1
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Goetschi AN, Verloo H, Wernli B, Wertli MM, Meyer-Massetti C. Prescribing pattern insights from a longitudinal study of older adult inpatients with polypharmacy and chronic non-cancer pain. Eur J Pain 2024. [PMID: 38838067 DOI: 10.1002/ejp.2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The present study sought to determine the prevalence of chronic non-cancer pain (CNCP) among older adult inpatients with polypharmacy. It also aimed to analyse prescription patterns and assess the therapy adequacy and patient complexity for those with and without CNCP. METHODS This 4-year longitudinal study examined data from an exhaustive acute care hospital register on home-dwelling older adult patients (≥65) with polypharmacy. Commonly known combinations of potentially inappropriate medications were used to estimate therapy adequacy. Patient complexity was evaluated by comparing number of comorbidities and investigating physical and cognitive deficits. RESULTS We determined a prevalence of CNCP of 9.7% among all older adult inpatients with polypharmacy, rising to 11.3% for those aged ≥85. Overall, CNCP patients were prescribed more drugs and had more comorbidities and physical and cognitive deficits than patients without CNCP. Older adult patients with CNCP received more analgesics, greater quantities of opioids, paracetamol and co-analgesics and elevated opioid dosages. Older adult patients with CNCP aged ≥85 received fewer analgesics, opioids, non-steroidal anti-inflammatory drugs and co-analgesics but more paracetamol. Older adult patients with CNCP were prescribed more potentially inappropriate medications involving opioids. In particular, 24.5% received an opioid and a hypnotic (benzodiazepine or Z-drug), and 8.6% received an opioid and a gabapentinoid. CONCLUSION Observed differences in medication use between older adult inpatients with or without CNCP may be relevant for clinical practice. Potentially inadequate co-prescribing (such as hypnotics and opioids) affects a higher proportion of patients with CNCP and may have serious unintended consequences. SIGNIFICANCE STATEMENT This study describes differences in prescription patterns between people with and without chronic non-cancer pain in a large dataset of 20,422 discharges. The differences found may be relevant to clinical practice. In particular, high co-prescribing of opioids and hypnotics may have serious unintended consequences. Greater physical and cognitive deficits may indicate greater patient complexity, and appropriate interventions need to be developed to improve the management of this vulnerable patient group.
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Affiliation(s)
- Aljoscha N Goetschi
- General Internal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Maria M Wertli
- General Internal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Carla Meyer-Massetti
- General Internal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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2
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Walker LE, Pirmohamed M. The status of drug evaluation in older adults in the United Kingdom: Bridging the representation gap. J Am Geriatr Soc 2024. [PMID: 38393834 DOI: 10.1111/jgs.18817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Older adults are persistently underrepresented in clinical drug trials worldwide, despite increasing multiple long-term conditions and significant prescribing in this demographic. We discuss systemic challenges such as the exclusion of people with comorbid conditions and the lack of assessment for comorbidities as modifiers of treatment effects and highlight the rising trend of polypharmacy, especially among the oldest age groups, which is linked to a significant percentage of unplanned hospitalizations and medication errors. The consequences of these trends prompted the United Kingdom National Overprescribing review, culminating in a set of recommendations for drug development tailored to older adults. Building on this, two critical reports released in April 2023 by the International Longevity Centre (ILC) and the Nuffield Council on Bioethics (NCOB) are discussed. These reports emphasize the importance of diversity and inclusion in clinical trials, advocating for ethical frameworks and methodologies that cater to the complex needs of older adults. The development of inclusive criteria, innovative statistical methodologies, and the integration of patient-reported outcomes are needed to address the persistent barriers to older adult participation in research, suggesting that pragmatic trials, exemplified by the UK's RECOVERY trial during the COVID-19 pandemic, could pave the way for more inclusive research practices.
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Affiliation(s)
- Lauren E Walker
- The Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Munir Pirmohamed
- The Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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3
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Pathak GN, Chandy RJ, Shah R, Feldman SR. The Pharmacist's role in dermatology: Patient medication adherence. J Dermatol 2023; 50:1099-1107. [PMID: 37489577 DOI: 10.1111/1346-8138.16895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Medication non-adherence is currently estimated to have caused at least 100 000 preventable deaths and over $100 billion in preventable medical costs. Adherence is particularly poor in dermatological conditions, with more than 50% of patients discontinuing topical treatments within the first year. Pharmacists are among the most accessible health-care professionals with the potential to greatly impact medication non-adherence through patient education, medication therapy management, and improved access to care. This review aimed to determine how pharmacists have improved medication adherence in dermatology and discuss strategies for further involvement. An extensive medical literature search using the PubMed database was conducted to evaluate clinical studies, published in the last 20 years, that have evaluated the pharmacist's role and impact on adherence of to dermatological products. PubMed search terms include: "pharmacists' role in dermatologic medication adherence", "pharmacist-led interventions in dermatology", "pharmacist medication adherence dermatology" and "pharmacist intervention dermatology". A total of 18 relevant studies were identified. Pharmacists improved dermatological medication adherence by increasing access to medications, providing medication counseling programs, and performing treatment monitoring services. However, corticophobia may contribute to pharmacists' hesitancy in making corticosteroid over-the-counter recommendations. Pharmacists are accessible health-care providers with the potential to improve dermatological medication adherence. Future advanced training in dermatology medications may refine pharmacists' knowledge of dermatological products.
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Affiliation(s)
- Gaurav N Pathak
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rithi J Chandy
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Radhika Shah
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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4
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van Staa TP, Pirmohamed M, Sharma A, Buchan I, Ashcroft DM. Clinical Relevance of Drug-Drug Interactions With Antibiotics as Listed in a National Medication Formulary: Results From Two Large Population-Based Case-Control Studies in Patients Aged 65-100 Years Using Linked English Primary Care and Hospital Data. Clin Pharmacol Ther 2023; 113:423-434. [PMID: 36448824 PMCID: PMC10107602 DOI: 10.1002/cpt.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
This study evaluated drug-drug interactions (DDIs) between antibiotic and nonantibiotic drugs listed with warnings of severe outcomes in the British National Formulary based on adverse drug reaction (ADR) detectable with routine International Classification of Diseases, Tenth Revision coding. Data sources were Clinical Practice Research Databank GOLD and Aurum anonymized electronic health records from English general practices linked to hospital admission records. In propensity-matched case-control study, outcomes were ADR or emergency admissions. Analyzed were 121,546 ADR-related admission cases matched to 638,238 controls. For most antibiotics, adjusted odds ratios (aORs) for ADR-related hospital admission were large (aOR for trimethoprim 4.13; 95% confidence interval (CI), 3.97-4.30). Of the 51 DDIs evaluated for ADR-related admissions, 38 DDIs (74.5%) had statistically increased aORs of concomitant exposure compared with nonexposure (mean aOR 3.96; range 1.59-11.42); for the 89 DDIs for emergency hospital admission, the results were 75 (84.3%) and mean aOR 2.40; range 1.43-4.17. Changing reference group to single antibiotic exposure reduced aORs for concomitant exposure by 76.5% and 83.0%, respectively. Medicines listed to cause nephrotoxicity substantially increased risks that were related to number of medicines (aOR was 2.55 (95% CI, 2.46-2.64) for current use of 1 and 10.44 (95% CI, 7.36-14.81) for 3 or more medicines). In conclusion, no evidence of substantial risk was found for multiple DDIs with antibiotics despite warnings of severe outcomes in a national formulary and flagging in electronic health record software. It is proposed that the evidence base for inclusion of DDIs in national formularies be strengthened and made publicly accessible and indiscriminate flagging, which compounds alert fatigue, be reduced.
