| 1. |
- Åstrand, Bengt, et al.
(författare)
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Detection of potential drug interactions : a model for a national pharmacy register
- 2006
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 62:9, s. 749-756
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Tidskriftsartikel (refereegranskat)abstract
- Objective The widespread use of pharmaceuticals prescribed by different physicians has caused the Swedish government to propose a new legislation with registration of all prescriptions dispensed at the Swedish pharmacies. In the present study, we wanted to examine the frequency, distribution and determinants of potential drug interactions.Methods The prescriptions from all individuals (n=8,214) with two or more prescriptions during October 2003 to December 2004 were collected from the ongoing Jämtland cohort study of a total of about 11,000 individuals. Potential drug–drug interactions were detected with a computerized interaction detection system and classified according to clinical relevance (types A–D).Results On average each individual filled 14.6 (men 14.3, women 14.8) prescriptions during the study period. 3.6% of the individuals used more than 15 different drugs. The number of detected potential drug interactions type A–D was 4,941 (men 1,949, women 2,992). The risk of receiving a potential interaction type A–D was estimated as the cumulative incidence 0.26 (2,116/8,214) overall, 0.22 (748/3,467) for men and 0.29 (1,368/4,747) for women during the 15-month study period. The age adjusted risk, RRadj, for women was estimated as 1.30. Excluding sex hormones and modulators of the genital system, the RRadj was 0.96, with no elevated risk for women. For potential interactions type D, that might have serious clinical consequences, 167 (cumulative incidence 0.0203) individuals (72 men, cumulative incidence 0.0208, 95 women cumulative incidence 0.0200) were detected. The risk of receiving a combination of potentially interacting drugs was positively correlated to age and polypharmacy. The cumulative incidence for elderly was estimated as 0.36 (65–84 years) and 0.39 (85 years and above). The relative risk for individuals with 15 drugs or more was estimated as 3.67 (95% CI 3.46–3.90).Conclusion In a general population there were relatively few severe potential drug interactions. The new Swedish national pharmacy register will provide health care professionals with a powerful tool to systematically review all prescriptions. An alert system should focus on the more potential drug interactions, type C–D, with close monitoring of elderly and patients with polypharmacy.
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| 2. |
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| 3. |
- Åstrand, Emelie, et al.
(författare)
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Potential drug interactions during a three-decade study period : a cross-sectional study of a prescription register
- 2007
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 63:9, s. 851-859
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The increased risk of adverse events in patients receiving potentially interacting drugs has long been recognized. The purpose of the present study was to evaluate the change in the risk of receiving potentially interacting drugs during a period covering three decades and to examine the relative risk of actual drug combinations. Methods The prescriptions from all individuals (about 8,000) with two or more prescriptions during three periods of 15 months, October to December 1983–1984, 1993–1994 and 2003–2004, were collected from an ongoing cohort study in the county of Jämtland, Sweden. The potential interactions were detected by a computerized system. Results The relative risk (RR) of receiving potentially interacting drugs increased for type C interactions [RR: 1.177, 95% confidence interval (CI): 1.104–1.256] and decreased for type D interactions (RR: 0.714, 95% CI: 0.587–0.868) from the period 1983–1984 to 2003–2004. Polypharmacy for the participants increased by 61%, from 9.05 filled prescriptions per subject in 1983–1984 to 10.6 in 1993–1994 and 14.6 in 2003–2004. The RR was positively correlated to the pronounced increase in polypharmacy; in addition, an exponential relationship was found for the more severe type D interactions. Few interacting drug combinations were responsible for a large proportion of the risk. Conclusion We conclude that the risk of receiving potentially interacting drugs was strongly correlated to the concomitant use of multiple drugs. The pronounced increase in polypharmacy over time implies a growing reason for prescribers and pharmacists to be aware of drug interactions. Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically.
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| 4. |
- Engquist, Bo, et al.
