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Hospitalizations due to preventable adverse reactions—a systematic review. Eur J Clin Pharmacol 2016; 73:385-398. [PMID: 27913837 DOI: 10.1007/s00228-016-2170-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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Colombo D, Zagni E, Nica M, Rizzoli S, Ori A, Bellia G. Gender differences in the adverse events' profile registered in seven observational studies of a wide gender-medicine (MetaGeM) project: the MetaGeM safety analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2917-2927. [PMID: 27695289 PMCID: PMC5028083 DOI: 10.2147/dddt.s97088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background MetaGeM is a wide gender-medicine project comprising post hoc and meta-analyses by gender of clinical outcomes, therapeutic approaches, and safety data from previously conducted observational studies to explore possible gender differences in real-life clinical settings. We report the results of the safety meta-analysis of seven MetaGeM studies, evaluating gender differences in adverse event (AE) incidence and severity. Methods Data were collected between February 2002 and July 2013. Male and female patients were compared for the main safety variables, using Student’s t-test, χ2 test, or Fisher’s exact test as appropriate. As supportive analysis, a logistic regression model was estimated to evaluate associations between gender and outcome. Results In total, 4,870 patients (46% females, 54% males) were included in the analysis; age was higher for females (mean ± standard deviation 61.2±18.3 years) than males (56.3±16.6 years). Overall, 264 AEs were reported (59.1% in males). There were no significant gender differences in the percentage of patients with at least one AE: 3.0% for females versus 3.9% for males, χ2 test P>0.05. According to the logistic regression model results, no association between gender and AEs occurrence seems to exist. A statistically significant gender difference in the percentage of drug-related AEs emerged (37.6% in females vs 20.8% in males, χ2P=0.0039). Slightly significantly more AEs in females were addressed with treatment compared with males (78.1% vs 66.7%, χ2P=0.0485). Total serious AEs (SAEs) were 47 (72% in males). The frequency of patients with ≥1 SAE was 0.6% in females versus 1.2% in males (χ2 test P=0.0246). Conclusion This safety analysis on a large sample of almost 5,000 patients with different diseases and treated with a wide range of different drugs provides a useful overview on possible gender differences in drug tolerability, which may be helpful in more accurately designing future clinical trials from a gender-specific perspective.
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Affiliation(s)
- Delia Colombo
- Patient Access, Novartis Farma S.p.A., Origgio, Varese
| | | | - Mihaela Nica
- Patient Access, Novartis Farma S.p.A., Origgio, Varese
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Teka F, Teklay G, Ayalew E, Teshome T. Potential drug-drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross sectional study. BMC Res Notes 2016; 9:431. [PMID: 27585436 PMCID: PMC5009535 DOI: 10.1186/s13104-016-2238-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 08/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The elderly are considered as special population, as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics, vulnerability to drug-drug interactions and adverse drug reactions. Despite the fact that the elderly patients are at high risk of having drug interaction and potential adverse outcomes, studies in this regard are scarce in resource limited settings like Ethiopia. The aim of this study was to assess the prevalence and determinants of potential drug-drug interaction in elderly patients admitted to medical ward of Ayder Referral Hospital in Northern Ethiopia. METHODS A cross sectional study was conducted among elderly inpatients aged 60 years and above. The study was conducted from February to May 2014. Prescribed drugs being taken concurrently for at least 24 h were included and checked for drug-drug interaction using Micromedex® 2.0 online drug reference. Data were analyzed using statistical software, statistical package for social sciences for windows version 20. Logistic regression model was used to analyze factors associated with occurrence of drug interaction. P value of <0.05 was considered statistically significant. RESULTS A total of 140 patients were participated in the study. The mean age (±standard deviation) of participants was 68 (±7) years. Majority (61.4 %) of patients were diagnosed with cardiovascular and/or renal diseases. A total of 814 drugs were prescribed with a mean of 6 (±4) medications per patient during a 13 (±9) days of hospital stay. About two-third (62.2 %) of the respondents were exposed to at least one potential drug-drug interaction. Among these 3.6, 32.9 and 25.7 % of patients had taken contraindicated drug combination, at least one major and at least one moderate drug-drug interaction, respectively. Patients with five or more prescribed medications were four times at risk of having drug-drug interaction (P = 0.00; adjusted odds ratio 4.047; 95 % confidence interval 1.867-8.775). CONCLUSION Drug-drug interaction in elderly patients was common in this resource limited set-up. Awareness creation and clinical pharmacist involvement in minimizing the risk associated with potentially harmful drug combinations are needed.
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Affiliation(s)
- Fantaye Teka
- Forecasting and Capacity Building Directorate, The Federal Democratic Republic of Ethiopia Pharmaceutical Fund and Supply Agency, Addis Ababa, Ethiopia
| | - Gebrehiwot Teklay
- Clinical Pharmacy Course and Research Unit, Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Eskindeir Ayalew
- Clinical Pharmacy Course and Research Unit, Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Terefe Teshome
- Pharmacoepidemiology and Social Pharmacy Course and Research Unit, Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Zheng Y, Lan C, Peng H, Li J. Using constrained information entropy to detect rare adverse drug reactions from medical forums. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:2460-2463. [PMID: 28268822 DOI: 10.1109/embc.2016.7591228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Adverse drug reactions (ADRs) detection is critical to avoid malpractices yet challenging due to its uncertainty in pre-marketing review and the underreporting in post-marketing surveillance. To conquer this predicament, social media based ADRs detection methods have been proposed recently. However, existing researches are mostly co-occurrence based methods and face several issues, in particularly, leaving out the rare ADRs and unable to distinguish irrelevant ADRs. In this work, we introduce a constrained information entropy (CIE) method to solve these problems. CIE first recognizes the drug-related adverse reactions using a predefined keyword dictionary and then captures high- and low-frequency (rare) ADRs by information entropy. Extensive experiments on medical forums dataset demonstrate that CIE outperforms the state-of-the-art co-occurrence based methods, especially in rare ADRs detection.
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Carnovale C, Gentili M, Fortino I, Merlino L, Clementi E, Radice S, on behalf the ViGer Group. The importance of monitoring adverse drug reactions in elderly patients: the results of a long-term pharmacovigilance programme. Expert Opin Drug Saf 2016; 15:131-9. [DOI: 10.1517/14740338.2016.1131816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Milan, Lombardy Region, Italy
| | - Luca Merlino
- Regional Health Ministry, Milan, Lombardy Region, Italy
| | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital “Luigi Sacco”, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
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Brunner-La Rocca HP, Fleischhacker L, Golubnitschaja O, Heemskerk F, Helms T, Hoedemakers T, Allianses SH, Jaarsma T, Kinkorova J, Ramaekers J, Ruff P, Schnur I, Vanoli E, Verdu J, Zippel-Schultz B. Challenges in personalised management of chronic diseases-heart failure as prominent example to advance the care process. EPMA J 2016; 7:2. [PMID: 26913090 PMCID: PMC4765020 DOI: 10.1186/s13167-016-0051-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022]
Abstract
Chronic diseases are the leading causes of morbidity and mortality in
Europe, accounting for more than 2/3 of all death causes and 75 % of the healthcare
costs. Heart failure is one of the most prominent, prevalent and complex chronic
conditions and is accompanied with multiple other chronic diseases. The current
approach to care has important shortcomings with respect to diagnosis, treatment and
care processes. A critical aspect of this situation is that interaction between
stakeholders is limited and chronic diseases are usually addressed in
isolation. Health care in Western countries requires an innovative approach to
address chronic diseases to provide sustainability of care and to limit the
excessive costs that may threaten the current systems. The increasing prevalence of
chronic diseases combined with their enormous economic impact and the increasing
shortage of healthcare providers are among the most critical threats. Attempts to
solve these problems have failed, and future limitations in financial resources will
result in much lower quality of care. Thus, changing the approach to care for
chronic diseases is of utmost social importance.
