| 1. |
- Bejhed, Rebecca S., et al.
(författare)
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Identification of Risk Factors for Bisphosphonate-Associated Atypical Femoral Fractures and Osteonecrosis of the Jaw in a Pharmacovigilance Database
- 2016
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Ingår i: The Annals of Pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 50:8, s. 616-624
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atypical femoral fractures (AFs) and osteonecrosis of the jaw (ONJ) are well-known adverse drug reactions (ADRs) associated with bisphosphonates. To prevent these ADRs and to aid in the search for pathogenic mechanisms, knowledge of risk factors can be helpful. Objective: To identify risk factors for bisphosphonate-related ONJ and AF. Methods: In this case-control study of reports of bisphosphonate-related ADRs from February 16, 1984, to October 16, 2013, in the Swedish national database of ADRs, we compared characteristics for cases of ONJ (n = 167) and AF (n = 55) with all other bisphosphonate-related ADRs (n = 565) with regard to demographic variables, clinical characteristics, and concomitant drug treatments. We adjusted for multiple comparisons with Bonferroni correction. Results: Time to onset of ADRs differed statistically significantly between cases of AF and controls (2156 vs 111 days). For ONJ versus controls, differences were statistically significant for time to onset (1240 vs 111 days), intravenous administration (40% vs 20%), dental procedures (49% vs 0.2%) and prostheses (5% vs 0%), cancer disease (44% vs 12%), multiple myeloma (21% vs 1%), rheumatoid arthritis (14% vs 5%), and treatment with antineoplastic agents and oxycodone. Conclusion: These results lend further evidence to previously identified risk factors for ONJthat is, intravenous bisphosphonate administration; invasive dental procedures and dental prostheses; cancer disease, in particular multiple myeloma; and possibly, long-term bisphosphonate treatment. A putative further risk factor is rheumatoid arthritis. Only long-term bisphosphonate treatment was more common among AF cases. The lack of overlap of risk factors between ONJ and AF suggests different pathogenic mechanisms.
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| 2. |
- Bingefors, Kerstin, et al.
(författare)
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Prescription drug and healthcare use among Swedish patients treated with antidepressants
- 1995
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 29:6, s. 566-72
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To analyze healthcare and prescription drug use among patients taking and those not taking antidepressant drugs in a Swedish community.DESIGN:Cross-sectional study.SETTING:General population of the rural Swedish municipality Tierp of approximately 20,000 inhabitants.PARTICIPANTS: All residents of Tierp aged 25 years or older during 1988.MAIN OUTCOME MEASURES:Mean number of ambulatory care visits, hospital bed days, and prescriptions per person; proportion of those taking prescription drugs in different pharmacologic classes.RESULTS: Patients treated with antidepressant drugs had a significantly (p < 0.05) greater use of ambulatory care, hospital care, and prescription drugs than those who did not take antidepressants in the study population. They also had an increased frequency of use of prescription drugs from virtually all pharmacologic classes. Furthermore, the risk for polypharmacy was high in patients treated with antidepressant medications.CONCLUSIONS:Those who took antidepressant drugs consumed more health services and prescription drugs than did those not taking an antidepressant. Patients receiving antidepressant treatment may be at serious risk for iatrogenic disease and should be evaluated carefully with respect to concomitant drug use.
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| 3. |
- Björkman, Ingeborg, et al.
(författare)
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Drug-drug interactions in the elderly
- 2002
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Ingår i: The Annals of pharmacotherapy. - 1060-0280 .- 1542-6270. ; 36:11, s. 1675-1681
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Chuc, NTK, et al.
(författare)
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Management of childhood acute respiratory infections at private pharmacies in Vietnam
- 2001
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Ingår i: The Annals of pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 35:10, s. 1283-1288
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the knowledge and practice among private pharmacy staff in Hanoi regarding case management of mild acute respiratory infection (ARI) in children. METHODS: Sixty private pharmacies in Hanoi were randomly selected. Knowledge was assessed through interviews with pharmacy staff using a questionnaire; practice was assessed through the Simulated Client Method. RESULTS: In the questionnaire, 20% of the pharmacy staff stated that they would dispense antibiotics. In practice, 83% of the pharmacies dispensed antibiotics. Only 36% of the cases were handled according to guidelines. In the questionnaire, 81% of interviewees stated that antibiotics are not effective in short therapeutic courses. In practice, 48% of the antibiotics were dispensed in courses less than five days. Traditional herbal medicines were dispensed in 41% of the encounters. In the questionnaire, 53% of the pharmacy staff stated that they would ask the patient about difficulty of breathing. In practice, questions related to difficulty of breathing were asked in less than 10% of the encounters. CONCLUSIONS: Dispensing of antibiotics for mild ARI was common practice among private pharmacies, and there was a significant difference between knowledge and practice. Interventions are needed to improve pharmacy practice in Hanoi.