(författare)
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Simplified methods of implant treatment in the edentulous lower jaw : A 3-year follow-up report of a controlled prospective study of one-stage versus two-stage surgery and early loading
- 2005
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Ingår i: Clinical Implant Dentistry and Related Research. - 1523-0899 .- 1708-8208. ; 7:2, s. 95-104
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interest in the use of one-stage surgery and immediate loading of oral implants has lately been increasing. Purpose: The aim of this study was to compare the 3-year results of one-stage surgery versus two-stage surgery, early loading versus loading after a 3-month healing period, and the use of one-piece implants versus the use of two-piece implants. Materials and Methods: The study included 108 patients with edentulous mandibles. Each patient was treated with four Brånemark System® implants (Nobel Biocare AB, Göteborg, Sweden) and with full fixed prostheses. Patients were consecutively treated and were distributed in four groups: group A (one-stage surgery), group B (control group with two-stage surgery), group C (one-piece implants), and group D (early loading). In groups A and B Brånemark Standard implants and standard abutments were used. In group C the conical one-piece Brånemark implant was used, and in group D the patients had Brånemark System Mk III implants together with multiunit abutments. All patients were observed for 3 years. Results: Of the 432 inserted implants, 24 were lost. Survival rates in the three experimental groups ranged from 93.2 to 93.3% whereas the survival rate in group B (the control group with two-stage surgery) was 97.5%. The differences between the groups were not statistically significant. The changes in marginal bone level were measured from fixture insertion to the final follow-up at 3 years. The bone loss in group D (early loading) was significantly less than in group B (the control group) whereas there were no differences in marginal bone change between the other groups. Conclusions: Early loading seemed to give good results in the anterior part of the mandible. The survival rate of the early-loaded implants did not significantly differ from that of implants inserted with the conventional two-stage procedure, but the mean marginal bone loss around the surviving implants was less with early loading. ©2005 BC Decker Inc.
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| 5. |
- Engquist, Bo, et al.
(författare)
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Simplified methods of implant treatment in the edentulous lower jaw. A controlled prospective study. Part I : one-stage versus two-stage surgery.
- 2002
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Ingår i: Clinical Implant Dentistry and Related Research. - 1523-0899 .- 1708-8208. ; 4:2, s. 93-103
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The original protocol for Brσnemark System implants in the mandible was a two-stage procedure with 3 months healing time. With five or six implants and a cast framework of gold, the treatment is rather expensive, and simplified methods would be desirable. PURPOSE: The goal of this controlled serial study was to investigate the outcome of a simplified procedure with one-stage surgery, four Brσnemark implants, shortened healing time, and a new titanium-acrylic fixed full prosthesis. MATERIALS AND METHODS: Eighty-two patients were treated in three different groups at two specialist centers. All patients were provided with four implants, loaded with a Procera All-in-One bridge (Nobel Biocare, Gothenburg, Sweden) after 12 weeks. In group A (n = 30), one-stage surgery was combined with two-piece implants. In group B (n = 30), the control group, two-stage surgery and two-piece implants were used. In group C (n = 22), one-stage surgery was combined with one-piece implants. Marginal bone level was rated from radiographs at implant insertion, at baseline, and after 1 year. RESULTS: The survival rate after 1 year for group A was 93.3%, group B, 97.5%, and group C, 93.2%. The differences were not statistically significant. Between fixture insertion and baseline, the average bone loss for group A was 1.2 mm, group B, 1.3 mm, and group C, 1.3 mm. No complications in the form of bridge loosening or acrylic fractures were recorded during the first year. CONCLUSIONS: The survival rates and the marginal bone changes did not differ significantly between the one-stage groups and the control group. The survival rate and the marginal bone changes were similar for one-piece and two-piece implants. Four implants were sufficient to support full fixed prostheses in the mandibles. The Procera All-in-One bridges proved to be of high quality, and no complications were experienced. key words: endosseous implants, nonsubmerged implants, one-piece implants, prospective clinical study, submerged implants
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| 6. |
- Engquist, Bo, et al.