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Affiliation(s)
- Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham, UK
| | - Iain Buchan
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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5
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Ing Lorenzini K, Wainstein L, Spechbach H, Sarasin F, Ramlawi M, Desmeules J, Piguet V. Opioid-related adverse drug reactions in patients visiting the emergency division of a tertiary hospital. Pharmacol Res Perspect 2022; 10:e01033. [PMID: 36404650 PMCID: PMC9676686 DOI: 10.1002/prp2.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022] Open
Abstract
Opioid use and associated morbidity and mortality have increased in several countries during the past 20 years. We performed a study whose objective was to assess the frequency and causes of opioid-related emergency division (ED) visits in an adult tertiary Swiss University Hospital over 9 weeks in 2018. We primarily assessed opioid-related adverse drug reactions (ADR), secondary overdose, misuse, abuse, and insufficient pain relief. Current opioid use was identified in 1037 (8.3%) of the 12 470 included ED visits. In 64 opioid users, an ADR was identified as a contributing cause of the ED visit, representing 6.2% of opioid users, and 0.5% of the total ED visits. Moreover, we identified an overdose in 16 opioid users, misuse or abuse in 19 opioid users, and compatible withdrawal symptoms in 7 opioid users. After pooling all these events, we conclude that the ED visits could be related to opioid use in 10.2% of opioid users. Finally, in 201 opioid users, insufficient pain relief (pain not responding to the current pharmacological treatment) was identified as a contributing cause of ED visits. In these cases, other factors than simply pharmacological nonresponse may have been involved. In the context of an ever-increasing opioid use to better control chronic pain situations, these results should reinforce emergency network epidemiological surveillance studies at a national level.
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Affiliation(s)
- Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Laura Wainstein
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Hervé Spechbach
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Primary Care, Department of Primary Care MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - François Sarasin
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Division of Emergency Medicine, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Majd Ramlawi
- Division of Emergency MedicineLa Tour Medical GroupMeyrinSwitzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency MedicineUniversity Hospitals of GenevaGenevaSwitzerland
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6
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Punj E, Collins A, Agravedi N, Marriott J, Sapey E. What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review. Pharmacol Res Perspect 2022; 10:e01007. [PMID: 36102210 PMCID: PMC9471999 DOI: 10.1002/prp2.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co-primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy-led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non-randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non-pharmacy control arm, with a Chi2 of 101.10 and I2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out-of-hours working.
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Affiliation(s)
- Ekta Punj
- Clinical Research NetworkUniversity of BirminghamBirminghamUK
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Abbie Collins
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Nirlep Agravedi
- Pharmacy DepartmentUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - Elizabeth Sapey
- University of BirminghamBirminghamUK
- PIONEER, HDRUK Health Data Hub in Acute CareBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Acute MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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7
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Letinier L, Pujade I, Duthoit P, Evrard G, Salvo F, Gil-Jardine C, Pariente A. Emergency room admissions induced by drug-drug interactions in the elderly: a cross-sectional study. Clin Transl Sci 2022; 15:1472-1481. [PMID: 35244984 PMCID: PMC9199869 DOI: 10.1111/cts.13262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
The elderly people are increasingly exposed to polymedication and therefore to the risks of drug–drug interactions (DDIs). However, there are few data available on the clinical consequences of these drug combinations. We investigated the impact of the various DDIs classified as severe in terms of emergency admissions in the elderly. A cross‐sectional study was conducted using information from the emergency department admissions of Bordeaux University Hospital between September 2016 and August 2017. Events of interest were frequency of concomitant uses of interacting drugs that are contraindicated or warned against and frequency of emergency admissions due to contraindicated or warned against concomitant uses of interacting drugs. Five thousand, eight hundred sixty (5860) admissions to the emergency department were analyzed. A total of 375 (6.4%) contraindicated or warned against concomitant uses were identified, including 163 contraindicated (43.5%) and 212 warned against (56.5%). Reason for admission appeared likely related to the underlying DDI in 58 cases. Within these, 36 admissions were assessed as probably due to a DDI (0.6% of hospitalizations) and 22 as certainly (0.4% of hospitalizations). Of these, there were 24 (45%) admissions related to a long QT syndrome (LQTS), nine (16%) related to a drug overdose, and eight (14%) related to a hemorrhage. An antidepressant was involved in 22 of the 24 cases of LQTS. Seven of the eight cases of hemorrhage involved the antithrombotic agents / non‐steroidal anti‐inflammatory drugs combination. Elderly patients admitted to emergency departments are particularly exposed to high‐risk potential DDIs. These drug combinations lead mainly to LQTS and involve certain antidepressants.
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Affiliation(s)
- Louis Letinier
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Iris Pujade
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Perrine Duthoit
- Emergency department for adults, Bordeaux University Hospital, France
| | - Grégoire Evrard
- Emergency department for adults, Bordeaux University Hospital, France
| | - Francesco Salvo
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | | | - Antoine Pariente
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
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8
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Kumar S, D'Souza RN, Corno M, Ullrich MS, Kuhnert N, Hütt MT. Cocoa bean fingerprinting via correlation networks. NPJ Sci Food 2022; 6:5. [PMID: 35075143 PMCID: PMC8786884 DOI: 10.1038/s41538-021-00120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
Cocoa products have a remarkable chemical and sensory complexity. However, in contrast to other fermentation processes in the food industry, cocoa bean fermentation is left essentially uncontrolled and is devoid of standardization. Questions of food authenticity and food quality are hence particularly challenging for cocoa. Here we provide an illustration how network science can support food fingerprinting and food authenticity research. Using a large dataset of 140 cocoa samples comprising three cocoa fermentation/processing stages and eight countries, we obtain correlation networks between the cocoa samples by computing measures of pairwise correlation from their liquid chromatography-mass spectrometry (LC-MS) profiles. We find that the topology of correlation networks derived from untargeted LC-MS profiles is indicative of the fermentation and processing stage as well as the origin country of cocoa samples. Progressively increasing the correlation threshold firstly reveals network clusters based on processing stage and later country-based clusters. We present both, qualitative and quantitative evidence through network visualization, network statistics and concepts from machine learning. In our view, this network-based approach for classifying mass spectrometry data has broad applicability beyond cocoa.