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| 5. |
- De Fazio, Salvatore, et al.
(författare)
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Role of CYP3AS in abnormal clearance of methadone
- 2008
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 42:6, s. 893-897
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To report a case of unusually low concentrations of methadone in a polydrug abuser during maintenance treatment with methadone. CASE SUMMARY: A 25-year-old man (weight 55 kg, height 165 cm) with a 12-year history of polydrug abuse was admitted to an opiates withdrawal methadone program. At the time of our observation, he was using both cannabinoids and heroin; no other medical conditions were discovered. Within the opiates withdrawal methadone program, under medical supervision, the patient started methadone therapy (20 mg/day). Two weeks later, an Abuscreen assay for methadone screening in the urine was negative and, to prevent the development of withdrawal symptoms, the dose of methadone was increased to 60 mg/day. One day later, the patient was asked to collect another urine sample in the presence of a nurse. The Abuscreen for methadone in urine remained negative. Evaluation of urinary samples collected over 24 hours documented low concentrations of methadone and high levels of 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (the primary metabolite of methadone). Evaluation for the presence of the most common polymorphisms in the cytochrome P450 and P-glycoprotein genes showed that the patient was heterozygous for the CYP3A5*1 allele and for 2 single nucleotide polymorphisms in the P-glyooprotein gene (1236C/T and 3435C/T). DISCUSSION: In this patient, poor methadone adherence was ruled out because of the presence of physicians and nurses during both methadone maintenance treatment and Abuscreen screening. Moreover, because the patient reported only heroin and cannabis at the time of evaluation, drug interactions were ruled out as possible causes for the rapid clearance of methadone. CONCLUSIONS: In this case, CYP3A5 polymorphism may have played a role in the rapid methadone metabolism.
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| 6. |
- Haasum, Ylva, et al.
(författare)
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Institutionalization as a Risk Factor for Inappropriate Drug Use in the Elderly : A Swedish Nationwide Register-Based Study
- 2012
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 46:3, s. 339-346
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. OBJECTIVE: To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. METHODS: We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). RESULTS: Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% Cl 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% Cl 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% Cl 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% Cl 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% Cl 0.55 to 0.65). CONCLUSIONS: Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Research is needed to identify underlying risk factors for PIDU within these settings.
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| 7. |
- Hallberg, Pär, et al.
(författare)
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Comparison of Clinical Factors Between Patients With Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema and Cough
- 2017
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Ingår i: The Annals of Pharmacotherapy. - Thousand Oaks, USA : Sage Publications. - 1060-0280 .- 1542-6270. ; 51:4, s. 293-300
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Tidskriftsartikel (refereegranskat)abstract
- Background: Angioedema is a rare and serious adverse drug reaction (ADR) to angiotensin-converting enzyme (ACE) inhibitor treatment. Dry cough is a common side effect of ACE inhibitors and has been identified as a possible risk factor for angioedema.Objective: We compared characteristics between patients with ACE inhibitor-induced angioedema and cough with the aim of identifying risk factors that differ between these adverse events.Methods: Data on patients with angioedema or cough induced by ACE inhibitors were collected from the Swedish database of spontaneously reported ADRs or from collaborating clinicians. Wilcoxon rank sum test, Fisher's exact test, and odds ratios (ORs) with 95% CIs were used to test for between-group differences. The significance threshold was set to P <0.00128 to correct for multiple comparisons.Results: Clinical characteristics were compared between 168 patients with angioedema and 121 with cough only. Smoking and concomitant selective calcium channel blocker treatment were more frequent among patients with angioedema than cough: OR = 4.3, 95% CI = 2.1-8.9, P = 2.2 × 10(-5), and OR = 3.7, 95% CI = 2.0-7.0, P = 1.7 × 10(-5) Angioedema cases were seen more often in male patients (OR = 2.2, 95% CI = 1.4-3.6, P = 1.3 × 10(-4)) and had longer time to onset and higher doses than those with cough (P = 3.2 × 10(-10) and P = 2.6 × 10(-4)). A multiple model containing the variables smoking, concurrent calcium channel blocker treatment, male sex, and time to onset accounted for 26% of the variance between the groups.Conclusion: Smoking, comedication with selective calcium channel blockers, male sex, and longer treatment time were associated with ACE inhibitor-induced angioedema rather than cough.
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| 8. |
- Hedenrud, Tove, et al.
