| 1. |
- Amundstuen Reppe, Linda, et al.
(författare)
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Quality assessment of structure and language elements of written responses given by seven Scandinavian drug information centres
- 2017
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Ingår i: European Journal of Clinical Pharmacology. - : SPRINGER HEIDELBERG. - 0031-6970 .- 1432-1041. ; 73:5, s. 623-631
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify structure and language elements affecting the quality of responses from Scandinavian drug information centres (DICs). Six different fictitious drug-related queries were sent to each of seven Scandinavian DICs. The centres were blinded for which queries were part of the study. The responses were assessed qualitatively by six clinical pharmacologists (internal experts) and six general practitioners (GPs, external experts). In addition, linguistic aspects of the responses were evaluated by a plain language expert. The quality of responses was generally judged as satisfactory to good. Presenting specific advice and conclusions were considered to improve the quality of the responses. However, small nuances in language formulations could affect the individual judgments of the experts, e.g. on whether or not advice was given. Some experts preferred the use of primary sources to the use of secondary and tertiary sources. Both internal and external experts criticised the use of abbreviations, professional terminology and study findings that was left unexplained. The plain language expert emphasised the importance of defining and explaining pharmacological terms to ensure that enquirers understand the response as intended. In addition, more use of active voice and less compressed text structure would be desirable. This evaluation of responses to DIC queries may give some indications on how to improve written responses on drug-related queries with respect to language and text structure. Giving specific advice and precise conclusions and avoiding too compressed language and non-standard abbreviations may aid to reach this goal.
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| 2. |
- Amundstuen Reppe, Linda, et al.
(författare)
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Relationship Between Time Consumption and Quality of Responses to Drug-related Queries: A Study From Seven Drug Information Centers in Scandinavia
- 2016
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Ingår i: Clinical Therapeutics. - : ELSEVIER. - 0149-2918 .- 1879-114X. ; 38:7, s. 1738-1749
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aims of this study were to assess the quality of responses produced by drug information centers (DICs) in Scandinavia, and to study the association between time consumption processing queries and the quality of the responses. Methods: We posed six identical drug-related queries to seven DICs in Scandinavia, and the time consumption required for processing them was estimated. Clinical pharmacologists (internal experts) and general practitioners (external experts) reviewed responses individually. We used mixed model linear regression analyses to study the associations between time consumption on one hand and the summarized quality scores and the overall impression of the responses on the other hand. Findings: Both expert groups generally assessed the quality of the responses as "satisfactory" to "good." A few responses were criticized for being poorly synthesized and less relevant, of which none were quality-assured using co-signatures. For external experts, an increase in time consumption was statistically significantly associated with a decrease in common quality score (change in score, -0.20 per hour of work; 95% CI, -0.33 to -0.06; P = 0.004), and overall impression (change in score, -0.05 per hour of work; 95% CI, -0.08 to -0.01; P = 0.005). No such associations were found for the internal experts assessment. Implications: To our knowledge, this is the first study of the association between time consumption and quality of responses to drug-related queries in DICs. The quality of responses were in general good, but time consumption and quality were only weakly associated in this setting. (C) 2016 The Authors. Published by Elsevier HS Journals, Inc.
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| 3. |
- Andersson, Marine L., et al.
(författare)
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Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX
- 2015
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Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 84:5, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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| 4. |
- Andersson, Marine L, et al.
(författare)
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High Prevalence of Drug-Drug Interactions in Primary Health Care is Caused by Prescriptions from other Healthcare Units.
- 2018
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Ingår i: Basic & Clinical Pharmacology & Toxicology. - : Wiley. - 1742-7835 .- 1742-7843. ; 122:5, s. 512-516
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Tidskriftsartikel (refereegranskat)abstract
- Drug-drug interactions are increasingly common, as patients are getting older and the number of drugs per patient is increasing. In this study, we investigated to which extent potential drug-drug interactions originated from single or multiple prescribers. All patients attending any of 20 primary healthcare centres were included in a retrospective observational cohort study. Data on all prescriptions to these patients, irrespectively of the prescriber, were collected for two 4-month periods. Potential drug interactions were identified using the drug-drug interaction database SFINX. Interactions were classified with respect to the workplace of the prescriber, and the prevalence of interactions according to origin was analysed. We found that the drug interactions were significantly more common when the drugs were prescribed from different healthcare centres, compared with drugs prescribed from the patients' primary healthcare centre only. One explanation for this increased risk of drug interactions could be that the prescribers at different primary healthcare centres do not share the same information concerning the total medication list of the patient.
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| 5. |
- Brinkman, D. J., et al.