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Affiliation(s)
- Santhust Kumar
- Department of Life Sciences and Chemistry, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany.
| | - Roy N D'Souza
- Department of Life Sciences and Chemistry, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany
| | - Marcello Corno
- Barry Callebaut AG, Westpark, Pfingstweidstrasse 60, Zurich, 8005, Switzerland
| | - Matthias S Ullrich
- Department of Life Sciences and Chemistry, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany
| | - Nikolai Kuhnert
- Department of Life Sciences and Chemistry, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany.
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9
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Loucks CM, Yan K, Tanoshima R, Ross CJD, Rassekh SR, Carleton BC. Pharmacogenetic testing to guide therapeutic decision-making and improve outcomes for children undergoing anthracycline-based chemotherapy. Basic Clin Pharmacol Toxicol 2022; 130 Suppl 1:95-99. [PMID: 33900042 DOI: 10.1111/bcpt.13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022]
Abstract
Anthracyclines are widely used as part of chemotherapeutic regimens in paediatric oncology patients. The most serious adverse drug reaction caused by anthracycline use is cardiotoxicity, a serious condition that can lead to cardiac dysfunction and subsequent heart failure. Both clinical and genetic factors contribute to a patient's risk of experiencing anthracycline-induced cardiotoxicity. In particular, genetic variants in RARG, UGT1A6 and SLC28A3 have been consistently shown to influence an individual's risk of experiencing this reaction. By combining clinical and genetic risks, decision-making can be improved to optimize treatment and prevent potentially serious adverse drug reactions. As part of a precision medicine initiative, we used pharmacogenetic testing, focused on RARG, UGT1A6 and SLC28A3 variants, to help predict an individual's risk of experiencing anthracycline-induced cardiotoxicity. Pharmacogenetic results are currently being used in clinical decision-making to inform treatment regimen choice, anthracycline dosing and decisions to initiate cardioprotective agents. In this case series, we demonstrate examples of the impact of genetic testing and discuss its potential to allow patients to be increasingly involved in their own treatment decisions.
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Affiliation(s)
- Catrina M Loucks
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kevin Yan
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Reo Tanoshima
- Department of Pediatrics, Yokohama City University Hospital, Yokohama, Japan
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan
| | - Colin J D Ross
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahrad R Rassekh
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, BC, Canada
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10
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Voutsa V, Battaglia D, Bracken LJ, Brovelli A, Costescu J, Díaz Muñoz M, Fath BD, Funk A, Guirro M, Hein T, Kerschner C, Kimmich C, Lima V, Messé A, Parsons AJ, Perez J, Pöppl R, Prell C, Recinos S, Shi Y, Tiwari S, Turnbull L, Wainwright J, Waxenecker H, Hütt MT. Two classes of functional connectivity in dynamical processes in networks. J R Soc Interface 2021; 18:20210486. [PMID: 34665977 PMCID: PMC8526174 DOI: 10.1098/rsif.2021.0486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
The relationship between network structure and dynamics is one of the most extensively investigated problems in the theory of complex systems of recent years. Understanding this relationship is of relevance to a range of disciplines-from neuroscience to geomorphology. A major strategy of investigating this relationship is the quantitative comparison of a representation of network architecture (structural connectivity, SC) with a (network) representation of the dynamics (functional connectivity, FC). Here, we show that one can distinguish two classes of functional connectivity-one based on simultaneous activity (co-activity) of nodes, the other based on sequential activity of nodes. We delineate these two classes in different categories of dynamical processes-excitations, regular and chaotic oscillators-and provide examples for SC/FC correlations of both classes in each of these models. We expand the theoretical view of the SC/FC relationships, with conceptual instances of the SC and the two classes of FC for various application scenarios in geomorphology, ecology, systems biology, neuroscience and socio-ecological systems. Seeing the organisation of dynamical processes in a network either as governed by co-activity or by sequential activity allows us to bring some order in the myriad of observations relating structure and function of complex networks.
