper in JAMA that found that 30% of oral antibiotics prescribed for outpatients were inappropriate. Subsequent studies have indicated the proportion of outpatient prescriptions considered inappropriate may be even higher. But as Ray and his co-authors note, the previous estimates have typically relied on documented diagnosis codes to classify the prescriptions as appropriate or inappropriate. As a result, they believe those studies may underestimate the problem.”The primary objective of this study was to highlight the potential degree of misclassification that may occur due to under-coding,” they write. “Our work complements previous work in this area by assessing the potential effect that prescribing without a documented indication may have on the estimated burden of unnecessary antibiotic use.”They add that the identification of risk factors associated with antibiotic prescribing without a documented indication may be useful for antibiotic stewardship efforts.See also:Dec 11 BMJ studyDec 11 Oregon State University press release
Robert MyrickRobert “Bob” Myrick, 75, of Oxford, died Thursday, March 19, 2020, at Ascension Via Christi St. Francis with his family by his side.Funeral Services will be at 10:30 a.m., Monday, March 23, 2020, at Oxford Christian Church. Burial will be at the Oxford Cemetery. Visitation will be Sunday, March 22, 2020, from 12 until 6 p.m. with the family receiving friends from 3 until 5 p.m. at Oxford Funeral Service. Memorials have been established with Oxford Christian Church and the Kansas Honor Flight. Contributions can be left with the Oxford Funeral Home, P.O. Box 123, Oxford, KS 67119. To leave an online condolence please visit www.oxfordfuneralservice.com.Bob was born June 6, 1944, the son of Orval and Mildred (Foth) Myrick in Neenah, Wisconsin. He graduated from Oxford High School in 1962 and joined the United States Air Force, serving for 20 years and a day as an aircraft and auto mechanic. On July 18, 1968 Bob was united in marriage to Uthai Boonpok in Korat, Thailand. Bob later worked on the farm for Wes Totten and drove a school bus for 10 years. Bob enjoyed fishing and traveling. He especially liked Thailand.Bob is survived by his loving wife, Uthai of the home; daughters: Sherry Myrick of Oxford and Jennifer Seibert (Perry) of Wichita, KS; one granddaughter, Crystal Seibert and sister, Sandra Sawyer (David) of Oxford.He is preceded in death by his parents and a brother, Donald Myrick.
MOST READ PM Boris Johnson visits Belfast as Brexit woes hurt UK economy PBA: Rain or Shine overcomes San Miguel, McCullough’s 51 to avert sweep What’s new in town: Eggplant parmigiana deep-dish pizza, tofu ‘kakigori,’ ‘kamias’-date sticky toffee pudding An adobo upgrade: Add rosemary She said the city will coordinate with the social welfare office and barangay captains to bring them to enjoy the fair.“They are the ones who need this the most,” Arce said. A nightly variety show will feature talents from different barangays can be enjoyed for free.Ten stalls will sell varied wares like the downtown night market in Colon Street and 30 food stalls. In a separate interview, Varquez said he was absent because city administrator Jose Marie Poblete told him there was no more need for his presence since Noel already withdrew the complaint against him. /with CORRESPONDENT Jose Santino S. BunachitaRead Next PCSO to focus on improving transparency of gaming activities PLAY LIST 03:26PCSO to focus on improving transparency of gaming activities01:39Sotto open to discuss, listen to pros and cons of divorce bill06:02Senate to probe Tolentino’s ‘novel legal theories’ on oral agreements01:50Palace open to make Dengvaxia usable again as dengue cases spike01:49House seeks probe on ‘massive corruption’ in PCSO01:37PCSO estimates P250M in Lotto revenue loss due to suspension Senate to probe Tolentino’s ‘novel legal theories’ on oral agreements And this is the only place firecrackers can be legally sold.But the amusement park, which opens at 6 p.m. till midnight, has unresolved issues of how revenues are collected by city managers and transparency in the collection.FEATURED STORIESNEWSINFOSenate to probe Tolentino’s ‘novel legal theories’ on oral agreementsNEWSINFOLocsin wants to drop ‘visas upon arrival’ privilegeNEWSINFOPalace open to make Dengvaxia usable again as dengue cases spikeOne trader who complained about paying P200,000 as a “registration fee” in last year’s fair suddenly withdrew his complaint of extortion against SRP manager Roberto “Bu” Varquez.Leonardo Noel Jr., in a letter to the City Council this week, said the money was already returned to his employer, a carnival operator, “since it