(författare)
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Beliefs about medicines and adherence among Swedish migraineurs
- 2008
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 42:1, s. 39-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The problem of low adherence to drug therapy is as prevalent in migraine as in any other disorder, with important consequences for the patient, such as impaired quality of life and absence from work. Beliefs about medicines have been identified as one of the most significant factors for adherence.OBJECTIVE: To analyze whether beliefs about medicines and medication-related factors are associated with adherence to prophylactic drug therapy among migraineurs at a Swedish tertiary care clinic.METHODS: A questionnaire was distributed to migraineurs visiting a tertiary care clinic in Sweden. All participants had recently been prescribed prophylactic medicine. The questionnaire was comprised of background questions, questions about disease characteristics, perceived effects, and adverse effects of migraine medications used, the Beliefs about Medicines questionnaire, and the Medication Adherence Report Scale. Medication-related variables, collected from patients' records with consent, were also included. Logistic regression analysis was performed to analyze the association between beliefs about medicines, medication-related variables, and adherence to prophylactic drugs.RESULTS: Of the 174 participants in the study, 64% were considered to be adherent to their prescribed prophylactic medicine. Users of beta-blockers were significantly more adherent compared with patients using other drugs (eg, tricyclic antidepressants [TCAs] or antiepileptics); the reverse was true for patients taking TCAs. Respondents with the lowest level of education (CONCLUSIONS: About one-third of the migraineurs did not adhere to their prophylactic drugs. Beliefs about medicines and medication-related factors could not predict nonadherence. We recommend further research on medication-related variables in relation to adherence among migraineurs.
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| 9. |
- Hyttinen, V, et al.
(författare)
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Incident Use of a Potentially Inappropriate Medication and Hip Fracture in Community-Dwelling Older Persons With Alzheimer's Disease
- 2017
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Ingår i: The Annals of pharmacotherapy. - : SAGE Publications. - 1542-6270 .- 1060-0280. ; 51:9, s. 725-734
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Tidskriftsartikel (refereegranskat)abstract
- Background: Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions and events and have been associated with greater health care service use, such as an increased risk of hospitalization. Objective: The aim of this study is to evaluate the association between PIM use and hip fractures in a nationwide cohort of community-dwelling persons ≥65 years old with Alzheimer’s disease (AD). Methods: The study, which is based on the Finnish nationwide MEDALZ cohort, included all persons diagnosed with AD between 2005 and 2011 (n = 70 718). After a 1-year washout period for PIM use and exclusion of persons with previous hip fracture before AD diagnosis or those who had been hospitalized, we included 47 850 persons ≥65 years old with AD. PIM use was identified using Finnish criteria. Associations between PIM use and hip fracture were analyzed with Cox proportional hazards regression. Results: Of the study population, 12.3% (n = 5895) initiated PIMs during the follow-up (maximum follow-up 2921 days and total number of person-years 139 538.7). Of those, 103 (1.7%) persons had hip fractures during the PIM use period. The results suggest that PIM use was only associated with an increased risk of hip fracture with incident PIM use (adjusted hazard ratio = 1.31; 95% CI = 1.06-1.63; P = 0.014). Conclusions: PIM use is associated with increased risk of hip fracture when a person uses PIMs for the first time. However, the association between PIM use and hip fracture should be investigated more comprehensively in future studies.
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| 10. |
- Isacson, Dag, et al.
(författare)
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Nationwide survey of subjectively reported adverse drug reactions in Sweden
- 2008
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 42:3, s. 347-353
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adverse drug reactions (ADRs) and the safety of drugs continue to be widely discussed. However, information on the prevalence of subjectively experienced ADRs (SADRs) and their subsequent burden in the general population is largely lacking. OBJECTIVE: To analyze, from an epidemiologic perspective, SADRs with respect to occurrence and health status. METHODS: A cross-sectional mail survey to a random national sample in Sweden of inhabitants aged 18-84 years was conducted; 61% (N = 4875) of the sample answered the questionnaire. Self-reported SADRs occurring during a 2-week period of using prescription, over-the-counter (OTC), or herbal drugs were classified according to Meyler's classification of ADRs. Self-perceived health status was assessed with a visual analog scale graded from 0 (worst possible health/death) to 1 (perfect health). RESULTS: SADRs were reported by 6.4% of the total study sample, 10.2% of the 2851 users of prescription drugs, 1.0% of the 2862 users of OTC drugs, and 0.1% of the 1352 users of herbal drugs. Of the total sample, 3.3% reported SADRs of the nervous system, 2.6% of the gastrointestinal system, and 0.6% of the cardiovascular system. Users of prescription drugs with SADRs reported a mean health status score of 0.655, while those who did not report SADRs scored 0.744. Among users of OTC and herbal drugs, the corresponding scores were 0.720 and 0.818, respectively. Those in the population who did not use any drugs rated their health status as 0.846. CONCLUSIONS: Both the prevalence of SADRs and the magnitude of the decrease in subjective health status in respondents experiencing them reflect the importance of individual subjective perceptions for public health. However, in a cross-sectional study like this, causal relationships cannot be firmly established. Further, other factors, such as comorbidity or disappointment with treatment outcomes, could be associated with the decrease in health status.