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Affiliation(s)
- Hans-Peter Brunner-La Rocca
- Heart Failure Clinic, Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | | | | | - Thomas Helms
- German Foundation for the Chronically Ill, Fürth, Germany
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McKay AJ, Newson RB, Soljak M, Riboli E, Car J, Majeed A. Are primary care factors associated with hospital episodes for adverse drug reactions? A national observational study. BMJ Open 2015; 5:e008130. [PMID: 26715478 PMCID: PMC4710827 DOI: 10.1136/bmjopen-2015-008130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/15/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Identification of primary care factors associated with hospital admissions for adverse drug reactions (ADRs). DESIGN AND SETTING Cross-sectional analysis of 2010-2012 data from all National Health Service hospitals and 7664 of 8358 general practices in England. METHOD We identified all hospital episodes with an International Classification of Diseases (ICD) 10 code indicative of an ADR, in the 2010-2012 English Hospital Episode Statistics (HES) admissions database. These episodes were linked to contemporary data describing the associated general practice, including general practitioner (GP) and patient demographics, an estimate of overall patient population morbidity, measures of primary care supply, and Quality and Outcomes Framework (QOF) quality scores. Poisson regression models were used to examine associations between primary care factors and ADR-related episode rates. RESULTS 212,813 ADR-related HES episodes were identified. Rates of episodes were relatively high among the very young, older and female subgroups. In fully adjusted models, the following primary care factors were associated with increased likelihood of episode: higher deprivation scores (population attributable fraction (PAF)=0.084, 95% CI 0.067 to 0.100) and relatively poor glycated haemoglobin (HbA1c) control among patients with diabetes (PAF=0.372; 0.218 to 0.496). The following were associated with reduced episode likelihood: lower GP supply (PAF=-0.016; -0.026 to -0.005), a lower proportion of GPs with UK qualifications (PAF=-0.035; -0.058 to -0.012), lower total QOF achievement rates (PAF=-0.021; -0.042 to 0.000) and relatively poor blood pressure control among patients with diabetes (PAF=-0.144; -0.280 to -0.022). CONCLUSIONS Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators. Further investigation with individual level data would help develop understanding of the associations identified. Interventions in primary care could help reduce the ADR burden. ADRs are candidates for primary care sensitive conditions.
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Affiliation(s)
- Ailsa J McKay
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Roger B Newson
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
| | - Josip Car
- Department of Primary Care and Public Health, Imperial College London, London, UK Department of LKCMedicine, Imperial College London-Nanyang Technological University, Singapore, Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Siramshetty VB, Nickel J, Omieczynski C, Gohlke BO, Drwal MN, Preissner R. WITHDRAWN--a resource for withdrawn and discontinued drugs. Nucleic Acids Res 2015; 44:D1080-6. [PMID: 26553801 PMCID: PMC4702851 DOI: 10.1093/nar/gkv1192] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/25/2015] [Indexed: 01/03/2023] Open
Abstract
Post-marketing drug withdrawals can be associated with various events, ranging from safety issues such as reported deaths or severe side-effects, to a multitude of non-safety problems including lack of efficacy, manufacturing, regulatory or business issues. During the last century, the majority of drugs voluntarily withdrawn from the market or prohibited by regulatory agencies was reported to be related to adverse drug reactions. Understanding the underlying mechanisms of toxicity is of utmost importance for current and future drug discovery. Here, we present WITHDRAWN, a resource for withdrawn and discontinued drugs publicly accessible at http://cheminfo.charite.de/withdrawn. Today, the database comprises 578 withdrawn or discontinued drugs, their structures, important physico-chemical properties, protein targets and relevant signaling pathways. A special focus of the database lies on the drugs withdrawn due to adverse reactions and toxic effects. For approximately one half of the drugs in the database, safety issues were identified as the main reason for withdrawal. Withdrawal reasons were extracted from the literature and manually classified into toxicity types representing adverse effects on different organs. A special feature of the database is the presence of multiple search options which will allow systematic analyses of withdrawn drugs and their mechanisms of toxicity.
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Affiliation(s)
- Vishal B Siramshetty
- Structural Bioinformatics Group, ECRC Experimental and Clinical Research Center, Charité - University Medicine Berlin, 13125 Berlin, Germany
| | - Janette Nickel
- Structural Bioinformatics Group, Institute of Physiology, Charité - University Medicine Berlin, 13125 Berlin, Germany German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christian Omieczynski
- Structural Bioinformatics Group, Institute of Physiology, Charité - University Medicine Berlin, 13125 Berlin, Germany
| | - Bjoern-Oliver Gohlke
- Structural Bioinformatics Group, Institute of Physiology, Charité - University Medicine Berlin, 13125 Berlin, Germany German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Malgorzata N Drwal
- Structural Bioinformatics Group, Institute of Physiology, Charité - University Medicine Berlin, 13125 Berlin, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Institute of Physiology, Charité - University Medicine Berlin, 13125 Berlin, Germany German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany BB3R - Berlin Brandenburg 3R Graduate School, Freie Universität Berlin, 14195 Berlin, Germany
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 425] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Hohl CM, Wickham ME, Sobolev B, Perry JJ, Sivilotti MLA, Garrison S, Lang E, Brasher P, Doyle-Waters MM, Brar B, Rowe BH, Lexchin J, Holland R. The effect of early in-hospital medication review on health outcomes: a systematic review. Br J Clin Pharmacol 2015; 80:51-61. [PMID: 25581134 DOI: 10.1111/bcp.12585] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/20/2014] [Accepted: 01/04/2015] [Indexed: 11/28/2022] Open
Abstract
AIMS Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data. METHODS We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis. RESULTS We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] -0.04 days, 95% confidence interval [CI] -1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design. CONCLUSIONS Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Maeve E Wickham
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Boris Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.,School of Population and Public Health, The University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9
| | - Jeff J Perry
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Ave., E-Main Room EM-206, Box 227, Ottawa, Ontario, K1Y 4E9.,Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON, K1Y 4E9
| | - Marco L A Sivilotti
- Departments of Emergency Medicine, and of Biomedical & Molecular Sciences, Queen's University, c/o 76 Stuart Street, Kingston, ON, K7L 2 V7
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, 8215-112 Street NW, Room 1706 College Plaza, Edmonton, Alberta
| | - Eddy Lang
- Department of Emergency Medicine, Faculty of Medicine, University of Calgary, Rockyview General Hospital, HCAC building, 7007 14th St. SW, Calgary, AB, T2V 1P9
| | - Penny Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada.,Department of Statistics, The University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Baljeet Brar
- Department of Emergency Medicine, The University of British Columbia, 855 West 12thAvenue, Vancouver, British Columbia, V5Z 1 M9, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 1G1.42 Walter Mackenzie Building, Edmonton, AB, T6G 2B7
| | - Joel Lexchin
- School of Health Policy and Management, York University, 4700 Keele St., Toronto, ON, M3J 1P3.,Emergency Department, University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4
| | - Richard Holland
- Public Health Medicine, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, United Kingdom
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Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review. Br J Clin Pharmacol 2015; 80:808-17. [PMID: 25677107 DOI: 10.1111/bcp.12600] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 12/01/2022] Open
Abstract
In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85,212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients.
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Affiliation(s)
- Eva A Saedder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Lisby
- Research Centre of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Birgitte Brock
- Department of Biochemistry and Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
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Nguyen TA, Caughey G, Pratt N, Shakib S, Kemp A, Roughead E. Hospitalization for drug-induced hepatotoxicity: linking Y-codes with pharmaceutical claims data to identify implicated medicines. J Clin Pharm Ther 2015; 40:213-9. [DOI: 10.1111/jcpt.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T. A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - G. Caughey
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - N. Pratt
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - S. Shakib
- Department of Clinical Pharmacology; The Royal Adelaide Hospital; Adelaide SA Australia
| | - A. Kemp
- Centre for Health Services Research; School of Population Health; The University of Western Australia; Crawley SA Australia
| | - E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
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Hohl CM, McGrail K, Sobolev B. The effect of pharmacist-led medication review in high-risk patients in the emergency department: an evaluation protocol. CMAJ Open 2015; 3:E103-10. [PMID: 25844362 PMCID: PMC4382036 DOI: 10.9778/cmajo.20140010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adverse drug events are unintended and harmful events related to medication use. They are a leading cause of visits to the emergency department, unplanned admissions to hospital and death. Adverse drug events can be misdiagnosed in the emergency department, resulting in treatment delays. Our objective was to describe a process to evaluate the effect of pharmacist-led medication review in high-risk patients in the emergency department on the number of days these patients subsequently spent in hospital within 30 days of their index visit. METHODS We describe the evaluation of a prospective multicentre quality improvement program. During the evaluation period, triage nurses will flag incoming patients to the emergency department at high risk for adverse drug events by applying a clinical decision rule consisting of 4 variables (comorbid conditions, antibiotic use within 7 days, medication changes within 28 days and age). Consecutive eligible patients will be enrolled in the study and systematically allocated to either a pharmacist-led medication review group or a control group. In the intervention group, pharmacists will collect best-possible medication histories, review the patient's medications for appropriateness and adverse drug events, and communicate the results of their medication review to patients, caregivers and physicians. In the control group, nurses will start medication reconciliation by collecting best-possible medication histories, and physicians will refer patients to onsite pharmacists for specific medication management questions as needed. Health outcomes will be assessed using anonymized data linkage to administrative health databases. The primary outcome will be the percent days spent in hospital over a 30-day period. INTERPRETATION This protocol describes the methods for evaluating the effect of pharmacist-led medication review in high-risk patients in the emergency department on use of health services, and highlights the methodological challenges that will be encountered. We plan to disseminate the results of this evaluation through articles published in peer-reviewed journals, presentations at scientific meetings and briefing notes to institutional, provincial and national stakeholders.
