1.
Hellström, Lina, et al.
(författare)
Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
2011
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 67:7, s. 741-752
Tidskriftsartikel (refereegranskat) abstract
PurposeTo examine the impact of systematic medication reconciliations when admitted to hospital, and medication review while in hospital, on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.MethodsA prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Patients received either standard care or care according to the Lund Integrated Medicines Management (LIMM) model. A multi-professional team, including a clinical pharmacist, provided medication reconciliations on admission and medication reviews during the hospital stay for the LIMM group. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within three months of discharge (using WHO causality criteria).ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (p=0.0469).ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits for elderly patients.
2.
Bondesson, Åsa ÅB, et al.
(författare)
A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data
2009
Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 15:4, s. 713-723
Tidskriftsartikel (refereegranskat) abstract
RATIONALE, AIMS AND OBJECTIVE: The objectives were to describe and evaluate the structured medication questionnaire and to improve data handling of results from the Morisky four-item scale for patient compliance and Beliefs about Medicines Questionnaire-specific (BMQ-specific). METHODS: A questionnaire was developed with the purpose of being used when identifying medication errors and assessing patient compliance to and beliefs about medicines. RESULTS: A majority of the respondents (62%; CI 45-77%) had at least one medication error. Assuming that all items are equally important in the Morisky four-item scale we presented four alternative ways to create a unidimensional global scale. A two-dimensional global scale was also constructed. The results from the BMQ-specific were presented in different ways, all taking into account that the scale has ordered verbal categories: at the level addressing each specific question, at the sub-scales 'concern' and 'necessity' level and at the global level. CONCLUSIONS: The structured medication questionnaire can be used in daily practice as a tool to identify drug-related problems. The choice of how to use and present data from those scales in research depends on patient characteristics and how discriminating one would like the scales to be.
3.
4.
Bergkvist, Anna, et al.
(författare)
Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
2009
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 1037-1046
Tidskriftsartikel (refereegranskat) abstract
PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.
5.
Chew, M, et al.
(författare)
Thalidomide inhibits early atherogenesis in apoE-deficient mice
2003
Ingår i: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. - 1600-0463. ; 111:Suppl., s. 113-116
Tidskriftsartikel (refereegranskat) abstract
Inflammation is present in all stages of atherosclerosis, from fatty streaks to rupture of mature plaques. Tumour necrosis factor (TNF)-alpha is expressed in atherosclerotic lesions but its role in atherogenesis has not been defined. To clarify the role of this cytokine, we administered thalidomide, a compound known to inhibit TNF-alpha production, to homozygous apolipoprotein E-deficient (apoE(-/-)) mice in order to examine the effect of thalidomide on the development of early atherosclerotic lesions. Twelve apoE(-/-) mice were randomized to receive either sustained-release thalidomide or placebo pellets implanted subcutaneously, and the amount of atherosclerosis was quantified six weeks later. Thalidomide was well tolerated and did not result in any changes in body weight. Mice treated with thalidomide had significantly smaller mean (7986+/-5189 vs 19607+/-10353 mum(2), p=0.05) and maximum (15800 [12777-23675] vs 37169 [28000-41351] mum(2), p=0.03) lesion sizes than those treated with placebo. Thus, thalidomide is capable of inhibiting the early development of atherosclerosis, presumably by inhibition of TNF-alpha secretion.
6.
Eriksson, Tommy, et al.
(författare)
Criteria for medicines management in hospitals
2011
Ingår i: EJHP Science. - 1781-7595. ; 17:3, s. 83-88
Tidskriftsartikel (refereegranskat) abstract
Study objectives: The aim of this study was to develop quality criteria for further development and use in the Medicines Management(MM) process in European hospitals. Methods: Criteria for MM were developed in three steps using a modified two-stage Delphi-technique. In the first step a literature search was performed and 300 topics were listed. These topics were grouped into three dimensions, eight main and 23 sub areas, rephrased and a questionnaire including 114 criteria that could be perceived as important today and in the near future was prepared. In steps 2 and 3 a panel of experts independently, based on questionnaires, evaluated the importance between the dimensions, areas, and criteria on a four-level Likert-scale. In the second questionnaire the panel had access to the group results from the first questionnaire. Total importance and the three domains of patient safety, environment, and cost-effectiveness were evaluated. Results: Nine of 11 experts completed the two questionnaires. The three dimensions of patient use, healthcare handling, and strategic MM work, were well balanced and the importance ratings between them were 35, 39, and 26%, respectively. No criteria had a full mean importance of 4 but 31 criteria scored between 3.6 and 3.9. The patient safety domain importance scores were generally very high and the environmental domain low. Five criteria were considered to be of very big importance among all experts in the patient safety domain and none in the other two domains. Conclusion: This study provides important information on criteria for the further development of standards and indicators for a quality system in hospital settings, High Performance Medicines Management (HPMM).