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| 11. |
- Jorgensen, T, et al.
(författare)
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Prescription drug use, diagnoses, and healthcare utilization among the elderly
- 2001
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Ingår i: The Annals of Pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 35:9, s. 1004-1009
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND More elderly patients affected by severe and chronic diseases are treated in primary care. Reports on the use of prescription drugs by the general elderly population are scarce, and more investigations are needed to optimize pharmaceutical care for these patients. OBJECTIVE To analyze prescription drug use, diagnoses, and healthcare utilization among noninstitutionalized elderly patients. DESIGN Retrospective cohort study. SETTING AND PATIENTS All people > or =65 years old (n = 4642) living in the community of Tierp, Sweden, in 1994 were included. Prescription drug use and healthcare utilization have been registered for all inhabitants of the community since 1972. Information about filled prescriptions and diagnoses were obtained from a computerized research register. RESULTS Prescription drug use was high among the elderly (78%); the most used pharmacologic groups were cardiovascular, nervous system, and gastrointestinal medications. Women used more prescription drugs than men (average 4.8 vs. 3.8) and had more nonfatal diagnoses. Use of five or more different prescription drugs during 1994 was common (39.0%), and multivariate analysis showed that the greatest number of primary care visits occurred with multiple drug use (> or =5 drugs over 1 y). CONCLUSIONs: This study shows an extensive multiple drug use among elderly people living at home. Whether this multiple drug use per se is harmful to the patients or not could not be evaluated in this study. Further focused investigations are needed to assess the effect of multiple drug use in an elderly population.
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| 12. |
- Kennerfalk, A, et al.
(författare)
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Geriatric drug therapy and healthcare utilization in the United Kingdom
- 2002
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 36:5, s. 797-803
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To describe the use of prescription drug therapy, especially polypharmacy, in an elderly general population; to relate that use to age, gender, and different types of healthcare utilization; and to investigate the influence of selection of different time windows on the result of the quantity as well as the categories of drugs used. METHODS Data on a sample of 5000 patients aged 65-90 years in 1996 were derived from the General Practice Research Database (GPRD). The population covered by GPRD is broadly representative of the UK population treated in general practice. Drug use was assessed using 2 time windows - current use of individual drugs on a random day (index date) and 1 month following the index date. Healthcare utilization was analyzed by use of information on visits to general practitioners (GPs), hospitalizations, and referrals to specialists. RESULTS Women used more drugs than men; however, the prevalence of polypharmacy, defined as concomitant use of > or =5 drugs, was similar in both genders. The most frequently used therapeutic groups were cardiovascular, central nervous, and gastrointestinal system drugs. Almost 80% of both women and men visited a GP at least once a year. Overall, women used more ambulatory care services and men were hospitalized more often. Use of random date compared with 1-month period resulted in a significant underestimation of the amount of drugs used for acute conditions and, consequently, the risk of polypharmacy. CONCLUSIONS The overall results confirm the findings in earlier studies suggesting that the GPRD might be a useful tool in further studies on prescription drug use among elderly persons. More information on the appropriateness of drug use is needed to prevent overuse as well as underuse of medications among the elderly.
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| 13. |
- Moen, Janne, et al.
(författare)
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Factors associated with multiple medication use in different age groups
- 2009
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 43:12, s. 1978-1985
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long period of time. By learning more about how multiple medication use develops, the quality of prescribing may be improved across the adult lifespan. OBJECTIVE: To describe patterns of multiple medicine use in the general Swedish population and its association with sociodemographic, lifestyle, and health status factors. METHODS: Data from a cross-sectional population health survey collected during 2001-2005 from 2816 randomly selected Swedish residents (age 30-75 y; response rate 76%) were analyzed. Multiple medicine use was restricted to prescription drugs and defined as the 75th percentile; that is, the 25% of the study group using the highest number of drugs per individual. RESULTS: Seventy-one percent of the respondents used some kind of drug, 51.5% used one or more prescription drug, 38.4% used one or more over-the-counter (OTC) medication, and 8.3% used one or more herbal preparation. The cutoff amounts defining multiple medicine use were: 2 or more medications for 30- to 49-year-olds, 3 or more for 50- to 64-year-olds, and 5 or more for 65- to 75-year-olds. No association between use of multiple medicines and use of OTC drugs or herbal preparations was found. When drugs were classified into therapeutic subgroups, 76.3% of those aged 30-49 years, 97.9% of those aged 50-64 years, and 100% of those aged 65-75 years were taking a unique combination of drugs. Multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female sex and hypertension were associated with multiple medicine use among those aged 30-49 and 50-64 years, current smoking among those aged 50-64 years, and obesity among those aged 65-75 years. CONCLUSIONS: Multiple medicine use was associated with morbidity and poor self-rated health across all age groups. The vast majority of users of multiple drugs are taking a unique combination of medications.