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Affiliation(s)
- Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, BC
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver BC
| | - Boris Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
- School of Population and Public Health, University of British Columbia, Vancouver, BC
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Perrone V, Conti V, Venegoni M, Scotto S, Degli Esposti L, Sangiorgi D, Prestini L, Radice S, Clementi E, Vighi G. Seriousness, preventability, and burden impact of reported adverse drug reactions in Lombardy emergency departments: a retrospective 2-year characterization. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:505-14. [PMID: 25506231 PMCID: PMC4259870 DOI: 10.2147/ceor.s71301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to determine the prevalence of adverse drug reactions (ADRs) reported in emergency departments (EDs) and carry out a thorough characterization of these to assess preventability, seriousness that required hospitalization, subsequent 30-day mortality, and economic burden. Methods This was a retrospective cohort study of data from an active pharmacovigilance project at 32 EDs in the Lombardy region collected between January 1, 2010 and December 31, 2011. Demographic, clinical, and pharmacological data on patients admitted to EDs were collected by trained and qualified monitors, and deterministic record linkage was performed to estimate hospitalizations. Pharmacoeconomic analyses were based on Diagnosis-Related Group reimbursement. Results 8,862 ADRs collected with an overall prevalence rate of 3.5 per 1,000 visits. Of all ADRs, 42% were probably/definitely preventable and 46.4% were serious, 15% required hospitalization, and 1.5% resulted in death. The System Organ Classes most frequently associated with ADRs were: skin and subcutaneous tissue, gastrointestinal, respiratory thoracic and mediastinal, and nervous system disorders. The most common Anatomical Therapeutic Chemical classes involved in admissions were J (anti-infectives and immunomodulating agents), B (blood and blood-forming organs), and N (nervous system). Older age, yellow and red triage, higher number of concomitantly taken drugs, and previous attendance in ED for the same ADR were significantly associated with an increased risk of hospitalization. The total cost associated with ADR management was €5,184,270, with a mean cost per patient of €585. Fifty-eight percent of the economic burden was defined as probably/definitely preventable. Conclusion ADRs are a serious health/economic issue in EDs. This assessment provides a thorough estimation of their seriousness, preventability, and burden impact in a large population from a representative European region.
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Affiliation(s)
- Valentina Perrone
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy
| | - Valentino Conti
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | - Mauro Venegoni
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | - Stefania Scotto
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | | | - Diego Sangiorgi
- CliCon Srl, Health, Economics and Outcomes Research, Ravenna, Italy
| | - Lucia Prestini
- Unit of Clinical Pharmacology and Pharmacovigilance, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy ; Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Giuseppe Vighi
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy ; Unit of Clinical Pharmacology and Pharmacovigilance, Niguarda Ca'Granda Hospital, Milan, Italy
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Bénard-Laribière A, Miremont-Salamé G, Pérault-Pochat MC, Noize P, Haramburu F. Incidence of hospital admissions due to adverse drug reactions in France: the EMIR study. Fundam Clin Pharmacol 2014; 29:106-11. [PMID: 24990220 DOI: 10.1111/fcp.12088] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Abstract
To assess the incidence of hospital admissions related to adverse drug reactions (ADRs) in France and the frequency of preventable ADRs in France, a prospective study was conducted among a representative randomly selected sample of medical wards in public hospitals between December 2006 and June 2007; all patients admitted during a 2-week period were included. An ADR-related hospitalization case was defined as a hospital admission because of an ADR, and an independent committee reviewed and validated all potential cases. Preventability was assessed using the French ADR preventability scale. Data were extrapolated to the population of France. Among 2692 admissions, 97 were related to an ADR (incidence 3.6%, 95% confidence interval, CI [2.8-4.4]). Patients admitted for an ADR were significantly older than those admitted for other reasons (P < 0.001). A third (32.0%) of ADR-related hospitalizations were 'preventable', 16.5% 'potentially preventable'. Drug interactions accounted for 29.9% of ADR-related hospitalizations. The most frequent causes of ADR-related hospitalizations were vascular disorders (20.6%), mainly bleeding complications, central nervous system disorders (11.3%), gastrointestinal disorders, and general disorders (9.3%). Antithrombotic and antineoplastic agents were the most frequently involved (12.6% each), followed by diuretics and analgesics (9.0% each). Vitamin-K-antagonists (VKAs) were the most common drugs associated with admission. The estimated annual number of ADR-related hospitalizations in France was 143 915 (95% CI [112 063-175 766]). ADRs were a significant cause of hospital admission in 2006-2007, in particular those due to VKAs. As new oral anticoagulants (NOACs) have been marketed, more attention needs to be paid to ensure a safe use of antithrombotic agents.
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de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf 2014; 4:147-54. [PMID: 25114778 DOI: 10.1177/2042098613486829] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Falls are the leading cause of injuries among older adults, aged 65 years and older. Furthermore, falls are an increasing public health problem because of ageing populations worldwide due to an increase in the number of older adults, and an increase in life expectancy. Numerous studies have identified risk factors and investigated possible strategies to prevent (recurrent) falls in community-dwelling older people and those living in long-term care facilities. Several types of drugs have been associated with an increased fall risk. Since drugs are a modifiable risk factor, periodic drug review among older adults should be incorporated in a fall prevention programme.
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Affiliation(s)
- Marlies R de Jong
- Reinier de Graaf Group, Departement of Surgery, Reinier de Graafweg 3-11, 2625 AD Delft, The Netherlands
| | | | - Klaas A Hartholt
- Department of Surgery, Reinier de Graaf Group, Delft, and Department of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Franconi F, Campesi I. Sex and gender influences on pharmacological response: an overview. Expert Rev Clin Pharmacol 2014; 7:469-85. [DOI: 10.1586/17512433.2014.922866] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Adverse drug reactions in an emergency medical dispatching centre. Eur J Clin Pharmacol 2014; 70:881-7. [PMID: 24798891 DOI: 10.1007/s00228-014-1685-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to assess the incidence of adverse drug reactions (ADR) leading to call an emergency medical dispatching centre. METHODS A prospective, observational, monocentric clinical study performed over a 2-year period (2011-2012) in a French prehospital emergency dispatching centre, the Service d'Aide Médicale Urgente (SAMU) covering 1,156,000 inhabitants. All adult patients (age≥18) who called for any cause were included. We created an electronic trigger 'iatrogenic event' implemented by the dispatching physician for each suspected case of ADR, then we completed the analyses of all the cases with a chief complain represented in more than 1% of the triggered cases. The primary outcome variable was the occurrence of any possible ADR. We then used the French method of causal relationship assessment. RESULTS The SAMU dispatched 339,915 calls during the study. In total, 1,467 ADRs were identified, representing 0.95% (CI 95% 0.90-1.00%) of cases. ADRs were as serious (SADR) in 51.06% (CI 95% 48.45-53.67%) of cases. The major ADR observed was haemorrhage, (42.81% (CI 95% 40.62-45.00%), n=628) followed by allergy, hypoglycaemia, vomiting, dizziness and drowsiness. The class of drugs most frequently involved was antithrombotic (43.69% (CI 95% 41.45-45.93%), n=641), followed by insulin (17.98% (CI 95%:17.06-18.90%), n=264). CONCLUSIONS Emergency calls concerning ADRs were estimated as 9/1,000, and one out of two is serious.
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Hohl CM, Karpov A, Reddekopp L, Stausberg J. ICD-10 codes used to identify adverse drug events in administrative data: a systematic review. J Am Med Inform Assoc 2014; 21:547-57. [PMID: 24222671 PMCID: PMC3994866 DOI: 10.1136/amiajnl-2013-002116] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/23/2013] [Accepted: 10/27/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events. METHODS We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner. RESULTS Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156-289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0-59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set. CONCLUSIONS Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Andrei Karpov
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Reddekopp
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jürgen Stausberg
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
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Stausberg J. International prevalence of adverse drug events in hospitals: an analysis of routine data from England, Germany, and the USA. BMC Health Serv Res 2014; 14:125. [PMID: 24620750 PMCID: PMC3984698 DOI: 10.1186/1472-6963-14-125] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse drug events (ADEs) are frequent in hospitals, occurring either in patients before admission or as a nosocomial event, and either as a drug reaction or as a consequence of a medication error. Routine data primarily recorded for reimbursement purposes are increasingly being used on a national level both in pharmacoepidemiological studies and in trigger tools. The aim of this study was to compare the prevalence rates of coded ADEs in hospitals on a transnational level. METHODS Hospital data for England and the USA were obtained for the fiscal or calendar year 2006. German data for 2006 were accessed via teleprocessing with the Federal Statistical Office. The datasets from England and the USA were adapted to the German data. About 6 million (England), 7 million (USA), and 16 million (Germany) inpatients could be included. ADEs were identified through a list of codes used in the national diagnosis classifications. RESULTS The overall prevalence rate (and 95% confidence interval, CI) of coded ADEs was 3.22% (3.20-3.23%) for England, 4.78% (4.73-4.83%) for Germany, and 5.64% (5.63-5.66%) for the USA. Most of the English ADE cases occurred in patients admitted as emergency. A non-surgical status and a longer length of stay were consistently associated with the occurrence of an ADE. Enterocolitis caused by Clostridium difficile was the most frequent ADE in all countries. CONCLUSIONS According to routine data, the overall ADE prevalence rates for England, Germany, and the USA are different. However, the differences are narrower than those determined from the rates of ADEs or adverse drug reactions inferred from prospective or retrospective pharmacoepidemiological studies. Since the ADEs in the countries examined in this study share several characteristics, the use of routine data for transnational research on ADEs is feasible.