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Affiliation(s)
- Venetia Voutsa
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28759 Bremen, Germany
| | - Demian Battaglia
- Aix-Marseille Université, Inserm, Institut de Neurosciences des Systèmes (UMR 1106), Marseille, France
- University of Strasbourg Institute for Advanced Studies (USIAS), Strasbourg 67083, France
| | | | - Andrea Brovelli
- Aix-Marseille Université, CNRS, Institut de Neurosciences de la Timone (UMR 7289), Marseille, France
| | - Julia Costescu
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Mario Díaz Muñoz
- Department of Sustainability, Governance and Methods, Modul University Vienna, 1190 Vienna, Austria
| | - Brian D. Fath
- Department of Biological Sciences, Towson University, Towson, Maryland 21252, USA
- Advancing Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg 2361, Austria
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Andrea Funk
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
- WasserCluster Lunz - Biologische Station GmbH, Dr. Carl Kupelwieser Promenade 5, 3293 Lunz am See, Austria
| | - Mel Guirro
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Thomas Hein
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
- WasserCluster Lunz - Biologische Station GmbH, Dr. Carl Kupelwieser Promenade 5, 3293 Lunz am See, Austria
| | - Christian Kerschner
- Department of Sustainability, Governance and Methods, Modul University Vienna, 1190 Vienna, Austria
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Christian Kimmich
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
- Regional Science and Environmental Research, Institute for Advanced Studies, 1080 Vienna, Austria
| | - Vinicius Lima
- Aix-Marseille Université, Inserm, Institut de Neurosciences des Systèmes (UMR 1106), Marseille, France
- Aix-Marseille Université, CNRS, Institut de Neurosciences de la Timone (UMR 7289), Marseille, France
| | - Arnaud Messé
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Germany
| | | | - John Perez
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Ronald Pöppl
- Department of Geography and Regional Research, University of Vienna, Universitätsstr. 7, 1010 Vienna, Austria
| | - Christina Prell
- Department of Cultural Geography, University of Groningen, 9747 AD, Groningen, The Netherlands
| | - Sonia Recinos
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
| | - Yanhua Shi
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Shubham Tiwari
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Laura Turnbull
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - John Wainwright
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Harald Waxenecker
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28759 Bremen, Germany
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11
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Ercan N, Konukbay D. The knowledge, attitudes and practices of healthcare workers on drug hypersensitivity reactions in children: A tertiary centre experience from Turkey. Int J Clin Pract 2021; 75:e14444. [PMID: 34105870 DOI: 10.1111/ijcp.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 12/20/2020] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adverse drug reactions are an important public health concern that affects doctor and dentist prescriptions and healthcare workers' practice. We planned to evaluate the knowledge, attitudes and practices of healthcare workers in our country about drug hypersensitivity reactions in paediatric patients and to determine the risk factors that may affect them. METHOD This study was carried out in a capital-located university hospital. Healthcare workers authorized to intervene in children (0-18 age group), including medical doctors, nurses, and dentists, were enrolled in the study. The study questionnaire was developed by paediatric allergy and immunology specialists and paediatric nurses by considering the other studies on the same subject. RESULTS Three hundred fifty-four (88.5%) out of 400 healthcare workers, whose study survey was distributed, returned to us by filling the questionnaire. According to the groups of the profession, there was a statistically significant difference between the average of correct answers given to the questions evaluating knowledge levels (P < .001). The doctors' knowledge score (M ± SD 18.6 ± 2.1) was the highest. The general attitudes of healthcare workers towards drug hypersensitivity reactions in children were similar and were positive (P < .053). However, general practice patterns were significantly different (P < .001). Nurses were observed to practice more positively than doctors and dentists. As the healthcare worker gets older, his practice score increased by 0.546; on the other hand, being a resident reduced the score from the practice score by 3.770. CONCLUSION Our results suggest that advanced training programmes must be provided for healthcare workers in learning drug hypersensitivity reactions, particularly in paediatric patients.
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Affiliation(s)
- Nazli Ercan
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Gulhane Research and Training Hospital, University of Health Sciences Turkey, Etlik, Turkey
| | - Dilek Konukbay
- Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Etlik, Turkey
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12
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Jeiziner C, Wernli U, Suter K, Hersberger KE, Meyer zu Schwabedissen HE. HLA-associated adverse drug reactions - scoping review. Clin Transl Sci 2021; 14:1648-1658. [PMID: 34105877 PMCID: PMC8504845 DOI: 10.1111/cts.13062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 01/18/2023] Open
Abstract
Alleles of the human leukocyte antigen (HLA) system have been associated with the occurrence of idiosyncratic adverse drug reactions (ADRs). Accordingly, it is assumed that pre-emptive testing for the presence of certain HLA alleles (HLA-typing) could prevent these ADRs in carriers. In order to perceive the current evidence for HLA-associated ADRs, we conducted a scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search on PubMed and on Embase was carried out on the July 8 and 9, 2020, respectively. To be included in the scoping review, the studies had to investigate an association of any HLA-associated ADR with any small molecule approved and available on the Swiss market. We considered English and German primary literature published since 2002. A total of 149 studies were included, whereof most were retrospective, whereas one was a prospective randomized controlled trial. The majority of the studies (n = 33) described the association of HLA-B*15:02 with carbamazepine. It was not possible to directly compare the studies, as they were too heterogeneous in terms of the ADR definition, the HLA alleles, the number of participants, and the study types. Therefore, we summarized the results in a descriptive manner. Even if an interpretation of the outcomes remains open, the descriptive overview revealed the prevailing complexity and uncertainty in the field. For the future, consistent definitions on the different phenotypes need to be established and applied and the reporting of association studies should follow a harmonized structure.
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Affiliation(s)
- Chiara Jeiziner
- Pharmaceutical Care Research GroupDepartment of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Ursina Wernli
- Pharmaceutical Care Research GroupDepartment of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Katja Suter
- European Center of Pharmaceutical MedicineFaculty of MedicineUniversity of BaselBaselSwitzerland
| | - Kurt E. Hersberger
- Pharmaceutical Care Research GroupDepartment of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
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13
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Létinier L, Jouganous J, Benkebil M, Bel-Létoile A, Goehrs C, Singier A, Rouby F, Lacroix C, Miremont G, Micallef J, Salvo F, Pariente A. Artificial Intelligence for Unstructured Healthcare Data: Application to Coding of Patient Reporting of Adverse Drug Reactions. Clin Pharmacol Ther 2021; 110:392-400. [PMID: 33866552 PMCID: PMC8359992 DOI: 10.1002/cpt.2266] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
Adverse drug reaction (ADR) reporting is a major component of drug safety monitoring; its input will, however, only be optimized if systems can manage to deal with its tremendous flow of information, based primarily on unstructured text fields. The aim of this study was to develop an automated system allowing to code ADRs from patient reports. Our system was based on a knowledge base about drugs, enriched by supervised machine learning (ML) models trained on patients reporting data. To train our models, we selected all cases of ADRs reported by patients to a French Pharmacovigilance Centre through a national web‐portal between March 2017 and March 2019 (n = 2,058 reports). We tested both conventional ML models and deep‐learning models. We performed an external validation using a dataset constituted of a random sample of ADRs reported to the Marseille Pharmacovigilance Centre over the same period (n = 187). Here, we show that regarding area under the curve (AUC) and F‐measure, the best model to identify ADRs was gradient boosting trees (LGBM), with an AUC of 0.93 (0.92–0.94) and F‐measure of 0.72 (0.68–0.75). This model was run for external validation showing an AUC of 0.91 and a F‐measure of 0.58. We evaluated an artificial intelligence pipeline that was found able to learn how to identify correctly ADRs from unstructured data. This result allowed us to start a new study using more data to further improve our performance and offer a tool that is useful in practice to efficiently manage drug safety information.