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| 14. |
- Schmidt, IK, et al.
(författare)
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Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes
- 1998
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 32:1, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the type and frequency of drug-related problems discussed in regular team meetings conducted in 15 Swedish nursing homes and report physician and staff assessments of these interventions and residents' outcomes. DATA SOURCES AND METHODS: The data were collected within the context of a controlled trial with the primary aim of exploring the effects of regular team interventions on drug prescribing practices in Swedish nursing homes. In 15 experimental nursing homes, the residents' drug therapy was discussed regularly by a team consisting of a pharmacist, a physician, nurses, undernurses (similar to licensed practical nurses), and nurse's aides. The pharmacist documented problems, made changes, and observed outcomes. Following the intervention period, a questionnaire was sent to the medical staff that contained items regarding perceived outcomes, the intervention's impact on knowledge of drug therapy in the elderly, and attitudes toward the pharmacist's role. RESULTS: Unclear indication and problematic choice of drugs were the most common drug-related problems discussed. In 19% of the situations, therapy changes were reported to have had a beneficial effect on the residents' clinical status; in 47% of the situations, staff reported no observable outcome from changes, suggesting that the changes had been appropriate. Finally, medical staff claimed in the follow-up survey that their knowledge about drug therapy had increased; they expressed an overall positive attitude toward this interactive collaboration. CONCLUSIONS: Regular intervention conducted by a multidisciplinary team incorporating a pharmacist can effectively improve prescribing practices, increase staff knowledge about appropriate drug therapy in the elderly, and result in improved quality of care for nursing home residents.
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| 15. |
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| 16. |
- Veninga, CCM, et al.
(författare)
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Treatment of uncomplicated urinary tract infections: exploring differences in adherence to guidelines between three European countries. Drug Education Project Group
- 2000
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Ingår i: The Annals of pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 34:1, s. 19-26
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate adherence of general practitioners to treatment guidelines regarding urinary tract infections in three European countries and to investigate whether differences in adherence at the prescribing level within and between countries could be explained by general practitioners' knowledge and attitudes, characteristics, or national setting. DESIGN: Prescribing data collected in 1994–1995 were analyzed regarding use of first-choice drugs and duration of treatment, knowledge and attitudes were assessed with a questionnaire, and multiple regression analysis was used to explain differences in prescribing behavior within and between countries. RESULTS: Our study is based on data from 85.6% of the 584 general practitioners who were scheduled to participate in a continuing education program. The mean proportion of responses in agreement with the guidelines regarding first-choice drugs was 0.69 in Sweden, 0.78 in the Netherlands, and 0.79 in Norway; regarding duration of treatment, the mean proportion was 0.56 in Sweden, 0.67 in the Netherlands, and 0.59 in Norway. The proportion of first-choice drugs prescribed for women (18–75 y) was 0.55 in Sweden, 0.83 in the Netherlands, and 1.00 in Norway (patients >16 y). The duration of treatment was 7.6 defined daily doses per prescription in Sweden, 5.9 in the Netherlands, and 6.6 in Norway. Knowledge and attitudes explained 0–17% of the variation in prescribing. Years in practice explained 0–11%, and the general practitioners' gender had no explanatory value. The national setting explained most of the variation between countries. CONCLUSIONS: Differences in prescribing behavior can be explained only to a small extent by deviations from the guidelines in terms of knowledge and attitudes. Between countries, differences in regulation, marketing, and distribution of drugs seem to be of much greater importance.
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| 17. |
- Wimmer, Barbara C., et al.
(författare)
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Medication Regimen Complexity and Polypharmacy as Factors Associated With All-Cause Mortality in Older People : A Population-Based Cohort Study
- 2016
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Ingår i: The Annals of Pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 50:2, s. 89-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate whether medication regimen complexity and/or polypharmacy are associated with all-cause mortality in older people. Methods: This was a population-based cohort study among community-dwelling and institutionalized people >= 60 years old (n = 3348). Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI) in 10-unit steps. Polypharmacy was assessed as a continuous variable (number of medications). Mortality data were obtained from the Swedish National Cause of Death Register. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% Cls for the association between regimen complexity and polypharmacy with all-cause mortality over a 3-year period. Subanalyses were performed stratifying by age (<= 80 and>80 years), sex, and cognition (Mini-Mental State Examination [MMSE] <26 and >= 2.6). Results: During follow-up, 14% of the participants (n = 470) died. After adjusting for age, sex, comorbidity, educational level, activities of daily living, MMSE, and residential setting, a higher MRCI was associated with mortality (adjusted HR = 1.12; 95% CI = 1.01-1.25). Polypharmacy was not associated with mortality (adjusted HR = 1.03; 95% Cl = 0.99-1.06). When stratifying by sex, both MRCI and polypharmacy were associated with mortality in men but not in women. MRCI was associated with mortality in participants <= 80 years old and in participants with MMSE but not in participants >80 years old or with MMSE <26. Conclusion: Regimen complexity was a better overall predictor of mortality than polypharmacy. However, regimen complexity was not predictive of mortality in women, in participants >80 years old, or in those with MMSE<26. These different associations with mortality deserve further investigation.
