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Abensur Vuillaume L, Ferreira JP, Asseray N, Trombert-Paviot B, Montassier E, Legrand M, Girerd N, Boivin JM, Chouihed T, Rossignol P. Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department. PLoS One 2020; 15:e0236934. [PMID: 32750075 PMCID: PMC7402484 DOI: 10.1371/journal.pone.0236934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. AIMS This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. METHODS Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. RESULTS A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048). CONCLUSIONS Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.
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Affiliation(s)
- Laure Abensur Vuillaume
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- Emergency Departement, Regional Hospital Metz-Thionville, Metz, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Nathalie Asseray
- Infectious Diseases Department, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
| | - Béatrice Trombert-Paviot
- Department of Public Health and Medical Informatics, University Hospital of Saint Etienne and Host Research Team SNA-EPIS, PRES Lyon, Jean Monnet University, Lyon, France
| | - Emmanuel Montassier
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Department of Emergency Medicine, Nantes University Hospital; MiHAR lab, Université de Nantes, Nantes, France
| | - Matthieu Legrand
- APHP, Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis University Hospital, INSERM UMR-S942, INI-CRCT network and Univ Paris Diderot, Paris, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Jean-Marc Boivin
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Tahar Chouihed
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
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Gras M, Champel V, Masmoudi K, Liabeuf S. Self-medication practices and their characteristics among French university students. Therapie 2020; 75:419-428. [PMID: 32204933 DOI: 10.1016/j.therap.2020.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/21/2019] [Accepted: 02/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inappropriate self-medication can have major impacts on health. The aim of the study was to describe the prevalence and characteristics of self-medication behaviours among undergraduate and postgraduate students from various academic sectors. We also sought to identify determinants of inappropriate self-medication. METHODS We performed a descriptive, cross-sectional study based on a self-questionnaire filled out by students from various academic sectors at the University of Picardy (Amiens, France). The survey comprised four sections: sociodemographic characteristics, health status, self-medication behaviour (including the names of medications taken), and knowledge about medications and the risks associated with self-medication. Inappropriate self-medication was defined as the reported administration of a prescription-only medication without a current prescription. RESULTS A total of 1257 students (715 from the health sector and 542 from other sectors; 983 [78.2%] women) completed the survey. In all, 1194 (95%) students reported self-medication. The most reported reason for self-medication was a supposed good knowledge of medications. The most frequently administered drug classes were analgesics (n=736, 46.7%), and anti-inflammatories/antirheumatics (n=299, 19%). In all, 51.7% (n=617) of the self-medicating students used a medicine from an old prescription including prescription-only drugs (mostly analgesics, antibiotics, and anxiolytics). Female sex, studying for a healthcare degree, having a chronic disease, smoking, having a healthcare professional in the family, and stress were all independently associated with inappropriate self-medication behaviours. CONCLUSION Our results showed that self-medication in general and the use of old prescription-only medications in particular are frequent among French university students. At-risk situations identification might facilitate the implementation of educational actions.
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Affiliation(s)
- Marion Gras
- Clinical pharmacology department, regional pharmacogivilance centre, Amiens-Picardie university hospital, 80054 Amiens, France
| | - Valérie Champel
- Clinical pharmacology department, regional pharmacogivilance centre, Amiens-Picardie university hospital, 80054 Amiens, France; MP3CV Laboratory, EA7517, university of Picardie Jules Verne, 80000 Amiens, France
| | - Kamel Masmoudi
- Clinical pharmacology department, regional pharmacogivilance centre, Amiens-Picardie university hospital, 80054 Amiens, France
| | - Sophie Liabeuf
- Clinical pharmacology department, regional pharmacogivilance centre, Amiens-Picardie university hospital, 80054 Amiens, France; MP3CV Laboratory, EA7517, university of Picardie Jules Verne, 80000 Amiens, France.