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Affiliation(s)
- Louis Létinier
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France.,Synapse Medicine, Bordeaux, France
| | | | - Mehdi Benkebil
- Surveillance Division, Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint Denis, France
| | | | | | - Allison Singier
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France
| | - Franck Rouby
- CRPV Marseille Provence Corse, Service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, Marseille, France
| | - Clémence Lacroix
- CRPV Marseille Provence Corse, Service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, Marseille, France
| | - Ghada Miremont
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Joëlle Micallef
- CRPV Marseille Provence Corse, Service Hospitalo-Universitaire de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, Marseille, France
| | - Francesco Salvo
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
| | - Antoine Pariente
- INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de Santé Publique, Service de Pharmacologie Médicale, Centre de Pharmacovigilance de Bordeaux, Bordeaux, France
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14
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Perrin-Cocon L, Vidalain PO, Jacquemin C, Aublin-Gex A, Olmstead K, Panthu B, Rautureau GJP, André P, Nyczka P, Hütt MT, Amoedo N, Rossignol R, Filipp FV, Lotteau V, Diaz O. A hexokinase isoenzyme switch in human liver cancer cells promotes lipogenesis and enhances innate immunity. Commun Biol 2021; 4:217. [PMID: 33594203 PMCID: PMC7886870 DOI: 10.1038/s42003-021-01749-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
During the cancerous transformation of normal hepatocytes into hepatocellular carcinoma (HCC), the enzyme catalyzing the first rate-limiting step of glycolysis, namely the glucokinase (GCK), is replaced by the higher affinity isoenzyme, hexokinase 2 (HK2). Here, we show that in HCC tumors the highest expression level of HK2 is inversely correlated to GCK expression, and is associated to poor prognosis for patient survival. To further explore functional consequences of the GCK-to-HK2 isoenzyme switch occurring during carcinogenesis, HK2 was knocked-out in the HCC cell line Huh7 and replaced by GCK, to generate the Huh7-GCK+/HK2− cell line. HK2 knockdown and GCK expression rewired central carbon metabolism, stimulated mitochondrial respiration and restored essential metabolic functions of normal hepatocytes such as lipogenesis, VLDL secretion, glycogen storage. It also reactivated innate immune responses and sensitivity to natural killer cells, showing that consequences of the HK switch extend beyond metabolic reprogramming. Many cancers fuel their rapid growth by replacing glucokinase with its higher affinity isoenzyme, hexokinase 2 (HK2), making HK2 an attractive drug target. In this study, Perrin-Cocon and Vidalain et al. use CRISPR/Cas-9 gene editing to reverse this enzymatic switch in human liver cancer cells, and find this restores innate immune function as well as reversing cancer-associated metabolic reprogramming.
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Affiliation(s)
- Laure Perrin-Cocon
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France
| | - Pierre-Olivier Vidalain
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France
| | - Clémence Jacquemin
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France
| | - Anne Aublin-Gex
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France
| | - Keedrian Olmstead
- Cancer Systems Biology, Institute for Diabetes and Cancer, Helmholtz Zentrum München, Ingolstädter Landstraße 1, München, D-85764, Germany
| | - Baptiste Panthu
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France.,Univ Lyon, CarMeN Laboratory, Inserm, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Hôpital Lyon Sud, Bâtiment CENS ELI-2D, 165 Chemin du grand Revoyet, Pierre-Bénite, F-69310, France
| | - Gilles Jeans Philippe Rautureau
- Université de Lyon, CNRS, Université Claude Bernard Lyon 1, ENS de Lyon, Centre de RMN à Très Hauts Champs (CRMN), FRE 2034, 5 rue de la Doua, Villeurbanne, F-69100, France
| | - Patrice André
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France
| | - Piotr Nyczka
- Department of Life Sciences and Chemistry, Jacobs University, Campus Ring 1, Bremen, D-28759, Germany
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University, Campus Ring 1, Bremen, D-28759, Germany
| | - Nivea Amoedo
- CELLOMET, Centre de Génomique Fonctionnelle de Bordeaux, 146 Rue Léo Saignat, Bordeaux, F-33000, France
| | - Rodrigue Rossignol
- CELLOMET, Centre de Génomique Fonctionnelle de Bordeaux, 146 Rue Léo Saignat, Bordeaux, F-33000, France.,Univ. Bordeaux, Inserm U1211, MRGM, Centre hospitalier universitaire Pellegrin, place Amélie Raba Léon, Bordeaux, F-33076, France
| | - Fabian Volker Filipp
- Cancer Systems Biology, Institute for Diabetes and Cancer, Helmholtz Zentrum München, Ingolstädter Landstraße 1, München, D-85764, Germany.,School of Life Sciences Weihenstephan, Technical University München, Maximus-von-Imhof-Forum 3, Freising, D-85354, Germany
| | - Vincent Lotteau
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France.
| | - Olivier Diaz
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 21 Avenue Tony Garnier, Lyon, F-69007, France.
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15
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Nguyen KA, Eadon MT, Yoo R, Milway E, Kenneally A, Fekete K, Oh H, Duong K, Whipple EC, Schleyer TK. Risk Factors for Bleeding and Clinical Ineffectiveness Associated With Clopidogrel Therapy: A Comprehensive Meta-Analysis. Clin Transl Sci 2020; 14:645-655. [PMID: 33202084 PMCID: PMC7993261 DOI: 10.1111/cts.12926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023] Open
Abstract
Although clopidogrel is a frequently used antiplatelet medication to treat and prevent atherothrombotic disease, clinicians must balance its clinical effectiveness with the potential side effect of bleeding. However, many previous studies have evaluated beneficial and adverse factors separately. The objective of our study was to perform a comprehensive meta‐analysis of studies of clopidogrel’s clinical effectiveness and/or risk of bleeding in order to identify and assess all reported risk factors, thus helping clinicians to balance patient safety with drug efficacy. We analyzed randomized controlled trials (RCTs) of maintenance use in four stages: search for relevant primary articles; abstract and full article screening; quality assessment and data extraction; and synthesis and data analysis. Screening of 7,109 articles yielded 52 RCTs that met the inclusion criteria. Twenty‐seven risk factors were identified. “Definite risk factors” were defined as those with aggregated odds ratios (ORs) > 1 and confidence intervals (CIs) > 1 if analyzed in more than one study. Definite risk factors for major bleeding were concomitant aspirin use (OR 2.83, 95% CI 2.04–3.94) and long duration of clopidogrel therapy (> 6 months) (OR 1.74, 95% CI 1.21–2.50). Dual antiplatelet therapy, extended clopidogrel therapy, and high maintenance dose (150 mg/day) of clopidogrel were definite risk factors for any bleeding. Reduced renal function, both mild and severe, was the only definite risk factor for clinical ineffectiveness. These findings can help clinicians predict the risks and effectiveness of clopidogrel use for their patients and be used in clinical decision support tools.