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| 18. |
- Wimmer, Barbara C., et al.
(författare)
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Medication Regimen Complexity and Unplanned Hospital Readmissions in Older People
- 2014
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Ingår i: The Annals of Pharmacotherapy. - : SAGE Publications. - 1060-0280 .- 1542-6270. ; 48:9, s. 1120-1128
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medication-related problems and adverse drug events are leading causes of preventable hospitalizations. Few previous studies have investigated the possible association between medication regimen complexity and unplanned rehospitalization. Objective: To investigate the association between discharge medication regimen complexity and unplanned rehospitalization over a I 2-month period. Method: The prospective study comprised patients aged >= 70 years old consecutively admitted to a Geriatrics Evaluation and Management (GEM) unit between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Cox proportional-hazards regression was used to compute unadjusted and adjusted hazard ratios (HRs) with 95% CIs for factors associated with rehospitalization over a 12-month follow-up period. Result: Of 163 eligible patients, 99 patients had one or more unplanned hospital readmissions. When adjusting for age, sex, activities of daily living, depression, comorbidity, cognitive status, and discharge destination, MRCI (HR = 1.01; 95% CI = 0.81-1.2), number of discharge medications (HR = 1.01; 95% CI = 0.94-1.08), and polypharnnacy (>= 9 medications; HR = 1.12; 95% CI = 0.69-1.80) were not associated with rehospitalization. In patients discharged to nonhome settings, there was an association between rehospitalization and the number of discharge medications (HR = 1.12; 95% CI = 1.01-1.25) and polypharmacy (HR = 2.24; 95% CI = 1.02-4.94) but not between rehospitalization and MRCI (HR = 1.32; 95% CI = 0.98-1.78). Conclusion: Medication regimen complexity was not associated with unplanned hospital readmission in older people. However, in patients discharged to nonhonne settings, the number of discharge medications and polypharmacy predicted rehospitalization. A patient's discharge destination is an important factor in unplanned medication-related readmissions.
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| 19. |
- Yagi, T, et al.
(författare)
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Association Between the Prothrombin Time-International Normalized Ratio and Concomitant Use of Antibiotics in Warfarin Users: Focus on Type of Antibiotic and Susceptibility of Bacteroides fragilis to Antibiotics
- 2021
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Ingår i: The Annals of pharmacotherapy. - : SAGE Publications. - 1542-6270 .- 1060-0280. ; 55:2, s. 157-164
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Tidskriftsartikel (refereegranskat)abstract
- The difference in type of antibiotics and susceptibility of Bacteroides fragilis to antibiotics may influence warfarin anticoagulation. However, these influences have not been clarified in clinical settings. Objectives: This study aimed to investigate association the between the prothrombin time–international normalized ratio (PT-INR) and concomitant use of antibiotics in a real-world population of warfarin users. Methods: This was a single-center cohort study using data from health records and included patients who received β-lactams (BLs)/fluoroquinolones (FQs) during ongoing warfarin treatment (2011-2015) at Hamamatsu University Hospital in Japan. Antibiotics were categorized into those to which B fragilis is susceptible (BLsus, FQsus) and those to which it is not (BLnon, FQnon) and into those given orally (BLpo, FQpo) or intravenously (BLiv, FQiv). Outcomes were excessive PT-INR and changes in PT-INR, defined as the ratio (INR ratio) and difference (ΔINR) of maximum PT-INR and baseline PT-INR. Excessive PT-INR was graded as INR ratio of >1.5 or >2.5. Results: A total of 1185 warfarin users were included. The proportion of INR ratio >2.5 in FQiv was higher than in BLiv (95% CI: 1.59-46.5). The proportions with an INR ratio of >1.5 in BLsus and FQsus were higher than in BLnon (1.72-14.1) and FQnon (1.05-9.36), respectively. ΔINR values in FQpo, FQiv, and FQsus were higher than those in BLpo, BLiv, and FQnon, respectively. Conclusions and Relevance: Concomitant use of FQs, or of antibiotics to which B fragilis is susceptible is associated with higher risk of excessive anticoagulation. These findings would contribute to safe and proper antibiotic treatment in warfarin users.