7.
Eriksson, Tommy, et al.
(författare)
Experiences from the implementation of structured patient discharge information for safe medication reconciliation at a Swedish university hospital
2011
Ingår i: EJHP Science. - 1781-7595. ; 17:2, s. 42-49
Tidskriftsartikel (refereegranskat) abstract
Study objectives: A method for medication reconciliation that reduces medication errors and healthcare contacts when a patient is discharged from hospital, LIMM-DI (Lund integrated medicines management-discharge information) had been previously developed by the authors. LIMM-DI is structured information written for the patient and sent to the next caregiver. In this study, the use (implementation ratio) and errors when used were measured. Methods: During two three-week periods in 2008 and 2009 information on the use of LIMM-DI for every discharged patient at Skåne University Hospital in Lund, Sweden was collected. Medication errors and quality by chart reviews based on a previously developed checklist were also measured. The focus was placed on the medication report—which medications have been changed and why—and the medication list, two vital parts of LIMM-DI. Results: One hundred and thirty eight (27%) and 163 (31%) of the patients received LIMM-DI in periods 1 and 2, respectively. The mean number of errors per patient decreased from period 1 to 2 in the medication list (6.5 [standard deviation, SD, 6.0] versus 3.9 (SD, 4.2), p = 0.00098) but not in the medication report (5.3 [SD, 6.3] versus 5.3 [SD, 5.9], p = 0.99). Conclusion: Contrary to expectations, the implementation of LIMM-DI was slow and there was no great reduction in the number of medication errors. There is a need to improve the current strategy and to consider alternative strategies for improving patient safety in the discharge medication reconciliation process.
8.
9.
Eriksson, Tommy
(författare)
Pharmacokinetics of the enantiomers of thalidomide
1997
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Thalidomide has a chiral center and the racemate of (+)-(R) and (-)-(S)-thalidomide was introduced as a hypnotic/sedative drug in 1957. In 1961 it was withdrawn due to teratogenicity and neuropathy. There is a growing interest in thalidomide treatment of immunomodulatory diseases. Given this renewed interest the aim of this thesis was to achieve a more rational use of thalidomide. Therefore some chemical and pharmacological aspects of the racemate and of the enantiomers were studied, with special emphasis on the pharmacokinetics of the enantiomers. HPLC assays for determination of thalidomide, its enantiomers and some hydroxylated metabolites were developed. So were different compartment models to describe the pharmacokinetics of the enantiomers of oral and i.v. administration. Solutions for i.v. administration of the enantiomers and methodology for concentration-effect relationship studies (sedation) of the enantiomers were developed. In addition, methods were created to avoid hydrolysis and chiral inversion in blood samples and during assay. The plasma protein binding was 56 for (+)-(R)- and 66% for (-)-(S)-thalidomide. Serum albumin catalysed the inversion, but not the degradation, at pH 7.4. This catalysis was inhibited to various extents in human plasma, and by capric acid, ASA or physostigmine. This supports that chiral inversion and hydrolysis occur by different mechanisms. The pharmacokinetics in a total of 22 healthy male volunteers was studied. The t½ was lower (4.7 h) than previously reported. CLtot was 14 and 24 L/h, and Vdss was 48 and 66 L for (+)-(R)- and (-)-(S)-thalidomide, respectively. It was shown that (+)-(R)-thalidomide is responsible for the sedative effects in humans. Other researchers have shown that the teratogenic and immunomodulatory effects possibly reside in the (-)-(S)-enantiomer. However, the tragedy in the 60s could not have been avoided with the use of the (+)-(R)-enantiomer since this study shows that there is rapid chiral inversion between the enantiomers in humans. The (+)-(R)-enantiomer is predominating at pseudoequilibrium, 8-10 hours after an oral dose of the separate enantiomers. 5'-hydroxy thalidomide but not three other hydroxylated metabolites were found in low concentrations in plasma from all 8 subjects, with a detection limit of 1-2 ng/ml. Three of the hydroxylated metabolites were identified after incubation with human S9 liver homogenate. Further development and studies of oral and i.v. administration forms based on (-)-(S)-thalidomide is suggested.
10.