(författare)
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Simplified methods of implant treatment in the edentulous lower jaw. Part II : Early loading
- 2004
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Ingår i: Clinical Implant Dentistry and Related Research. - 1523-0899 .- 1708-8208. ; 6:2, s. 90-100
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most implant treatment is performed with a two-stage surgical procedure. A disadvantage of these implant treatments is that they are time-consuming. Purpose: The aim of the present study was to evaluate the results of early loading in the edentulous mandible and to compare those results with treatment results of one-stage surgery followed by a healing period and with two-stage surgery. Material and Methods: The material comprises four treatment groups with a total of 108 patients with edentulous lower jaws and 432 implants. All patients were treated with Brånemark implants (Nobel Biocare AB, Gothenburg, Sweden) with a turned surface and fixed prostheses in the lower jaw, supported by four implants. The patients in group A were treated with a one-stage procedure, a two-piece implant, and a 3-month healing period before loading. Group B (control group) had a two-stage procedure, a two-piece implant, and a 3-month healing period. Group C had a one-stage procedure, a one-piece implant, and a 3-month healing period. Group D was treated with a one-stage surgical procedure, a two-piece implant, and early loading (within 3 weeks). All patients were provided with a Procera® Implant Bridge (Nobel Biocare) with a framework made by computer-assisted milling of one piece of pure titanium. All patients have been followed up for 1 year. Results: The survival rates were 93.2 to 93.3% in the experimental groups and 97.5% in the control group. The difference was not statistically significant. The measurements of the marginal bone level demonstrated a mean bone loss of 0.8 mm between fixture insertion and the 1-year examination in patients with early loading (group D) whereas the bone loss in patients who underwent a healing period before loading was 1.3 to 1.6 mm. The difference between the control group and the group with early loading was significant. Conclusions: Survival rates for patients treated with a one-stage procedure were lower than survival rates for patients treated according to a "classical concept," but the differences were not statistically significant. There was no difference between treatment results with one-piece and two-piece implants. The implant loss in patients with early loading was probably caused by overloading, and careful supervision of occlusal loading is recommended. Early loading gave significantly less marginal bone loss when compared with two-stage surgery.
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| 7. |
- Hammar, Tora, 1984-, et al.
(författare)
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Patients satisfied with e-prescribing in Sweden: a survey of a nationwide implementation
- 2011
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Ingår i: Journal of pharmaceutical health services research. - : Oxford University Press (OUP). - 1759-8885. ; 2:2, s. 97-105
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate Swedish patients’ attitudes towards e-prescribing, including the transfer of e-prescriptions, electronic storing of prescriptions and mail-order prescriptions.MethodsThis study was a nationwide survey of attitudes among Swedish patients and was conducted as a postal questionnaire. The questionnaire was developed for the purpose of thisstudy and aimed to evaluate respondents’ views concerning e-prescribing, electronic storingof e-prescriptions and mail-order prescriptions from aspects including safety, personal benefits and effectiveness. A study population of 1500 individuals meeting the inclusioncriteria was randomly selected from a database of individuals in Sweden storing prescriptions electronically (n = 5 840 599).The response rate was 52% (739/1429).Key findingsThe vast majority of the respondents had a positive attitude towards e-prescriptions (85%, 628/739) and electronic storing of prescriptions (86%, 633/739), andregarded e-prescriptions to be safe (79%, 584/739), creating benefits for them (78%, 576/739) and promoting faster dispensing (69%, 512/739). Significant differences in attitudes towards e-prescriptions and electronic storing of prescriptions were detected between age groups. Patients storing all their prescriptions electronically had a more positive attitudetowards both e-prescriptions and electronic storing of prescriptions compared to patientswho stated they had paper prescriptions. The most common suggestion (n = 27) for improvement was to extend the information given about the services.ConclusionOur nationwide survey showed that a vast majority of Swedish patients had positive attitudes towards e-prescriptions and electronic storing of prescriptions. However, a need for extended information regarding e-prescribing was identified.
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| 8. |
- Hammar, Tora, et al.