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Affiliation(s)
- Khoa A Nguyen
- College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Michael T Eadon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Ryan Yoo
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Evan Milway
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Allison Kenneally
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Kevin Fekete
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Hyun Oh
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Khanh Duong
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | | | - Titus K Schleyer
- Regenstrief Institute, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
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16
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Peck CC, Breckenridge RA. Sir Alasdair Breckenridge 1937–2019. A Celebratory Tribute. Clin Pharmacol Ther 2020; 108:22-25. [DOI: 10.1002/cpt.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Carl C. Peck
- Department of Bioengineering and Therapeutic Sciences University of California at San Francisco San Francisco California USA
- NDA Partners, LLC Rochelle Virginia USA
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17
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Shah RR. Genotype‐guided warfarin therapy: Still of only questionable value two decades on. J Clin Pharm Ther 2020; 45:547-560. [DOI: 10.1111/jcpt.13127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/07/2020] [Indexed: 12/20/2022]
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18
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Kosmidis K, Jablonski KP, Muskhelishvili G, Hütt MT. Chromosomal origin of replication coordinates logically distinct types of bacterial genetic regulation. NPJ Syst Biol Appl 2020; 6:5. [PMID: 32066730 PMCID: PMC7026169 DOI: 10.1038/s41540-020-0124-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/21/2020] [Indexed: 01/16/2023] Open
Abstract
For a long time it has been hypothesized that bacterial gene regulation involves an intricate interplay of the transcriptional regulatory network (TRN) and the spatial organization of genes in the chromosome. Here we explore this hypothesis both on a structural and on a functional level. On the structural level, we study the TRN as a spatially embedded network. On the functional level, we analyze gene expression patterns from a network perspective (“digital control”), as well as from the perspective of the spatial organization of the chromosome (“analog control”). Our structural analysis reveals the outstanding relevance of the symmetry axis defined by the origin (Ori) and terminus (Ter) of replication for the network embedding and, thus, suggests the co-evolution of two regulatory infrastructures, namely the transcriptional regulatory network and the spatial arrangement of genes on the chromosome, to optimize the cross-talk between two fundamental biological processes: genomic expression and replication. This observation is confirmed by the functional analysis based on the differential gene expression patterns of more than 4000 pairs of microarray and RNA-Seq datasets for E. coli from the Colombos Database using complex network and machine learning methods. This large-scale analysis supports the notion that two logically distinct types of genetic control are cooperating to regulate gene expression in a complementary manner. Moreover, we find that the position of the gene relative to the Ori is a feature of very high predictive value for gene expression, indicating that the Ori–Ter symmetry axis coordinates the action of distinct genetic control mechanisms.
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Affiliation(s)
- Kosmas Kosmidis
- Division of Theoretical Physics, Physics Department, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.,PharmaInformatics Unit, Research Center ATHENA, Athens, Greece
| | - Kim Philipp Jablonski
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany.,Department of Biosystems Science and Engineering, ETH Zürich, Zürich, Switzerland
| | | | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany.
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19
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Arabyat RM, Sanchez Martinez A, Nusair MB. Adverse drug event reporting by pharmacists: a systematic literature review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rasha M. Arabyat
- Department of Pharmacy Practice Faculty of Pharmacy Yarmouk University Irbid Jordan
| | | | - Mohammad B. Nusair
- Department of Pharmacy Practice Faculty of Pharmacy Yarmouk University Irbid Jordan
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20
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Mullan KA, Anderson A, Illing PT, Kwan P, Purcell AW, Mifsud NA. HLA-associated antiepileptic drug-induced cutaneous adverse reactions. HLA 2019; 93:417-435. [PMID: 30895730 DOI: 10.1111/tan.13530] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/31/2022]
Abstract
Adverse drug reactions (ADRs) are a common cause of hospital admissions (up to 19%), with the majority of cases due to off-target predictable drug effects (type A reactions). However, idiosyncratic drug-induced immune activated (type B) reactions contribute to a range of hypersensitivity reactions, with T-cell-mediated type IV hypersensitivity reactions mainly manifesting as cutaneous ADRs (cADRs). Aromatic antiepileptic drugs (AEDs), used in the treatment of epilepsy as well as bipolar disorder or neuropathic pain, have been implicated as culprit drugs in a spectrum of pathologies ranging from mild maculopapular exanthema (MPE) to severe and life-threatening conditions including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These AED-induced cADRs are unpredictable based on pharmacological and clinical factors alone, thereby prompting investigations into genomic contributors mediating risk of pathology. The most strongly associated risk genes identified are from the human leukocyte antigen (HLA) class I alleles, which play a critical role in adaptive immunity by flagging either infected or aberrant cells for recognition by surveying T-cells. In the setting of drug hypersensitivity, the immunogenicity of HLA molecules and their peptide cargo can be modulated by interactions with small drug molecules that drive inappropriate T-cell responses. This review discusses the current understanding of HLA class I molecules in modifying risk of AED-induced cADRs.
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Affiliation(s)
- Kerry A Mullan
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Alison Anderson
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Patricia T Illing
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Victoria, Australia.,Department of Neuroscience, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony W Purcell
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Nicole A Mifsud
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
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21
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Kosmidis K, Hütt MT. The E. coli transcriptional regulatory network and its spatial embedding. THE EUROPEAN PHYSICAL JOURNAL. E, SOFT MATTER 2019; 42:30. [PMID: 30879159 DOI: 10.1140/epje/i2019-11794-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Usually complex networks are studied as graphs consisting of nodes whose spatial arrangement is of no significance. Several real biological networks are, however, embedded in space. In this paper we study the transcription regulatory network (TRN) of E. coli as a spatially embedded network. The embedding space of this network is the circular E. coli chromosome, i.e. it is practically one dimensional. However, the TRN itself is a high-dimensional network due to the existence of an adequate number of long-range connections. We find that nodes in short topological distance l = 1, 2 tend, on average, to be in shorter spatial distances r indicating an abundance of short-range connections as well. Community analysis of the TRN reveals the interesting fact that highly interconnected subnets consist of nodes that tend to be in spatial proximity on the circular chromosome. We also find indications that for certain transcriptional aspects of the E. coli it is advantageous to treat the circular genome as two line segments starting from the OriC and ending to Ter.
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Affiliation(s)
- Kosmas Kosmidis
- Physics Department, Aristotle University of Thessaloniki, 54124, Panepistimioupolis, Greece.