(författare)
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Essential Competencies in Prescribing: A First European Cross-Sectional Study Among 895 Final-Year Medical Students
- 2017
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Ingår i: Clinical Pharmacology and Therapeutics. - : WILEY-BLACKWELL. - 0009-9236 .- 1532-6535. ; 101:2, s. 281-289
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Tidskriftsartikel (refereegranskat)abstract
- European medical students should have acquired adequate prescribing competencies before graduation, but it is not known whether this is the case. In this international multicenter study, we evaluated the essential knowledge, skills, and attitudes in clinical pharmacology and therapeutics (CPT) of final-year medical students across Europe. In a cross-sectional design, 26 medical schools from 17 European countries were asked to administer a standardized assessment and questionnaire to 50 final-year students. Although there were differences between schools, our results show an overall lack of essential prescribing competencies among final-year students in Europe. Students had a poor knowledge of drug interactions and contraindications, and chose inappropriate therapies for common diseases or made prescribing errors. Our results suggest that undergraduate teaching in CPT is inadequate in many European schools, leading to incompetent prescribers and potentially unsafe patient care. A European core curriculum with clear learning outcomes and assessments should be urgently developed.
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| 6. |
- Böttiger, Ylva, et al.
(författare)
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Development and pilot testing of PHARAO-a decision support system for pharmacological risk assessment in the elderly
- 2018
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Ingår i: European Journal of Clinical Pharmacology. - : SPRINGER HEIDELBERG. - 0031-6970 .- 1432-1041. ; 74:3, s. 365-371
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study are to describe the development of PHARAO (Pharmacological Risk Assessment Online), a decision support system providing a risk profile for adverse events, associated with combined effects of multiple medicines, and to present data from a pilot study, testing the use, functionality, and acceptance of the PHARAO system in a clinical setting. About 1400 substances were scored in relation to their risk to cause any of nine common and/or serious adverse effects. Algorithms for each adverse effect score were developed to create individual risk profiles from the patients list of medication. The system was tested and integrated to the electronic medical record, during a 4-month period in two geriatric wards and three primary healthcare centers, and a questionnaire was answered by the users before and after the test period. A total of 732 substances were tagged with one or more of the nine risks, most commonly with the risk of sedation or seizures. During the pilot, the system was used 933 times in 871 patients. The most common signals generated by PHARAO in these patients were related to the risks of constipation, sedation, and bleeding. A majority of responders considered PHARAO easy to use and that it gives useful support in performing medication reviews. The PHARAO decision support system, designed as a complement to a database on drug-drug interactions used nationally, worked as intended and was appreciated by the users during a 4-month test period. Integration aspects need to be improved to minimize unnecessary signaling.
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| 7. |
- Böttiger, Ylva, 1965-
(författare)
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Förskrivningsrätt bör kopplas till nationell läkemedelsexamen [The license to prescribe should be linked to a national examination]
- 2020
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Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- The prescription of medicines is one of the most common acts performed by physicians. Yet, several studies have shown that junior doctors are not well prepared for the task. The teaching of basic and clinical pharmacology varies greatly between universities, both within Sweden and in Europe. National prescribing exams have been introduced in the UK, the Netherlands and Belgium, and there is an on-going project to develop a European exam, focusing on a list of essential medicines and patient safety. With the new six year curriculum for medical education in Sweden, the license to prescribe could be linked to a national prescribing exam, to ensure good knowledge of both therapeutics and Swedish drug regulation.
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| 8. |
- Böttiger, Ylva
(författare)
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Metabolic drug interactions in man : methodological aspects on in vivo studies
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate methodological aspects on in vivo metabolic drug interaction studies in man. Five pharmacokinetic studies in healthy persons or patients are presented. Together, they represent a set of model studies to evaluate the occurrence of, and extent of metabolic drug interactions in vivo. They are all based on previous in vitro findings, and were designed to take advantage of the current knowledge concerning specificity and selectivity of drug metabolising enzymes and interindividual differences in drug metabolising capacity. A special focus was the study of omeprazole as a probe for, and ketoconazole as an inhibitor of the CYP3A4 enzyme. Ketoconazole (repeated doses) markedly inhibited the CYP3A4 mediated sulphoxidation of omeprazole (single doses) in a dose-dependant manner, in both extensive and poor hydroxylators (CYP2C19) of omeprazole. This study confirms that omeprazole sulphoxidation is the main metabolic pathway in individuals devoid of CYP2C19 activity, and shows that these subjects develop very high omeprazole concentrations during ketoconazole co-administration. Tolterodine, which is mainly metabolised by CYP2D6, was given in repeated doses to both poor and extensive metabolisers (CYP2D6), but did not influence the metabolism (as indicated by metabolite ratios) of single doses of the probe drugs debrisoquine (CYP2D6), omeprazole (CYP2C19 and CYP3A4) or caffeine (CYP1A2), given on three consecutive days. Tolterodine is thus unlikely to inhibit the metabolism of drugs eliminated via these enzymes. Data from the above studies, together with data from two other omeprazole studies, support the use of omeprazole as a probe for the evaluation of CYP3A4 activity, as well as its previously suggested use as a probe for CYP2C19. Fluvoxamine (a CYP1A2 inhibitor), but not ketoconazole, had a significant effect on the clearance of intravenously administered ropivacaine. This study confirms in vitro and in vivo pharmacokinetic findings indicating CYP1A2 as the most important enzyme in ropivacaine metabolism, and shows that CYP1A2 inhibitors may cause clinically relevant interactions with ropivacaine. Concomitant administration of single doses of sirolimus and diltiazem lead to increased sirolimus exposure in 16 out of 18 subjects, presumably by inhibition of intestinal CYP3A4 and/or P-glycoprotein. This interaction needs further evaluation during steady-state conditions, but does point to the possibility of other CYP3A4 inhibitors interacting with sirolimus. Lamotrigine drug interactions were studied in a therapeutic drug monitoring material including 104 patients. A widespread intra- and interindividual variation in the concentration/dose ratio for lamotrigine could largely be explained by pharmacokinetic interactions with phenytoin, carbamazepine, phenobarbital (all three inducing lamotrigine metabolism) and valproic acid (an inhibitor of lamotrigine glucuronidation). The systematic knowledge concerning drug metabolising pathways and mechanisms of metabolic drug interactions is growing. Effective and informative in vitro studies are already in use, and are also being continuously developed. So far, there is no universally reliable method to extrapolate in vitro findings to in vivo clinical conditions. However, with the current knowledge of drug metabolism and a base of in vitro study methods, it is possible to use a confined number of well designed interaction studies in vivo, with specific and selective inhibitors and probe drugs in appropriate doses, given to panels of extensive and poor metabolisers. Such studies, in combination with routine evaluation of data from therapeutic drug monitoring, as exemplified in this work, can provide clinically useful information concerning pharmacokinetic drug interactions, leading to safer, better individualised and more cost-effective drug treatment.