(författare)
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Swedish pharmacists value ePrescribing : a survey of a nation-wide implementation
- 2010
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Ingår i: Journal of Pharmaceutical Health Services Research. - : Wiley-Blackwell. - 1759-8885. ; 1:1, s. 23-32
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate Swedish pharmacists’ attitudes towards ePrescribing, including thetransfer of ePrescriptions, electronic storing of prescriptions and mail-order prescriptions.MethodThis study was conducted as a web-based survey among 500 randomly selectedSwedish community pharmacists. The questionnaire included open-ended questions,multiple-choice questions and statements to which respondents gave their degree ofagreement on a six-point Likert-type rating scale. Free-text answers were categorized intothe most commonly mentioned opinions. Differences in respondents’ general characteristicsand their level of satisfaction with ePrescribing were tested for significance using χ2test. The survey had a response rate of 52% (259/500). 96% (248/259) of the respondentswere female, and 76% (196/259) were aged 40–64 years.Key findings Swedish community pharmacists were generally satisfied with ePrescribing(98%, 253/259). No significant (P > 0.05) difference in the general satisfaction could beexplained by the respondents’ age, gender or years in practice. A majority of the respondentsregarded ePrescriptions and electronic storing of prescriptions as being safe for patients (95 and93% respectively), providing patient benefits (96 and 95% respectively), being cost-effectivefor the pharmacy (92 and 91% respectively) and contributing to better communication andrelationships with both patients and prescribers (62–88%). The positive aspects of ePrescribingmost frequently mentioned in free-text answers were being safe (72%, 187/259) and timesaving(55%, 143/259). However, several weaknesses with ePrescribing were also describedby the respondents, as well as suggestions for improvement.ConclusionOur nationwide survey of Swedish community pharmacists’ attitudestowards ePrescribing shows that pharmacists are generally satisfied with it, including thetransfer of ePrescriptions, electronic storing of prescriptions and to a lower degree mailorderprescriptions.
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| 9. |
- Hellström, Lina, 1975-, et al.
(författare)
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Physicians' attitudes towards ePrescribing : evaluation of a Swedish full-scale implementation
- 2009
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 9:August, s. Article number: 37-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The penetration rate of Electronic Health Record (EHR) systems in health care is increasing. However, many different EHR-systems are used with varying ePrescription designs and functionalities. The aim of the present study was to evaluate experienced ePrescribers' attitudes towards ePrescribing for suggesting improvements. METHODS: Physicians (n = 431) from seven out of the 21 Swedish health care regions, using one of the six most widely implemented EHR-systems with integrated electronic prescribing modules, were recruited from primary care centers and hospital clinics of internal medicine, orthopaedics and surgery. The physicians received a web survey that comprised eight questions on background data and 19 items covering attitudes towards ePrescribing. Forty-two percent (n = 199) of the physicians answered the questionnaire; 90% (n = 180) of the respondents met the inclusion criteria and were included in the final analysis. RESULTS: A majority of the respondents regarded their EHR-system easy to use in general (81%), and for the prescribing of drugs (88%). Most respondents believed they were able to provide the patients better service by ePrescribing (92%), and regarded ePrescriptions to be time saving (91%) and to be safer (83%), compared to handwritten prescriptions. Some of the most frequently reported weaknesses were: not clearly displayed price of drugs (43%), complicated drug choice (21%), and the perception that it was possible to handle more than one patient at a time when ePrescribing (13%). Moreover, 62% reported a lack of receipt from the pharmacy after successful transmission of an ePrescription. Although a majority (73%) of the physicians reported that they were always or often checking the ePrescription a last time before transmitting, 25% declared that they were seldom or never doing a last check. The respondents suggested a number of improvements, among others, to simplify the drug choice and the cancellation of ePrescriptions. CONCLUSION: The Swedish physicians in the group studied were generally satisfied with their specific EHR-system and with ePrescribing as such. However, identified weaknesses warrant improvements of the EHR-systems as well as of their implementation in the individual health care organisation.
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| 10. |
- Holmgren, Christina M, et al.
(författare)
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Changes in Medication Preceding Out-of-hospital Cardiac Arrest Where Resuscitation Was Attempted
- 2014
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Ingår i: Journal of Cardiovascular Pharmacology. - : Lippincott Williams & Wilkins. - 0160-2446 .- 1533-4023. ; 63:6, s. 497-503
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. Methods: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. Results: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 +/- 16 years vs. 54 +/- 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded ;rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. Conclusions: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.
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