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Affiliation(s)
- Jürgen Stausberg
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany.
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Barbosa BRD, Barbosa SF, Tavares GD, Chacra NAB, Pinto TDJA. Critical evaluation of the off-label indication and of the risks associated to the use of multi-dose vials on the treatment of age-related macular degeneration. BRAZ J PHARM SCI 2014. [DOI: 10.1590/s1984-82502011000100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Age-related macular degeneration (AMD) is an ocular inflammatory diseases treated mainly by means of a bevacizumab (Avastin®) or ranibizumab (Lucentis®) intravitreal injection. Among these drugs, only ranibizumab has a specific therapeutic indication for AMD. Considering that, the off-label use on ophthalmic therapy seems to become a rule when it should be an exception. Furthermore, bevacizumab presentation consists of multi-dose vials although it does not contain preservatives in its formula. The current literature review aimed at assessing the risks for the patient related to the use of off-label indication and multi-dose vials on AMD treatment. Considering this, the proposal related to the Brazilian Public Consultation no.10, dated September 12, 2012, which proposes the Clinical Protocol and Therapeutic Guidelines for AMD treatment, was evaluated. This systematic review allowed to conclude that the bevacizumab off-label indication results in increased risks for the patient when compared to the product with specific therapeutic indication for AMD treatment (ranibizumab), especially referring to the significant raise in the adverse events. The risks for the patient related to the multi-dose vial use, referring to the microbiological stability and dose precision, were also made clear.
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Qing-ping S, Xiao-dong J, Feng D, Yan L, Mei-ling Y, Jin-xiu Z, Shu-qiang Z. Consequences, measurement, and evaluation of the costs associated with adverse drug reactions among hospitalized patients in China. BMC Health Serv Res 2014; 14:73. [PMID: 24533894 PMCID: PMC3931293 DOI: 10.1186/1472-6963-14-73] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/14/2014] [Indexed: 12/25/2022] Open
Abstract
Background Adverse drug reactions (ADRs) are a leading cause of morbidity in developed countries and represent a substantial burden on health-care resources. Many countries spent 15% to 20% of their hospital budgets to treat drug complications. However, few studies have measured the pharmacoeconomic effects of ADRs on hospitalized patients in China. The study estimates the costs of ADRs as identified from the spontaneous voluntary reports completed from healthcare professionals. To do so, we calculate these costs, determine the sum of Medicare payments and their proportion of total healthcare spending, and evaluate the incidence of ADRs, characteristics of hospitalized ADR patients, and outcomes of ADRs in China. Methods This retrospective survey studied patients who experienced ADRs during their hospitalization at a Chinese tertiary-care teaching hospital. The patients were divided into group A and group B according to general ADRs and serious ADRs in Provisions for Adverse Drug Reaction Monitoring and Reporting. The direct costs included treatment fees, inspection fees, laboratory fees, materials fees, bed charges, drug charges, nursing care, meals, and other expenses and the sunk-cost losses were calculated according to the hospital information system (HIS). Indirect costs of ADR treatment were calculated according to the human capital approach. The epidemiological characteristics of ADRs were evaluated. Results 2739 were diagnosed with ADR during the study period, which translates to an ADR rate of 0.81%. The total socioeconomic loss from 2739 cases of ADR was estimated at ¥817401.69, consisting of direct costs of ¥603252.81 and indirect costs of ¥214148.88. On average, the costs per patient amounted to ¥196.10 in group A, ¥7032.29 in group B. The sum of medicare payment and proportion were ¥219061.13 (65.23%) and ¥105422.02 (39.42%) in group A and B. The ADR incidence in old-age patients was significantly higher than in other age groups (P < 0.0001). The most common drug class associated with ADRs represented antibiotics (957 patients, 34.94%). Conclusions The costs of especially severe ADRs could not be ignored, and in this hospital 0.13% of patients were diagnosed with ADRs associated with relatively higher direct costs than who suffered from mild ADRs, largely due to extended hospitalization.
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Affiliation(s)
- Shi Qing-ping
- Department of Pharmacy, the first Affiliated Hospital of Bengbu Medical College, 287 Zhihuai Road, Bengbu 233004, China.
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de Paula TC, Bochner R, Montilla DER. Clinical and epidemiological analysis of hospitalizations of elderly due to poisoning and adverse effects of medications, Brazil from 2004 to 2008. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 15:828-44. [PMID: 23515778 DOI: 10.1590/s1415-790x2012000400014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/24/2012] [Indexed: 11/22/2022] Open
Abstract
The elderly are more susceptible to adverse drugs effects due to a variety of factors, such as excessive and concomitant use of several drugs, administration errors, physiological changes in the body that alter the pharmacodynamics and pharmacokinetics. In order to determine the main therapeutic classes involved in hospital admissions of elderly people due to intoxication and adverse drug effects, as well as major health problems related to these events, 9,793 hospitalizations of people aged 60 or over registered in the Hospital Information System of the Unified Health System (SIH-SUS) in the period of 2004 to 2008 were analyzed. Unspecified drugs, systemic antibiotics, psychotropics, psychoactives, antiepileptics, sedatives, hypnotics and antiparkinsonians accounted for 57% of the total of admissions analyzed. Injuries and falls were the main health problems related to intoxication and adverse drug effects. Hospitalizations due to injuries were associated with analgesic, antipyretic and antirheumatic non-opioid. Falls were associated with systemic antibiotics, contradicting studies which point out psychotropic drugs as the main drug involved in these events. The results reflect the growing trend of problems associated with drug use by elderly people. It was verified that the consumption profile alone is not sufficient to explain the concentration of cases of the major therapeutic classes. We suggest the adoption of more effective programs of pharmacovigilance, capable of intervening at different stages of drug use: prescribing, dispensing, marketing, administration and compliance.
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Affiliation(s)
- Tatiana Cruz de Paula
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz
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Paul L, Robinson KM. Capture and documentation of coded data on adverse drug reactions: an overview. Health Inf Manag 2014; 41:27-36. [PMID: 23705134 DOI: 10.1177/183335831204100304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Allergic responses to prescription drugs are largely preventable, and incur significant cost to the community both financially and in terms of healthcare outcomes. The capacity to minimise the effects of repeated events rests predominantly with the reliability of allergy documentation in medical records and computerised physician order entry systems (CPOES) with decision support such as allergy alerts. This paper presents an overview of the nature and extent of adverse drug reactions (ADRs) in Australia and other developed countries, a discussion and evaluation of strategies which have been devised to address this issue, and a commentary on the role of coded data in informing this patient safety issue. It is not concerned with pharmacovigilance systems that monitor ADRs on a global scale. There are conflicting reports regarding the efficacy of these strategies. Although in many cases allergy alerts are effective, lack of sensitivity and contextual relevance can often induce doctors to override alerts. Human factors such as user fatigue and inadequate adverse drug event reporting, including ADRs, are commonplace. The quality of and response to allergy documentation can be enhanced by the participation of nurses and pharmacists, particularly in medication reconciliation. The International Classification of Diseases (ICD) coding of drug allergies potentially yields valuable evidence, but the quality of local and national level coded data is hampered by under-documenting and under-coding.
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Affiliation(s)
- Lindsay Paul
- School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora VIC 3086, Australia.