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| 21. |
- Ariano, RE, et al.
(författare)
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Pharmacokinetics and pharmacodynamics of meropenern in febrile neutropenic patients with bacteremia
- 2005
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Ingår i: Annals of Pharmacotherapy. - 1060-0280. ; 39:1, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pharmacodynamic investigations with antimicrobials define the relationship between the infecting organism and achievable drug concentrations with clinical outcome. Objective: To examine this relationship for meropenem in a population of patients who are at high risk of infection-related morbidity and mortality. Methods: The study was a retrospective analysis of a multicenter, randomized, blinded clinical trial. A population-based predictive model was created using data from adults with febrile neutropenia and the nonparametric modeling program, NPEM. Patient age, body weight, and serum creatinine level were covariates in the model used to predict unbound concentrations for each patient. Pathogen susceptibility was estimated using product literature minimum inhibitory concentrations for effectiveness against 50% of microorganisms (MIC50) for specific organisms. The pharmacodynamic index of percent time above MIC (% T>MIC) was analyzed for its association with clinical outcome. Results: A 2-compartment pharmacokinetic model using patient covariates of body weight and renal function best described the pharmacokinetics of meropenem in febrile neutropenic patients. Sixty patients with confirmed gram-positive or -negative bacteremia were studied. An average of 83% T>MIC was identified for the 42 clinical responders compared with 59% T>MIC for the 18 nonresponders (p=0.04). An 80% clinical response rate was evident when the % T>MIC for meropenem exceeded 75% of the dosing interval (p=0.01). Conclusions: To our knowledge, this is the first published report of a relationship between a pharmacodynamic index and clinical outcome in a febrile neutropenic population. Based on this relationship, dosing with intravenous meropenem 500 mg every 6 hours is predicted to be comparable to the currently recommended 1 g every 8 hours for serious infections. Our model provides further justification for a prospective clinical trial to evaluate a pharmacodynamically targeted meropenem dosing schedule as to its ability to improve clinical outcome in these patients.
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| 26. |
- Thomsen, Linda Aagaard, et al.
(författare)
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Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care
- 2007
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Ingår i: Annals of Pharmacotherapy. - 1060-0280. ; 41:9, s. 1411-1426
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To estimate the incidence and describe characteristics of preventable adverse drug events (pADEs) in ambulatory care. DATA SOURCES: Studies were searched in PubMed (1966-March 2007), International Pharmaceutical Abstracts (1970-December 2006), the Cochrane database of systematic reviews (1993-March 2007), EMBASE (1980-February 2007), and Web of Science (1945-March 2007). Key words included medication error, adverse drug reaction, iatrogenic disease, outpatient, ambulatory care, primary health care, general practice, patient admission, hospitalization, observational study, retrospective studies, health services research, and follow-up studies. Additional articles were found in the reference sections of retrieved articles. STUDY SELECTION AND DATA EXTRACTION: Peer-reviewed articles assessing pADEs in ambulatory care, with detailed descriptions/frequency distributions of (1) ADE/pADE incidence, (2) clinical outcomes, (3) associated drug groups, and/or (4) underlying medication errors were included. Study country, year and design, sample size, follow-up time, ADE/pADE identification method, proportion of ADEs/pADEs and ADEs/pADEs requiring hospital admission, and frequency distribution of adverse outcome, associated drug groups, or medication errors were extracted. DATA SYNTHESIS: Twenty-nine studies met inclusion criteria: 14 were ambulatory-based and 15 were hospital-based. Seven studies enrolled only eldery patients. The median ADE incidence was 14.9 (range 4.0-91.3) per 1000 person-months, and the pADE incidence was 5.6 per 1000 person-months (1.1-10.1). The median ADE preventability rate was 21% (11-38%). The median incidence of ADEs requiring hospital admission was 0.45 (0.10-13.1) per 1000 person-months, and the median incidence of pADEs requiring hospital admission was 4.5 per 1000 person months. Cardiovascular drugs, analgesics, and hypoglycemic agents together accounted for 86.5% of pADEs, and 77.2% of pADEs resulted in symptoms of the central nervous system, electrolyte/renal system, and gastrointestinal tract. Medication errors resulting in pADEs occurred in the prescribing and monitoring stages. The most frequent drug therapy problem and error of commission reported in ambulatory-based studies on pADEs was the use of inappropriate drugs (42.7%; 40.4-450%). For pADEs requiring hospital admission, the most frequent drug therapy problem and error of omission reported was inadequate monitoring (45.4%; range 22.2-69.8%). Failure to prescribe prophylaxis to patients taking nonsteroidal antiinflammatory drugs or antiplatelet drugs frequently caused gastrointestinal toxicirty whereas lack of monitoring of diuretic, hypoglycemic, and anticoagulant use caused over- or under-diuresis, hyper- or hypoglycemia, and bleeding. CONCLUSIONS: ADEs in ambulatory care are common, with many being pre-ventable and many resulting in hospitalization. Quality improvement programs should target errors in prescribing and monitoring, especially for patients using cardiovascular, analgesic, and, hypoglycemic agents.