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| 9. |
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| 10. |
- Chermá Yeste, Maria Dolores, 1961-
(författare)
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Therapeutic Drug Monitoring in Psychiatry : Some aspects of utility in clinical practice and research
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives: Several new psychoactive drugs for the treatment of psychiatric disorders have been introduced onto the market since the late 1980s. Basic aspects of pharmacodynamics and pharmacokinetics (PK) are investigated before approval for general prescription. Thus, a limited number of subjects are exposed to the drug before it is marketed and only sparse measurements of drug concentration are performed during phases II and III of drug development. The objective of this thesis was to provide further descriptive PK and linked patients data in naturalistic clinical settings. The PK of psychoactive drugs was also studied in the elderly and the young, major risk groups that are exposed in normal everyday clinical practice but that are underrepresented in the phases of drug development. The PK-data were to be assessed by samples sent to the Therapeutic Drug Monitoring (TDM) laboratory service. In a subset of individuals, the genotypes of the cytochrome P450 (CYP) enzymes were described.Results: Serum concentration of the parent compound and its metabolites was provided from TDM-data on antidepressant escitalopram (Paper I) and antipsychotic ziprasidone (Paper II). A large interindividual PK variability was found. The daily dose of the drug was higher than the defined daily dose (DDD) for both escitalopram and ziprasidone (median dose 20 mg and 120 mg, respectively). The median number of drugs per patient, apart from the studied drug, was 4 and 3, respectively (range 1-18). If repeated eligible TDM-data were available, change in treatment strategies could be seen between the first and second sample for the patient, and the metabolite/parent compound (M/P) ratio had lower intraindividual than interindividual variation in the escitalopram study but opposite results were found in the ziprasidone study.The prescription of antidepressant drugs (ADs) in the nursing homes studied was 38 % (Paper III). The concentration of the ADs was higher, or much higher, than could be expected from the dose administered in 73 %. The majority of the elderly people were treated with citalopram. No clear time schedule for how long the drug treatment should continue was found in the patients’ current medical record. The median number of drugs per patient apart from the AD was 11 (range 4-19), no monotherapy was found in these patients. The genetically impaired metabolic activity of CYP enzymes correlated to higher drug concentration as expected, in patients medicated with an AD that is substrate for the CYP enzyme genotype.The concentrations of ADs were as expected from the dose administered in 63 % of the children/adolescents evaluated (Paper IV). The majority of TDM samples requested sertraline. PK outcome of sertraline was similar to the results in adult populations. Monotherapy was documented in 49 % (median number of drugs apart from AD was 1 per patient, range 1-7). Changes in treatment strategies were also shown, if repeated TDM-samples were available. The median variation of the M/P ratio for sertraline between the first and the last samples within the same patient was 20 % (the interindividual variation was 37 %). The poor metabolizers (PM) for CYP2D6 medicated with a CYP2D6 substrate had a lower dose than did non-PM for the same drug.Conclusion: These studies provide reference data for the evaluation of the therapeutic response, i.e. a reference range of what is to be expected in a normal clinical setting, as well as the toxicological information concerning the psychoactive drugs studied. When available, the M/P ratio between two patients’ samples may assess patient compliance, as well as drug-drug interactions. Thus, the use of TDM can be beneficial for individual dose optimisation and drug safety, above all in the studied populations, elderly people and children/adolescents, when the selection of doses requires a consideration of PK parameters. TDM may be a tool for research, increasing knowledge of the psychoactive drug in TDM service, as well as toxicology. A more frequent clinical use of TDM and pharmacogenetic testing in clinical practice would contribute to a better quality when treating with psychoactive drugs.
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