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Franconi F, Campesi I. Pharmacogenomics, pharmacokinetics and pharmacodynamics: interaction with biological differences between men and women. Br J Pharmacol 2014; 171:580-94. [PMID: 23981051 PMCID: PMC3969074 DOI: 10.1111/bph.12362] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/05/2013] [Accepted: 08/16/2013] [Indexed: 12/16/2022] Open
Abstract
Pharmacological response depends on multiple factors and one of them is sex-gender. Data on the specific effects of sex-gender on pharmacokinetics, as well as the safety and efficacy of numerous medications, are beginning to emerge. Nevertheless, the recruitment of women for clinical research is inadequate, especially during the first phases. In general, pharmacokinetic differences between males and females are more numerous and consistent than disparities in pharmacodynamics. However, sex-gender pharmacodynamic differences are now increasingly being identified at the molecular level. It is now even becoming apparent that sex-gender influences pharmacogenomics and pharmacogenetics. Sex-related differences have been reported for several parameters, and it is consistently shown that women have a worse safety profile, with drug adverse reactions being more frequent and severe in women than in men. Overall, the pharmacological status of women is less well studied than that of men and deserves much more attention. The design of clinical and preclinical studies should have a sex-gender-based approach with the aim of tailoring therapies to an individual's needs and concerns.
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Affiliation(s)
- Flavia Franconi
- Department of Biomedical Sciences, University of SassariSassari, Italy
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and BiosystemsOsilo, Italy
| | - Ilaria Campesi
- Laboratory of Sex-Gender Medicine, National Institute of Biostructures and BiosystemsOsilo, Italy
- Department of Surgical, Microsurgical and Medical Sciences, University of SassariSassari, Italy
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Frequency of metabolic syndrome and 25-hydroxyvitamin D3 levels in patients with non-alcoholic fatty liver disease. Br J Gen Pract 2013; 63:e534-42. [PMID: 24008607 DOI: 10.3399/bjgp13x670660] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM It is known that insulin resistance has an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and that serum 25-hidroksivitamin D3 [25-(OH)D] levels are found low in the presence of insulin resistance. Metabolic syndrome (MetS) is characterized by insulin resistance. The purpose of the present study was to determine the levels of 25-(OH)D and the frequency of MetS in patients with NAFLD, and to evaluate the association of 25-(OH)D with the histology of NAFLD and metabolic parameters. METHOD Sixty-three patients with NAFLD confirmed by liver biopsy (29 females and 34 males, mean age 42.70±9.82 years) and 46 healthy controls (16 females and 30 males, mean age 37.54±8.56 years) were included in the study. International Diabetes Federation criteria were used for MetS diagnosis. Insulin resistance was determined according to the Homeostasis Model of Assessment (HOMA-IR) method. The groups were compared for 25-(OH)D levels and MetS frequencies. Correlation analysis was used to evaluate relationships between 25-(OH)D and metabolic parameters and/or NAFLD histology. RESULTS 25-(OH)D levels were lower in the NAFLD group compared to the control group (36.06±13.07 ng/mL vs. 51.19±23.45 ng/mL, respectively, P<0.01), while MetS frequency was higher (66.7% vs. 15.2%, P<0.01). In the NAFLD group, 25-(OH)D levels were negatively correlated with non-alcoholic steatohepatitis scores and HOMA-IR (r=-0.317, P=0.011 and r=-0.437, P=0.001, respectively). CONCLUSION The present study demonstrated higher frequency of MetS and lower levels of 25-(OH)D in patients with NAFDL, and a negative association of 25-(OH)D levels with non-alcoholic steatohepatitis scores and insulin resistance.
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Lux R, Wärntges S, Bergner S, Kütting B. [Improvement of medication safety by identification of genetically predisposed subjects. Personalized clinical strategies and regulatory advices]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:1545-56. [PMID: 24170084 DOI: 10.1007/s00103-013-1827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because adverse drug events (ADEs) have a high socio-economic impact there is an urgent need for effective prevention. In addition to process-related avoidable errors personalised approaches for the prevention of ADEs should also focus on genetic polymorphisms as potential causative agents. AIM Using five case reports as examples therapeutic modalities are described to illustrate the clinical impact of prospective testing aimed at estimating the individual risk of susceptible subjects. MATERIAL AND METHODS The role of the HLA system, the cytochrome P450 family, other metabolic enzymes and transport proteins are described to illustrate the broad range of genetic susceptibility. It is shown, why, when and for whom pretherapeutic tests on genetic polymorphisms are recommended to reduce the risk of ADEs. RESULTS The determination of genetic susceptibility is already implemented in clinical practice prior to (1) carbamazepine therapy in south-east Asians and (2) treatment with abacavir independent of ethnicity. Before prescribing carbamazepine or abacavir, it is recommended that therapeutic decisions be based on these test results. CONCLUSION The broad application of personalised medicine used as an effective tool for minimizing ADE risks is limited by the evidence-based benefit for the patient on the one hand and the costs of the test on the other hand.
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Affiliation(s)
- R Lux
- Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Deutschland
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78
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Mahmoud MA, Alsowaida Y, Alshammari T, Khan TM, Alrasheedy A, Hassali MA, Aljadhey H. Community pharmacists' knowledge, behaviors and experiences about adverse drug reaction reporting in Saudi Arabia. Saudi Pharm J 2013; 22:411-8. [PMID: 25473329 DOI: 10.1016/j.jsps.2013.07.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/29/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess community pharmacists' knowledge, behaviors and experiences relating to Adverse Drug Reaction (ADR) reporting in Saudi Arabia. METHODS A cross-sectional study was conducted using a validated self-administered questionnaire. A convenience sample of 147 community pharmacists working in community pharmacies in Riyadh, Saudi Arabia. RESULTS The questionnaire was distributed to 147 pharmacists, of whom 104 responded to the survey, a 70.7% response rate. The mean age of participants was 29 years. The majority (n = 101, 98.1%) had graduated with a bachelorette degree and worked in chain pharmacies (n = 68, 66.7%). Only 23 (22.1%) said they were familiar with the ADR reporting process, and only 21 (20.2%) knew that pharmacists can submit ADR reports online. The majority of the participants (n = 90, 86.5%) had never reported ADRs. Reasons for not reporting ADRs most importantly included lack of awareness about the method of reporting (n = 22, 45.9%), misconception that reporting ADRs is the duty of physician and hospital pharmacist (n = 8, 16.6%) and ADRs in community pharmacies are simple and should not be reported (n = 8, 16.6%). The most common approach perceived by community pharmacists for managing patients suffering from ADRs was to refer him/her to a physician (n = 80, 76.9%). CONCLUSION The majority of community pharmacists in Riyadh have poor knowledge of the ADR reporting process. Pharmacovigilance authorities should take necessary steps to urgently design interventional programs in order to increase the knowledge and awareness of pharmacists regarding the ADR reporting process.
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Affiliation(s)
| | - Yazed Alsowaida
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Thamir Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia ; College of Pharmacy, Hail University, Riyadh, Saudi Arabia
| | - Tahir Mehmood Khan
- Department of Pharmacy, Monash University, 46150 Bandar Sunway Selangor Darul Ehsan, Malaysia
| | - Alian Alrasheedy
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohamad Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hisham Aljadhey
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
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Wilbur K, Hazi H, El-Bedawi A. Drug-Related Hospital Visits and Admissions Associated with Laboratory or Physiologic Abnormalities-A Systematic-Review. PLoS One 2013; 8:e66803. [PMID: 23826139 PMCID: PMC3694970 DOI: 10.1371/journal.pone.0066803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Countless studies have demonstrated that many emergency-room visits and hospital admissions are drug-related and that a significant proportion of these drug-related visits (DRVs) are preventable. It has not been previously studied which DRVs could be prevented through enhanced monitoring of therapy. The objective of the study was to determine the incidence of DRVs attributed to laboratory or physiologic abnormalities. Three authors independently performed comprehensive searches in relevant health care databases using pre-determined search terms. Articles discussing DRV associated with poisoning, substance abuse, or studied among existing in-patient populations were excluded. Study country, year, sample, design, duration, DRV identification method, proportion of DRVs associated with laboratory or physiologic abnormalities and associated medications were extracted. The three authors independently assessed selected relevant articles according to the Strengthening the reporting of observational studies in epidemiology (STROBE) as applicable according to the studies' methodology. The initial literature search yielded a total of 1,524 articles of which 30 articles meeting inclusion criteria and reporting sufficient laboratory or physiologic data were included in the overall analysis. Half employed prospective methodologies, which included both chart review and patient interview; however, the overwhelming majority of identified studies assessed only adverse drug reactions (ADRs) as a drug-related cause for DRV. The mean (range) prevalence of DRVs found in all studies was 15.4% (0.44%–66.7%) of which an association with laboratory or physiologic abnormalities could be attributed to a mean (range) of 29.4% (4.3%–78.1%) of cases. Most laboratory-associated DRVs could be linked to immunosuppressant, antineoplastic, anticoagulant and diabetes therapy, while physiologic-associated DRVs were attributed to cardiovascular therapies and NSAIDs. Significant proportions of laboratory and physiologic abnormalities contribute to DRVs and are consistently linked to specific drugs. These therapies are potential targets for enhanced medication monitoring initiatives to proactively avert potential DRVs.