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece.
| | - Marc-Thorsten Hütt
- Computational Systems Biology, Jacobs University Bremen, 28759, Bremen, Germany
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22
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Blin P, Dureau‐Pournin C, Cottin Y, Bénichou J, Mismetti P, Abouelfath A, Lassalle R, Droz C, Moore N. Comparative Effectiveness and Safety of Standard or Reduced Dose Dabigatran vs. Rivaroxaban in Nonvalvular Atrial Fibrillation. Clin Pharmacol Ther 2019; 105:1439-1455. [DOI: 10.1002/cpt.1318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/30/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | | | - Yves Cottin
- Service de CardiologieCHU de Dijon Dijon France
| | - Jacques Bénichou
- INSERM U1219Université de Bordeaux Bordeaux France
- CHU de RouenUnité de Biostatistique Rouen France
| | - Patrick Mismetti
- Unité de Recherche Clinique Innovation et PharmacologieHôpital Nord Saint‐Etienne France
| | - Abdelilah Abouelfath
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Regis Lassalle
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Cécile Droz
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Nicholas Moore
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
- INSERM U1219Université de Bordeaux Bordeaux France
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23
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Blin P, Dureau-Pournin C, Cottin Y, Bénichou J, Mismetti P, Abouelfath A, Lassalle R, Droz C, Moore N. Effectiveness and safety of 110 or 150 mg dabigatran vs. vitamin K antagonists in nonvalvular atrial fibrillation. Br J Clin Pharmacol 2018; 85:432-441. [PMID: 30423205 DOI: 10.1111/bcp.13815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS We compared the 1-year safety and effectiveness of dabigatran 110 mg (D110) or 150 mg (D150) twice daily to vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation. METHODS New user cohort study of patients dispensed D110 or D150 vs. VKA in 2013 for nonvalvular atrial fibrillation, followed 1 year in the French Système National des Données de Santé (66 million persons). D110 and D150 users were matched 1:1 with VKA users on sex, age, date of first drug dispensing and high-dimensional propensity score. Hazard ratios [HR (95% confidence intervals)] for stroke and systemic embolism (SSE), major bleeding (MB) and death were computed using Cox proportional hazards or Fine and Gray models during exposure. RESULTS In 14 442 matched D110 and VKA patients, mean age 79, 49% male, 91% with CHA2 DS2 -VASc ≥2 and 8% with HAS-BLED score >3, incidence rates of SSE were 1.9% and 2.6% person-years [HR 0.69 (0.56-0.84)], MB 1.8% and 2.9% [0.62 (0.51-0.76)], death 7.2% and 8.6% [0.84 (0.76-0.94)]. In 8389 matched D150 and VKA patients, mean age 67, 67% male, 65% with CHA2 DS2 -VASC ≥2; < 5% HAS-BLED >3, incidence rates were for SSE 1.4% and 1.9% [0.76 (0.56-1.04)], MB 0.6% and 1.9% [0.30 (0.20-0.46)], death 1.6% and 3.6% [0.46 (0.35-0.59)]. Numbers needed to treat to observe one fewer death were 78 for D110, 88 for D150. CONCLUSION In real life D110 and D150 were at least as effective, and safer than VKA.
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Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Caroline Dureau-Pournin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Yves Cottin
- CHU de Dijon, Service de Cardiologie, 21079, Dijon, France
| | - Jacques Bénichou
- INSERM U1219, Université de Bordeaux, 33076, Bordeaux, France.,CHU de Rouen, Unité de Biostatistique, 76031, Rouen, France
| | - Patrick Mismetti
- Hôpital Nord, Unité de Recherche Clinique Innovation et Pharmacologie, 42055, Saint-Etienne, France
| | - Abdelilah Abouelfath
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Regis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France.,INSERM U1219, Université de Bordeaux, 33076, Bordeaux, France
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24
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Thevelin S, Spinewine A, Beuscart JB, Boland B, Marien S, Vaillant F, Wilting I, Vondeling A, Floriani C, Schneider C, Donzé J, Rodondi N, Cullinan S, O'Mahony D, Dalleur O. Development of a standardized chart review method to identify drug-related hospital admissions in older people. Br J Clin Pharmacol 2018; 84:2600-2614. [PMID: 30007041 DOI: 10.1111/bcp.13716] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 01/06/2023] Open
Abstract
AIMS We aimed to develop a standardized chart review method to identify drug-related hospital admissions (DRA) in older people caused by non-preventable adverse drug reactions and preventable medication errors including overuse, underuse and misuse of medications: the DRA adjudication guide. METHODS The DRA adjudication guide was developed based on design and test iterations with international and multidisciplinary input in four subsequent steps: literature review; evaluation of content validity using a Delphi consensus technique; a pilot test; and a reliability study. RESULTS The DRA adjudication guide provides definitions, examples and step-by-step instructions to measure DRA. A three-step standardized chart review method was elaborated including: (i) data abstraction; (ii) explicit screening with a newly developed trigger tool for DRA in older people; and (iii) consensus adjudication for causality by a pharmacist and a physician using the World Health Organization-Uppsala Monitoring Centre and Hallas criteria. A 15-member international Delphi panel reached consensus agreement on 26 triggers for DRA in older people. The DRA adjudication guide showed good feasibility of use and achieved moderate inter-rater reliability for the evaluation of 16 cases by four European adjudication pairs (71% agreement, κ = 0.41). Disagreements arose mainly for cases with potential underuse. CONCLUSIONS The DRA adjudication guide is the first standardized chart review method to identify DRA in older persons. Content validity, feasibility of use and inter-rater reliability were found to be satisfactory. The method can be used as an outcome measure for interventions targeted at improving quality and safety of medication use in older people.
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Affiliation(s)
- Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU Dinant-Godinne UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Jean-Baptiste Beuscart
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Benoit Boland
- Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Marien
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Fanny Vaillant
- Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Ingeborg Wilting
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ariel Vondeling
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Older Persons (EPHOR), University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Carmen Floriani
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Shane Cullinan
- Pharmaceutical Care Research Group, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, College Road, Cork, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital and Department of Medicine, University College Cork, Cork, Ireland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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25
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Turnbull L, Hütt MT, Ioannides AA, Kininmonth S, Poeppl R, Tockner K, Bracken LJ, Keesstra S, Liu L, Masselink R, Parsons AJ. Connectivity and complex systems: learning from a multi-disciplinary perspective. APPLIED NETWORK SCIENCE 2018; 3:11. [PMID: 30839779 PMCID: PMC6214298 DOI: 10.1007/s41109-018-0067-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/29/2018] [Indexed: 05/05/2023]
Abstract
In recent years, parallel developments in disparate disciplines have focused on what has come to be termed connectivity; a concept used in understanding and describing complex systems. Conceptualisations and operationalisations of connectivity have evolved largely within their disciplinary boundaries, yet similarities in this concept and its application among disciplines are evident. However, any implementation of the concept of connectivity carries with it both ontological and epistemological constraints, which leads us to ask if there is one type or set of approach(es) to connectivity that might be applied to all disciplines. In this review we explore four ontological and epistemological challenges in using connectivity to understand complex systems from the standpoint of widely different disciplines. These are: (i) defining the fundamental unit for the study of connectivity; (ii) separating structural connectivity from functional connectivity; (iii) understanding emergent behaviour; and (iv) measuring connectivity. We draw upon discipline-specific insights from Computational Neuroscience, Ecology, Geomorphology, Neuroscience, Social Network Science and Systems Biology to explore the use of connectivity among these disciplines. We evaluate how a connectivity-based approach has generated new understanding of structural-functional relationships that characterise complex systems and propose a 'common toolbox' underpinned by network-based approaches that can advance connectivity studies by overcoming existing constraints.