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| 28. |
- Westerlund, Tommy, 1952, et al.
(författare)
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Nonprescription drug-related problems and pharmacy interventions.
- 2001
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Ingår i: The Annals of pharmacotherapy. - 1060-0280. ; 35:11, s. 1343-1349
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To document the number and types of drug-related problems (DRPs) identified in customers purchasing nonprescription products in Swedish pharmacies; describe the distribution of DRPs by customer's gender, age, underlying ailment, and class of drug; determine whether problems are identified to the same extent in pharmacies with staffed nonprescription self-service departments as in pharmacies with over-the-counter sales; and document the number and types of pharmacy interventions to prevent or resolve DRPs, including reasons for drug switches and referrals to physicians. METHODS: A computerized instrument for documentation of DRPs and pharmacy interventions was developed. The study was conducted in 45 volunteer pharmacies in Sweden during ten weeks in late 1999. RESULTS: A total of 1425 problems and 2040 interventions were recorded by 308 pharmacy practitioners. Relatively fewer DRPs were documented in pharmacies with self-service departments. The most common DRPs were uncertainty about the indication for the drug (33.5%) and therapy failure (19.5%). Dyspepsia was the most frequently specified symptom (11.4%). Consumers of dermatologic products had significantly higher rates of problems than expected in relation to sales volume. The most common ways of responding to a problem were with consumer drug counseling (61.1%), switching of drugs (43.9%), and referral to a physician (27.5%). CONCLUSIONS: The study has demonstrated a need for more professional attention and intervention by pharmacy staff to prevent and rectify DRPs in nonprescription consumers. It seems especially important to make sure that consumers receive the appropriate drugs for their current ailments.
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| 30. |
- Westerlund, Tommy, 1952, et al.
(författare)
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Pharmacy practitioners' views on computerized documentation of drug-related problems.
- 2003
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Ingår i: The Annals of pharmacotherapy. - 1060-0280. ; 37:3, s. 354-360
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the practice by community pharmacy practitioners of computerized documentation of drug-related problems (DRPs) and pharmacy interventions in nonprescription drug consumers. METHODS: A questionnaire was administered in December 1999 to pharmacy practitioners in 45 community pharmacies of different sizes and locations across Sweden to survey their attitudes and experiences after participation in a 10-week period of computerized DRP documentation. RESULTS: The participants (n = 376, response rate 84%) found the development of computerized documentation of DRPs and pharmacy interventions to be very important. The instrument was perceived as easy to learn and to work well in daily practice. The documentation made many practitioners more attentive to the drug-related needs of self-care consumers and changed their perception of good quality in self-care counseling. The weighted multiple linear regression analysis showed no correlation between the proportion of practitioners experiencing time constraints and the DRP documentation rate of their work site. However, the magnitude of interest in the documentation practice had a significant effect on the documentation rate, regardless of the extent of the time constraints experienced (p = 0.004). CONCLUSIONS: The positive findings of the evaluation speak in favor of an expanded implementation of computerized documentation of DRPs and pharmacy interventions. Commitment among participating pharmacy practitioners to the new practice is essential and appears to overcome possible time constraints.
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| 31. |
- Besnard, Céline, et al.
(författare)
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Azinyl sulfides - Part LXVIII - X-ray structure of 14-phenyldiquino[3,4 b;4 ',3 '-e][1,4]thiazine
- 2005
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Ingår i: Journal of Chemical Crystallography. - : Springer Science and Business Media LLC. - 1074-1542 .- 1572-8854. ; 35:9, s. 731-736
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Tidskriftsartikel (refereegranskat)abstract
- The title compound 1 (C24H15N3S) crystallizes in an orthorhombic unit cell, with a = 8.2355(3), b = 19.1499(8), and c = 11.3520(5) angstrom, Z = 2, and space group Pnma. The pentacyclic ring system is folded mainly along the S-N(2) axis and slightly along the C(3)-C(4) and C(3')-C(4') axes. The butterfly folding angle between the two quinoline planes is 48.96(3)degrees and the angle between the planes of the two halves of the thiazine ring is 43.46(7)degrees. The central thiazine ring is in a boat conformation. The phenyl substituent is unexpectedly in an axial location with respect to the thiazine ring with the C-N center dot center dot center dot S angle of 114.0(1)degrees and it is perpendicular to the bisecting plane of the pentacyclic ring system.
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