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Affiliation(s)
- Kerry Wilbur
- College of Pharmacy, Qatar University, Doha, Qatar
- * E-mail:
| | - Huda Hazi
- College of Pharmacy, Qatar University, Doha, Qatar
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80
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Fox BI, Hollingsworth JC, Gray MD, Hollingsworth ML, Gao J, Hansen RA. Developing an expert panel process to refine health outcome definitions in observational data. J Biomed Inform 2013; 46:795-804. [PMID: 23770041 DOI: 10.1016/j.jbi.2013.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/30/2013] [Accepted: 05/14/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Drug safety surveillance using observational data requires valid adverse event, or health outcome of interest (HOI) measurement. The objectives of this study were to develop a method to review HOI definitions in claims databases using (1) web-based digital tools to present de-identified patient data, (2) a systematic expert panel review process, and (3) a data collection process enabling analysis of concepts-of-interest that influence panelists' determination of HOI. METHODS De-identified patient data were presented via an interactive web-based dashboard to enable case review and determine if specific HOIs were present or absent. Criteria for determining HOIs and their severity were provided to each panelist. Using a modified Delphi method, six panelist pairs independently reviewed approximately 200 cases across each of three HOIs (acute liver injury, acute kidney injury, and acute myocardial infarction) such that panelist pairs independently reviewed the same cases. Panelists completed an assessment within the dashboard for each case that included their assessment of the presence or absence of the HOI, HOI severity (if present), and data contributing to their decision. Discrepancies within panelist pairs were resolved during a consensus process. RESULTS Dashboard development was iterative, focusing on data presentation and recording panelists' assessments. Panelists reported quickly learning how to use the dashboard. The assessment module was used consistently. The dashboard was reliable, enabling an efficient review process for panelists. Modifications were made to the dashboard and review process when necessary to facilitate case review. Our methods should be applied to other health outcomes of interest to further refine the dashboard and case review process. CONCLUSION The expert review process was effective and was supported by the web-based dashboard. Our methods for case review and classification can be applied to future methods for case identification in observational data sources.
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Affiliation(s)
- Brent I Fox
- Auburn University, Harrison School of Pharmacy, Department of Pharmacy Care Systems, 020 Foy Hall, Auburn, AL 36849, USA.
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Hansen RA, Gray MD, Fox BI, Hollingsworth JC, Gao J, Hollingsworth ML, Carpenter DM. Expert panel assessment of acute liver injury identification in observational data. Res Social Adm Pharm 2013; 10:156-67. [PMID: 23746420 DOI: 10.1016/j.sapharm.2013.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Observational data are useful for studying drug safety; however, to be effective, accurate outcome measurement is paramount. OBJECTIVES This study compared alternative outcome definitions for acute liver injury (ALI) and explored opportunities for improving ALI identification in observational data. METHODS The Truven MarketScan® Lab Database (MSLR) was used to identify patients meeting at least 1 of 4 ALI definitions, including definitions based on diagnosis codes, laboratory measures, or combinations of diagnoses, procedures, and/or laboratory measures. Expert panelists reviewed patient data using a Web dashboard. Panelists determined whether they believed the patient had ALI and identified factors influencing their decision. Logistic regression models explored which factors were influential in case determination. RESULTS Overall, only 37 of 208 reviewed patients (17.8%) were classified as cases. The diagnosis-based definition yielded no positive cases and the laboratory-based definition yielded the most positive cases (31 of 60). The most influential factors in case classification were occurrence of procedures after the index date (OR = 13.2, 95% CI = 5.3-32.9), no occurrence of drug treatments before the index date (OR = 4.6; 95% CI = 1.6-13.2), occurrence of drug treatments before the index date (OR = 0.3; 95% CI = 0.1-0.6), and no drug treatments after the index date (OR = 0.2; 95% CI = 0.0-0.5). CONCLUSIONS Comparing ALI definitions illustrated tradeoffs between the number of plausible cases identified and the likelihood of cases being classified as positive. Future research should refine ALI case definitions, considering the import of laboratory results, procedures, and drugs in defining a case.
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Affiliation(s)
- Richard A Hansen
- Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, AL.
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82
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Adverse drug reactions to local anesthetics: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:319-27. [DOI: 10.1016/j.oooo.2012.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 03/27/2012] [Accepted: 04/03/2012] [Indexed: 02/04/2023]
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83
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Ahern F, Sahm LJ, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study. Emerg Med J 2013; 31:24-9. [DOI: 10.1136/emermed-2012-201945] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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84
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Wu C, Bell CM, Wodchis WP. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Saf 2012; 35:769-81. [PMID: 22823502 PMCID: PMC3714138 DOI: 10.1007/bf03261973] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: The rapid rise in the availability and use of pharmaceutical agents, and particularly polypharmacy, directly increases the risk for patients to experience adverse drug reactions (ADRs). There are few studies on the overall incidence and costs of ADRs. Objective: The aim of this study was to estimate the incidence and costs of emergency department (ED) visits related to ADRs for patients greater than 65 years of age using administrative data, and to describe risk factors for experiencing severe ADRs. Methods: We employed a retrospective cohort design based on population-based healthcare administrative clinical databases. Identification of ADR-related ED visits from the administrative database was based on International Classification of Diseases, 10th Revision-Canadian Enhancement (ICD-10-CA) codes for each ED visit. The incidence and costs of ADR-related ED visits and subsequent hospital admissions were estimated for all adults aged 66 years and above for the period April 2003–March 2008. Costs were standardized and reported in 2008 Canadian dollars. Logistic regression was used to detect risk factors for severe ADRs. Results: Approximately 0.75% of total annual ED visits among adults aged 66 years and above were found to be ADR-related, and among these patients 21.6% were hospitalized. In 2007, the cost of ADR-related visits was $333 per ED visit and $7528 per hospitalization for a total annual cost of $13.6 million in Ontario, or an estimated $35.7 million in Canada. Severe ADRs were associated with sex, age, comorbid disease burden, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and long-term care (LTC) residence. Conclusions: ADRs are an important public health issue that threaten the safety of drug therapy and results in significant economic burden to the healthcare system. ED visits related to ADRs may be underestimated in retrospective studies using administrative data compared with prospective studies. Further research is needed to better understand the risk of experiencing severe ADRs among LTC residents.
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Affiliation(s)
- Chen Wu
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 4th floor, 155 College Street, Suite 425, Toronto, Ontario ON M5T 3M6 Canada
| | - Chaim M. Bell
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 4th floor, 155 College Street, Suite 425, Toronto, Ontario ON M5T 3M6 Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada
- St Michael’s Hospital, Toronto, Ontario Canada
| | - Walter P. Wodchis
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 4th floor, 155 College Street, Suite 425, Toronto, Ontario ON M5T 3M6 Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada
- Toronto Rehabilitation Institute, Toronto, Ontario Canada
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Abstract
Large numbers of frail elderly people spend some time of their lives in care homes. Increasing age is associated with altered physiology, multiple diagnoses and complex comorbidity, and polypharmacy. Those living in care homes often take larger numbers of medications than those who live in the community and the risk of morbidity as a direct or indirect result of medications is high. Many methods have been suggested to revise the number and type of medications prescribed for individuals at risk of adverse drug reactions (ADRs), both in the community and in hospital with variable success and implementation. Assessment of prescribed and nonprescribed medications by pharmacists, nurses and general practitioners all have a role in optimizing therapeutics with evidence that improved prescribing can reduce the risk of ADRs. In conjunction with these professionals, community geriatricians undertaking a comprehensive geriatric assessment can reduce the number of medications prescribed or optimize therapy where there may be underprescribing (e.g. in depression), thereby reducing the overall risk of hospital admission ADRs.
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86
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Haga SB, Burke W, Ginsburg GS, Mills R, Agans R. Primary care physicians' knowledge of and experience with pharmacogenetic testing. Clin Genet 2012; 82:388-94. [PMID: 22698141 PMCID: PMC3440554 DOI: 10.1111/j.1399-0004.2012.01908.x] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/30/2012] [Accepted: 06/04/2012] [Indexed: 11/29/2022]
Abstract
It is anticipated that as the range of drugs for which pharmacogenetic testing becomes available expands, primary care physicians (PCPs) will become major users of these tests. To assess their training, familiarity, and attitudes toward pharmacogenetic testing in order to identify barriers to uptake that may be addressed at this early stage of test use, we conducted a national survey of a sample of PCPs. Respondents were mostly white (79%), based primarily in community-based primary care (81%) and almost evenly divided between family medicine and internal medicine. The majority of respondents had heard of PGx testing and anticipated that these tests are or would soon become a valuable tool to inform drug response. However, only a minority of respondents (13%) indicated they felt comfortable ordering PGx tests and almost a quarter reported not having any education about pharmacogenetics. Our results indicate that primary care practitioners envision a major role for themselves in the delivery of PGx testing but recognize their lack of adequate knowledge and experience about these tests. Development of effective tools for guiding PCPs in the use of PGx tests should be a high priority.