is not a requirement for the Kasadya sa SRP”. Carpio gets nominated as CJ for 4th time For the holiday season, the Cebu city government opens today its third annual “Kasadya sa SRP”, a fair ground with carnival rides, a bazaar, food stalls and a nightly variety show at the south reclamation area.Entrance is free. Visitors only pay for rides and vended food.ADVERTISEMENT LATEST STORIES “We have to ask for an explanation. In the letter complaint, it is very clear that Noel is accusing Bu Varquez of extortion and now he is changing his mind?” said Councilor Eugenio Gabuya Jr.At 4 p.m. today, a Mass and program will kick off the annual fair which runs from Dec. 6 to Feb. 24 next year.The amusement park will continue through the Sinulog festival in January.The carnival rides and festive atmosphere attract students, families and other revelers to the SRP, where free bus rides are offered to and from the site.After supertyphoon “Yolanda” and the earthquake last October, the ‘Kasadya sa SRP’ offers the public a chance to feel the Christmas spirit in a “family-friendly” setting, said city market administrator Raquel Arce in a press conference yesterday.“This is one of the ways for us to move on, forget our troubles and divert our attention from the tragedies that happened. This is for all of us to feel the spirit of Christmas,” she said.She said this dovetails with the city’s program “Carbon Pasko Na” where 9-day dawn masses are held in the middle of Carbon market, which Mayor Michael Rama attends every year.Under a city ordinance, the SRP is the only site designated for the legitimate sale of firecrackers and pyrotechnics. Stalls will be set up from December 15 to 31, the fourth year the city government is managing it.“This is were we put the legitimate firecracker vendors. Our Task Force Pabuto will be going after those who sell anywhere else in the city and confiscate illegal firecrackers,” said Arce.Souvenirs and dry goods will be sold at affordable prices for Christmas shoppers she said. Don’t miss out on the latest news and information. “If you are looking for cheap buys, the ‘Kasadya sa SRP’ is the place to go,” said Arce.She said the city government earns from daily market fees or “arkabala” paid by vendors and special permits issued by the treasurer’s office.Firecrackers vendors are also required to secure permit from the police.Food vendors pay P25 a day while dry goods and firecrackers vendors pay P20.No stall rentals are charged, she said.Instead vendors pay seed money of P6,000 to P9,000 to their association to take care of nightly operation expenses.This includes the cost of electricity, meals of entertainers, local talents from the different barangays, and fielding three city Kaohsiung buses to ferry people for free from three access points to the Sugbu building grounds in SRP: Senior Citizen’s Park behind City Hall, the Mambaling access road of the SRP and in Laray, Talisay.Asked if activities of vendors and carnival ride operators are covered by a contract, Arce said no contract was needed since the ‘Kasadya sa SRP’ was operated as a “private-public partnership.”“We started with firecracker vending because of the passage of an ordinance designating the SRP as the vending site. Vendors later thought of adding more activities in the area to attract people to come,” she said.Asked if a day will be set aside to treat typhoon Yolanda evacuees who are housed in Cebu City, Arce said that was a “good idea” they would definitely adopt. View comments Noel and Varquez were both invited to an executive session of the council last Wednesday to shed light on the complaint, but both didn’t show up.MORE STORIESnewsinfoBaguio folk urged to use kitchen waste to grow foodnewsinfoSerbia’s ultra-expensive donkey cheesenewsinfoMillions of pigs culled as swine fever spreads through AsiaMORE STORIESnewsinfoBaguio folk urged to use kitchen waste to grow foodnewsinfoSerbia’s ultra-expensive donkey cheesenewsinfoMillions of pigs culled as swine fever spreads through AsiaNoel said he was “busy” attending to paperwork to join this year’s SRP carnival while Varquez said his attendance was no longer needed since the complaint was withdrawn.Not satisfied with the brushoff, the City Council set another executive meeting next week to invite the two parties.“Where did the money go? Why was it returned after one year?” said Councilor James Cuenco after the letter was read aloud.Councilor Margot Osmeña is asking who signed the contracts with operators and vendors since none have passed through the council.ADVERTISEMENT SRP manager Varquez to speak up next week Pagasa: Rain expected as LPA enters PAR SMC bags Bulacan airport project