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Caillet C, Sichanh C, Assemat G, Malet-Martino M, Sommet A, Bagheri H, Sengxeu N, Mongkhonmath N, Mayxay M, Syhakhang L, Lapeyre-Mestre M, Newton PN, Roussin A. Role of Medicines of Unknown Identity in Adverse Drug Reaction-Related Hospitalizations in Developing Countries: Evidence from a Cross-Sectional Study in a Teaching Hospital in the Lao People's Democratic Republic. Drug Saf 2017; 40:809-821. [PMID: 28528487 PMCID: PMC5569138 DOI: 10.1007/s40264-017-0544-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The health dangers of medicines of unknown identity (MUIs) [loose pharmaceutical units repackaged in individual bags without labelling of their identity] have been suspected in L/MICs. Using visual and analytical tools to identify MUIs, we investigated the frequency of, and factors associated with, adverse drug reaction (ADR)-related hospitalizations in a central hospital in Vientiane Capital, Lao People's Democratic Republic (PDR). METHODS All unplanned admissions, except for acute trauma and intentional overdose, were prospectively recorded during a 7-week period in 2013, leading to include 453 adults hospitalized for ≥24 h. The patients or their relatives were interviewed to complete the study questionnaire. MUIs suspected of being involved in ADR(s) were identified through comparison of visual characteristics of tablets/capsules with that of reference medicines (photograph tool), and by proton nuclear magnetic resonance and mass spectrometry analyses. Factors associated with ADRs were identified by multivariate logistic regression. RESULTS The frequency of hospitalizations related to an ADR was 5.1% (23/453, 95% confidence interval [CI] 3.1-7.1). Forty-eight (12.8%) patients used MUI(s) in the last 2 weeks preceding hospitalization. They were more likely to be hospitalized because of an ADR (adjusted odds ratio 4.5, 95% CI 1.7-11.5) than patients using medicines of known identity. MUIs were mainly involved in bleeding gastroduodenal ulcers. The photograph tool led to the misidentifications because of look-alike pharmaceutical units in the medicines photograph collection. CONCLUSION According to the results of this study, there is a need to ensure appropriate labelling of medicines at dispensing and to provide well-suited tools to identify MUIs in clinical settings to improve drug safety and patients' care in developing countries with limited capacities for drug analysis.
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Affiliation(s)
- Céline Caillet
- Pharmacoépidémiologie, Faculté de Médecine, UMR 1027 INSERM-Université Toulouse III, 37, Allées Jules Guesde, 31000, Toulouse, France.
- Infectious Diseases Data Observatory-WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, Churchill Hospital, CCVTM, University of Oxford, Oxford, UK.
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
| | - Chanvilay Sichanh
- Infectious Diseases Data Observatory-WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, Churchill Hospital, CCVTM, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Gaëtan Assemat
- Groupe de RMN Biomédicale, Laboratoire SPCMIB, UMR CNRS 5068-Université Toulouse III, Toulouse, France
| | - Myriam Malet-Martino
- Groupe de RMN Biomédicale, Laboratoire SPCMIB, UMR CNRS 5068-Université Toulouse III, Toulouse, France
| | - Agnès Sommet
- Pharmacoépidémiologie, Faculté de Médecine, UMR 1027 INSERM-Université Toulouse III, 37, Allées Jules Guesde, 31000, Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre d'Investigation Clinique, CIC1436, Toulouse University Hospital, Toulouse, France
| | - Haleh Bagheri
- Pharmacoépidémiologie, Faculté de Médecine, UMR 1027 INSERM-Université Toulouse III, 37, Allées Jules Guesde, 31000, Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Toulouse University Hospital, Toulouse, France
| | - Noudy Sengxeu
- Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Niphonh Mongkhonmath
- Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Lamphone Syhakhang
- Food and Drug Department, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Maryse Lapeyre-Mestre
- Pharmacoépidémiologie, Faculté de Médecine, UMR 1027 INSERM-Université Toulouse III, 37, Allées Jules Guesde, 31000, Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre d'Investigation Clinique, CIC1436, Toulouse University Hospital, Toulouse, France
| | - Paul N Newton
- Infectious Diseases Data Observatory-WorldWide Antimalarial Resistance Network, Centre for Tropical Medicine and Global Health, Churchill Hospital, CCVTM, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Anne Roussin
- Pharmacoépidémiologie, Faculté de Médecine, UMR 1027 INSERM-Université Toulouse III, 37, Allées Jules Guesde, 31000, Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre d'Investigation Clinique, CIC1436, Toulouse University Hospital, Toulouse, France
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Williams A, Crawford K. Self-medication practices among undergraduate nursing and midwifery students in Australia: a cross-sectional study. Contemp Nurse 2016; 52:410-420. [PMID: 27278099 DOI: 10.1080/10376178.2016.1197782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-medication is a global phenomenon and a major form of self-care. OBJECTIVES To explore the self-medication practices of Australian nursing and midwifery students. METHODS An online questionnaire that examined the prevalence of self-medication, reasons for self-medication, medications consumed and medication knowledge was distributed to student nurses and midwives at one university in Victoria, Australia. Data were collected between February and May 2014. RESULTS Self-medication practices were reported in 91.7% (n = 110) of students. Students reported the main reason for self-medication was to play an active role in their health. The incidence of stress was high (n = 82, 74.5%), along with back pain (n = 84, 76.4%) and nearly half the students (n = 46, 42.2%) reported using antibiotics that were prescribed for a previous health problem. CONCLUSION Self-medication practices were common in this student cohort and some results give rise to concern for the general wellbeing of our future nursing and midwifery workforce.