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Affiliation(s)
- S B Haga
- Institute for Genome Sciences & Policy, Duke University, Durham, NC 27708, USA.
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87
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Mandavi, D’Cruz S, Sachdev A, Tiwari P. Adverse drug reactions & their risk factors among Indian ambulatory elderly patients. Indian J Med Res 2012; 136:404-10. [PMID: 23041733 PMCID: PMC3510886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND & OBJECTIVES Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group from outpatient setting. However, adverse drug reactions (ADRs) particularly among a large sample of ambulatory elderly patients in India has not been reported. This study has attempted to identify ADRs and assessed their causality, preventability and severity, and also their risk factors in Indian ambulatory elderly patients. METHODS A 2 year long term prospective study included 4005 ambulatory elderly patients (60 yr or above; either sex) at a public teaching hospital. Suspected ADRs were assessed for causality, preventability and severity using Naranjo's probability scale, modified Schumock and Thornton's criteria, and modified Hartwig's criteria, respectively. RESULTS Of the total 4005 prescriptions, 406 were identified with ADRs, giving the occurrence of 10 per cent ADRs in elderly. The total number of ADRs was 422 in 406 prescriptions. Type A ADRs accounted for 46 per cent of the total ADRs. Majority of the ADRs (88.6%) were classified as 'probable'. The definitely preventable reactions were 22 per cent. The percentage of moderate reaction was 16 per cent. Only 1.6 per cent ADRs was severe in nature. The most common type of ADR was peripheral oedema. The most commonly offending class of drug was cardiovascular drugs (57.6%). Using logistic regression analysis, the risk factors which contributed to ADRs were age above 80 yr (OR=1.7), prescription of multiple drugs (OR=1.8), longer duration of treatment (OR=2.28) and multiple diagnoses (OR=1.8). INTERPRETATION & CONCLUSIONS In this study, 10 per cent ambulatory elderly patients were found to have ADRs. This indicates that the elderly patients should be closely monitored for ADRs, to avoid clinically significant harmful consequences. The awareness of risk factors of ADRs would help physicians to identify elderly patients with greater risk of ADRs and, therefore, might benefit from ADRs monitoring and reporting programme.
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Affiliation(s)
- Mandavi
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education & Research, S.A.S. Nagar, Punjab, India
| | - Sanjay D’Cruz
- Department of General Medicine, Government Medical College & Hospital, Chandigarh, India
| | - Atul Sachdev
- Department of General Medicine, Government Medical College & Hospital, Chandigarh, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education & Research, S.A.S. Nagar, Punjab, India,Reprint requests: Prof. P. Tiwari, Professor & Head, Department of Pharmacy Practice, National Institute of Pharmaceutical Education & Research, Sector 67, SAS Nagar 160 062, Punjab, India e-mail:
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88
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A GENS-based approach to cardiovascular pharmacology: impact on metabolism, pharmacokinetics and pharmacodynamics. Ther Deliv 2012; 2:1437-53. [PMID: 22826875 DOI: 10.4155/tde.11.117] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pharmacological outcomes depend on many factors, with many of them being sexually dimorphic. Thus, physiological gender/sex (GENS) differences can influence pharmacokinetics, pharmacodynamics and, thus, bioavailability and resulting in efficacy of treatment, meaning GENS differences should be an important consideration in therapeutics. In particular, drug response can change according to different hormonal environments. Therefore, GENS-specific differences have a particular clinical relevance in terms of drug delivery, especially for those substances with a narrow therapeutic margin. Since adverse effects are more frequent among women, safety is a key issue. Overall, the status of women, from a pharmacological point of view, is often different and less studied than that of men and deserves particular attention. Further studies focused on women's responses to drugs are necessary in order to make optimal pharmacotherapeutic decisions.
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Thompson RA, Isin EM, Li Y, Weidolf L, Page K, Wilson I, Swallow S, Middleton B, Stahl S, Foster AJ, Dolgos H, Weaver R, Kenna JG. In Vitro Approach to Assess the Potential for Risk of Idiosyncratic Adverse Reactions Caused by Candidate Drugs. Chem Res Toxicol 2012; 25:1616-32. [DOI: 10.1021/tx300091x] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Emre M. Isin
- DMPK Innovative Medicine, AstraZeneca,
Mölndal, 431 83, Sweden
| | - Yan Li
- Discovery DMPK, AstraZeneca, Wilmington,
Delaware, United States
| | - Lars Weidolf
- DMPK Innovative Medicine, AstraZeneca,
Mölndal, 431 83, Sweden
| | - Ken Page
- DMPK
Innovative Medicine, AstraZeneca, Alderley
Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Ian Wilson
- DMPK
Innovative Medicine, AstraZeneca, Alderley
Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Steve Swallow
- Global Safety Assessment, AstraZeneca,
Alderley Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Brian Middleton
- Discovery Sciences, AstraZeneca, Alderley
Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Simone Stahl
- Global Safety Assessment, AstraZeneca,
Alderley Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Alison J. Foster
- Global Safety Assessment, AstraZeneca,
Alderley Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
| | - Hugues Dolgos
- DMPK Innovative Medicine, AstraZeneca,
Mölndal, 431 83, Sweden
| | - Richard Weaver
- Discovery
DMPK, AstraZeneca, Loughborough, Leicestershire
LE11 5RH, United Kingdom
| | - J. Gerry Kenna
- Global Safety Assessment, AstraZeneca,
Alderley Park, Macclesfield, Cheshire
SK10 4TG, United Kingdom
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Burns represent a significant proportion of the total serious trauma workload in England and Wales. Burns 2012; 38:330-9. [DOI: 10.1016/j.burns.2011.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 11/20/2022]
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Tsang C, Majeed A, Aylin P. Routinely recorded patient safety events in primary care: a literature review. Fam Pract 2012; 29:8-15. [PMID: 21878467 DOI: 10.1093/fampra/cmr050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Existing patient-level data can be used to measure and monitor patient safety. Data from sources including electronic patient records are routinely collected in primary care and may be suitable for adverse event screening, such as patient safety indicators. To inform the feasibility of developing primary care measures of patient harm, information about routinely collected data is needed. OBJECTIVE A literature review was conducted to determine the types of adverse events that are routinely recorded in primary care. METHODS We searched ASSIA, Cochrane Library, Embase, HMIC, ISI Web of Science, Medline and PsycInfo databases, grey literature and websites. We included only original research studies in English where routinely collected patient data were used to identify adverse events occurring in primary or ambulatory care settings. Adverse events were defined as unexpected and undesirable patient outcomes arising from health care contact. RESULTS Of 5029 citations identified, 15 were reviewed. Twelve studies used multiple data sources. Approximately 6.5% of adult emergency admissions were due to drug-related events (n = 1225). Between 0.7% and 2.3% of deaths following adverse events were attributed to treatment in primary care. A large proportion of adverse events resulting in the most severe harm may be preventable. For example, one study estimated that 42% of serious adverse drug events were avoidable. CONCLUSIONS There is limited use of routinely collected data to measure adverse events in primary care despite large volumes of data generated. The potential for using readily available data recorded in primary care for active patient safety surveillance needs further exploration.
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Affiliation(s)
- Carmen Tsang
- Dr Foster Unit at Imperial College, Department of Primary Care and Public Health, Imperial College London, London, UK.
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92
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Spoletini I, Vitale C, Malorni W, Rosano GMC. Sex differences in drug effects: interaction with sex hormones in adult life. Handb Exp Pharmacol 2012:91-105. [PMID: 23027447 DOI: 10.1007/978-3-642-30726-3_5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In recent years, it has become clear that women and men may differ for drug response. Also, there is an increasing recognition on the role of sex hormones on pharmacokinetics and pharmacodynamics as mechanism accounting for sex differences in drug effects.In women, the phases of menstrual cycle, of reproductive life and fluctuations in the concentrations of sexual steroids on pharmacokinetics and pharmacodynamics must be considered. Furthermore, the use of oral contraceptives or hormonal replacement therapy, the sex hormone-related changes in total body water or in the amount of fat influence the overall effect of drugs.On the contrary, the influence of androgens on drug effects is minimal because of the even plasma levels of these hormones in adult males.Nevertheless, since women have been scarcely included in the early phases of clinical trials, the results obtained in men have been often translated to women and their exact response to drugs is still not well known.The available evidence suggests that sex hormones influence drug absorption, distribution, metabolism, pharmacodynamics, and adverse effects. For instance, many cardiovascular drugs are metabolized by enzymes of the cytochrome P450 mono-oxygenases system, which is more expressed in females than in males, showing sex differences in drug response.Upcoming pharmacological research should aim to further clarify the influence of sex hormones on drug effects and, for this purpose, to increase the number of women enrolled in all phases of clinical trials. An evidence-based pharmacotherapy in women is therefore auspicable for women's health.
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Affiliation(s)
- Ilaria Spoletini
- Department of Medical Sciences, IRCCS San Raffaele Pisana, via della Pisana, Rome, Italy
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93
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High prevalence of off-label and unlicensed drug prescribing in a Brazilian intensive care unit. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70159-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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94
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Abreu Ferreira LD, Cunha Ibiapina CD, Penido Machado MG, Tavares Fagundes ED. A alta prevalência de prescrições de medicamentos off-label e não licenciados em unidade de terapia intensiva pediátrica brasileira. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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95
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Franconi F, Campesi I, Occhioni S, Antonini P, Murphy MF. Sex and gender in adverse drug events, addiction, and placebo. Handb Exp Pharmacol 2012:107-126. [PMID: 23027448 DOI: 10.1007/978-3-642-30726-3_6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sex-gender-based differences in response to pharmaceutical treatments are still under evaluation but evidence already exists regarding the impact of sex-gender-related differences on drug safety profile, drug abuse/addiction, and placebo effects. For a number of drugs it is well recognized that a sex-gender dimorphic profile in terms of drug adverse effects exists and appears to be more frequent and severe in women than in men. However, it is not well known whether this is due to pharmacodynamic or pharmacokinetic differences. Indeed the optimization of therapy requires that attention is paid to single sex-gender. Numerous pharmacokinetic, pharmacodynamic, and sociocultural differences between women and men in drug abuse have been described. Here we focus on sex-gender differences in alcoholism and nicotine addiction. The relevance of sex and gender differences in addiction appear to be relevant. Specific programs aimed to address addicted women's specific needs (child care, pregnancy, housing, and violence and others) are recommended. Finally, this article discusses the possible effect of sex-gender on placebo response in the light of the more significant recent literature evidencing that studies are urgently required in order to better understand the role of sex-gender on placebo mechanism and its impact on randomized clinical trials outcomes.
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Affiliation(s)
- Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
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96
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Szczepura A, Wild D, Nelson S. Medication administration errors for older people in long-term residential care. BMC Geriatr 2011; 11:82. [PMID: 22151472 PMCID: PMC3254134 DOI: 10.1186/1471-2318-11-82] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 12/07/2011] [Indexed: 12/01/2022] Open
Abstract
Background Older people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system. Methods A prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors. Results A total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12/41 staff administering drugs reported they were aware of potential administration errors in their care home. Conclusions The incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring.
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Affiliation(s)
- Ala Szczepura
- Warwick Medical School, University of Warwick, Coventry, UK.
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97
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Picking D, Younger N, Mitchell S, Delgoda R. The prevalence of herbal medicine home use and concomitant use with pharmaceutical medicines in Jamaica. JOURNAL OF ETHNOPHARMACOLOGY 2011; 137:305-11. [PMID: 21645607 DOI: 10.1016/j.jep.2011.05.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 05/25/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The work described in this paper aimed to study the prevalence of herbal medicine use in treating illness and concomitant use with pharmaceutical medicines in Jamaica. MATERIALS AND METHODS A survey using a structured questionnaire was administered by a trained interviewer to randomly selected adults in systematically selected households within randomly selected urban and rural clusters. Categorical data analysis was performed using Stata version 10 software. RESULTS 91.4%(372/407) of selected people agreed to participate. 72.6%(270/372) self-medicated with herbs within the previous year. Commonly treated were illnesses of the respiratory system (RS, 77.8%(210/270)), gastro-intestinal tract (GIT, 53.3%(144/270)) and health maintenance using tonics (29.6%(80/270)). 26.7%(72/270) of respondents used pharmaceuticals concomitantly with medicinal plants. Commonly treated were illnesses of the RS (20.4%(55/270)), GIT (13.7%(37/270)) and hypertension (10.0%(27/270)). 19.4% (14/72) of physicians knew of such practices. There was significant association of herb use with/without drugs with age (p<0.001), employment status (p<0.001), religion (p=0.004), gender (p=0.02) and educational level (p=0.031). Thus prevalence of herb use alone was greatest amongst people aged 35-44 and 45-54 years; those employed; Rastafarians; those without health insurance; males and people who had completed secondary education. Whilst prevalence of concomitant herb-drug use was greater amongst people aged 65 years and older; those retired; those of religions other than Rastafarians and Christians, females and people who had attained primary education and below. CONCLUSIONS Self-medication with herbs in Jamaica is highly prevalent and highest for self-limiting conditions of the RS, GIT and health maintenance with tonics. Concomitant herb and drug use is highest for self-limiting conditions of the RS, GIT and hypertension, and the use of combined therapy highlights the need for investigations on potential drug-herb interactions. Physicians have limited awareness and knowledge of such concomitant usage, further highlighting the need for increased dialogue with patients, knowledge of medicinal plants and their uses and a heightened pharmacovigilance to avoid adversities that may arise from potential drug-herb interactions.
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Affiliation(s)
- David Picking
- Natural Products Institute, University of the West Indies, Mona, Kingston 7, Jamaica
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98
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Jouanjus E, Leymarie F, Tubery M, Lapeyre-Mestre M. Cannabis-related hospitalizations: unexpected serious events identified through hospital databases. Br J Clin Pharmacol 2011; 71:758-65. [PMID: 21204913 DOI: 10.1111/j.1365-2125.2010.03897.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Cannabis is the most prevalent illicit drug used worldwide and can be responsible for serious health defects in users. However, the risk related to cannabis consumption is not well established. The present study aimed to assess cannabis-related adverse events leading to hospitalization, and to estimate the corresponding annual risk for consumers. METHODS Participants were patients admitted to the public hospitals in the Toulouse area (France) between January 2004 and December 2007 in relation to the use of cannabis. Reasons for admission and other occurring events were identified through hospital discharge summaries. We described all observed adverse events (AEs) and estimated their regional incidence on the basis of cannabis consumption data. RESULTS We included 200 patients, and identified a total of 619 adverse events (AEs), one of which was lethal. Psychiatric disorders involved 57.7% of patients and accounted for 18.2% of AEs. Most frequent outcomes were central and peripheral nervous system disorders (15.8% of AEs), acute intoxication (12.1%), respiratory system disorders (11.1%) and cardiovascular disorders (9.5%). We estimated that in 2007 the incidence of cannabis-related AEs in the Midi-Pyrenees region ranged from 1.2 per 1000 regular cannabis users (95% confidence interval (CI) 0.7, 1.6) to 3.2 (95% CI 2.5, 3.9). CONCLUSIONS Cannabis use is associated with complications, considered to be serious since they lead to hospitalization. Beyond the well-known and widely investigated psychiatric events, serious cerebro and cardiovascular complications have been identified. These findings contribute to improve the knowledge of cannabis-related adverse events.
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Affiliation(s)
- Emilie Jouanjus
- Université de Toulouse, UPS, Equipe de Pharmacoépidémiologie INSERM U 1027, Faculté de Médecine, 37 allées Jules Guesde, F-31000 Toulouse, France.
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99
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Adverse drug reaction reporting in the Czech Republic 2005–2009. Int J Clin Pharm 2011; 33:683-9. [DOI: 10.1007/s11096-011-9527-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 05/28/2011] [Indexed: 10/18/2022]
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100
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Stausberg J, Hasford J. Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data. BMC Health Serv Res 2011; 11:134. [PMID: 21619706 PMCID: PMC3116475 DOI: 10.1186/1472-6963-11-134] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 05/29/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Adverse reactions and medication errors are complications of drug use. Spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. In this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ADE) in Germany were assessed using routinely collected hospital data. METHODS The study was based on aggregated hospital routine data covering the period 2003 to 2007 and annually recorded as part of the further development of the German Diagnosis-Related Groups. The 505 ICD-10-codes indicating an ADE were categorized in seven groups according to their certainty. Primary diagnoses were considered as a proxy for drug-related admissions, and secondary diagnoses as a proxy for hospital-acquired ADE. RESULTS Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced. There was a significant increase in the overall rate of drug-related admissions over time (p < 0.038). Enterocolitis due to Clostridium difficile infection was the most frequent cause of a drug-related admission. About 4.5% of in-patients had experienced a hospital-acquired ADE. In addition, over the course of the study period, the overall frequency of hospital-acquired ADEs significantly increased (p < 0.001). CONCLUSIONS In Germany, more than 5% of hospital episodes are either caused or complicated by an ADE. Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE. Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.
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Affiliation(s)
- Jürgen Stausberg
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Marchioninistraße 15, D-81377 München, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Marchioninistraße 15, D-81377 München, Germany
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