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Affiliation(s)
- Allison Williams
- a Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery , Monash University, Clayton , Victoria , Australia
| | - Kimberley Crawford
- a Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery , Monash University, Clayton , Victoria , Australia
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Self-medication practices among parents in Italy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:580650. [PMID: 25688359 PMCID: PMC4320888 DOI: 10.1155/2015/580650] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/28/2014] [Indexed: 11/18/2022]
Abstract
The aims of this cross-sectional survey were to document the prevalence, the determinants, and the reasons of oral medication use without the prescription of a physician among a random sample of 672 parents of students attending randomly selected public schools in Italy. A total of 69.2% practiced self-medication at least once. The odds of having performed a self-medication were higher in females, in younger population, and in those who have had a health problem in the preceding year and were lower in respondents with a middle or lower school level of education. Among those reporting experience of self-medication, 53.4% have practiced at least once in the last year and this was more likely for those who have had a health problem. Nonsteroidal anti-inflammatory drugs were more frequently used without a prescription in the last year. Two-thirds inappropriately self-medicated in the last year at least once. Of those who did not report a self-medication, 13.1% were willing to practice it. Females were more willing and those with a secondary school level of education less willing to practice self-medication. The frequency of oral self-medication was quite high and in most cases inappropriate with a potential impact on the health status and educative programs are needed.
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Asseray N, Ballereau F, Trombert-Paviot B, Bouget J, Foucher N, Renaud B, Roulet L, Kierzek G, Armand-Perroux A, Potel G, Schmidt J, Carpentier F, Queneau P. Frequency and severity of adverse drug reactions due to self-medication: a cross-sectional multicentre survey in emergency departments. Drug Saf 2014; 36:1159-68. [PMID: 24163273 PMCID: PMC3834162 DOI: 10.1007/s40264-013-0114-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Little is known about the relation of adverse drug reactions (ADRs) to self-use of medications. Objective The aim of this study was to determine the frequency and severity of ADRs related to self-medication (ADR-SM) among emergency department (ED) patients and to describe their main characteristics. Methods A prospective, cross-sectional, observational study was conducted over a period of 8 weeks (1 March to 20 April 2010), in the ED of 11 French academic hospitals. Adult patients presenting to the ED during randomization periods were included, with the exception of cases of self-drug poisoning, inability to complete self-medication questionnaire, or refusal. Clinical outcomes were assessed as well as history of self-medication behaviours and all drugs taken. All doubtful files and those related to ADR-SM were systematically reviewed by an expert committee. Results A total of 3,027 of 4,661 patients presenting to the ED met the inclusion criteria. Of these, 84.4 % declared a self-medication behaviour, 63.7 % took at least one non-prescribed drug during the previous 2 weeks and 59.9 % took a prescribed medication. A total of 296 patients experienced an ADR (9.78 %), of which 52 (1.72 %) were related to self-medication. Those ADRs related to self-medication included prescribed drugs (n = 19), non-prescribed drugs (n = 17), treatment discontinuation (n = 14), and interactions between non-prescribed and prescribed drugs (n = 2). The ADRs attributed to non-prescribed drugs represented 1 % of all patients taking non-prescribed drugs (n = 1,927). ADR severity was significantly lower for those related to self-medication (p = .032). Conclusion Self-medication is frequent; its potential toxicity should not be neglected, taking into account the rate of adverse drug reactions in about 1 % of ED patient. Electronic supplementary material The online version of this article (doi:10.1007/s40264-013-0114-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie Asseray
- EA 3826, Faculté de Médecine, 1 rue Gaston Veil, 44035, Nantes, France,
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Establishing a pharmacy presence in the emergency department: opportunities and challenges in the French setting. Int J Clin Pharm 2014; 36:471-5. [DOI: 10.1007/s11096-014-9934-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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