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Affiliation(s)
| | | | | | - Stuart Kininmonth
- Stockholm Resilience Institute, Stockholm, Sweden
- The University of South Pacific, Suva, Fiji
| | | | - Klement Tockner
- Freie Universität Berlin, Berlin, Germany
- Leibniz-Institute of Freshwater Ecology and Inland Fisheries, Berlin, Germany
- Austrian Science Funds, Berlin, Germany
| | | | | | - Lichan Liu
- Laboratory for Human Brain Dynamics, Nicosia, Cyprus
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26
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Klosik DF, Grimbs A, Bornholdt S, Hütt MT. The interdependent network of gene regulation and metabolism is robust where it needs to be. Nat Commun 2017; 8:534. [PMID: 28912490 PMCID: PMC5599549 DOI: 10.1038/s41467-017-00587-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022] Open
Abstract
Despite being highly interdependent, the major biochemical networks of the living cell-the networks of interacting genes and of metabolic reactions, respectively-have been approached mostly as separate systems so far. Recently, a framework for interdependent networks has emerged in the context of statistical physics. In a first quantitative application of this framework to systems biology, here we study the interdependent network of gene regulation and metabolism for the model organism Escherichia coli in terms of a biologically motivated percolation model. Particularly, we approach the system's conflicting tasks of reacting rapidly to (internal and external) perturbations, while being robust to minor environmental fluctuations. Considering its response to perturbations that are localized with respect to functional criteria, we find the interdependent system to be sensitive to gene regulatory and protein-level perturbations, yet robust against metabolic changes. We expect this approach to be applicable to a range of other interdependent networks.Although networks of interacting genes and metabolic reactions are interdependent, they have largely been treated as separate systems. Here the authors apply a statistical framework for interdependent networks to E. coli, and show that it is sensitive to gene and protein perturbations but robust against metabolic changes.
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Affiliation(s)
- David F Klosik
- Institute for Theoretical Physics, University of Bremen, Hochschulring 18, 28359, Bremen, Germany
| | - Anne Grimbs
- Department of Life Sciences and Chemistry, Jacobs University, Campus Ring 1, 28759, Bremen, Germany
| | - Stefan Bornholdt
- Institute for Theoretical Physics, University of Bremen, Hochschulring 18, 28359, Bremen, Germany.
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University, Campus Ring 1, 28759, Bremen, Germany.
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27
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Byrne CJ, Cahir C, Curran C, Bennett K. High-risk prescribing in an Irish primary care population: trends and variation. Br J Clin Pharmacol 2017; 83:2821-2830. [PMID: 28701029 DOI: 10.1111/bcp.13373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/03/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022] Open
Abstract
AIMS The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies. METHODS A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing. RESULTS There were significant reductions in the rates of most indicators over time (P < 0.001). A total of 66 022 of 300 906 patients at risk in 2011 [21.9%, 95% confidence interval (CI) 21.8, 22.1%], and 42 109 of 278 469 in 2015 (15.1%, 95% CI 15.0, 15.3%), received ≥1 high-risk prescription (P < 0.001). In 2015, indicators with the highest rates of HRP were prescription of a nonsteroidal anti-inflammatory drug (NSAID) without gastroprotection in those ≥75 years (37.2% of those on NSAIDs), coprescription of warfarin and an antiplatelet agent or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively) and prescription of digoxin ≥250 μg day-1 in those ≥65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P < 0.001). a) After controlling for patient variables, the variation in the rate of HRP between GPs was significant (P < 0.05); and b) after controlling for patient variables and the prescribing GP, the variation in the rate of dispensing of high-risk prescriptions between pharmacies was significant (P < 0.05). CONCLUSIONS HRP in Ireland has declined over time, although some indicators persist. The variation between GPs and pharmacies suggests the potential for improvement in safe medicines use in community care, particularly in vulnerable older populations.
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Affiliation(s)
- Catherine J Byrne
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Curran
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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28
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Goldring C, Antoine DJ, Bonner F, Crozier J, Denning C, Fontana RJ, Hanley NA, Hay DC, Ingelman-Sundberg M, Juhila S, Kitteringham N, Silva-Lima B, Norris A, Pridgeon C, Ross JA, Sison Young R, Tagle D, Tornesi B, van de Water B, Weaver RJ, Zhang F, Park BK. Stem cell-derived models to improve mechanistic understanding and prediction of human drug-induced liver injury. Hepatology 2017; 65:710-721. [PMID: 27775817 PMCID: PMC5266558 DOI: 10.1002/hep.28886] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/01/2016] [Indexed: 01/12/2023]
Abstract
Current preclinical drug testing does not predict some forms of adverse drug reactions in humans. Efforts at improving predictability of drug-induced tissue injury in humans include using stem cell technology to generate human cells for screening for adverse effects of drugs in humans. The advent of induced pluripotent stem cells means that it may ultimately be possible to develop personalized toxicology to determine interindividual susceptibility to adverse drug reactions. However, the complexity of idiosyncratic drug-induced liver injury means that no current single-cell model, whether of primary liver tissue origin, from liver cell lines, or derived from stem cells, adequately emulates what is believed to occur during human drug-induced liver injury. Nevertheless, a single-cell model of a human hepatocyte which emulates key features of a hepatocyte is likely to be valuable in assessing potential chemical risk; furthermore, understanding how to generate a relevant hepatocyte will also be critical to efforts to build complex multicellular models of the liver. Currently, hepatocyte-like cells differentiated from stem cells still fall short of recapitulating the full mature hepatocellular phenotype. Therefore, we convened a number of experts from the areas of preclinical and clinical hepatotoxicity and safety assessment, from industry, academia, and regulatory bodies, to specifically explore the application of stem cells in hepatotoxicity safety assessment and to make recommendations for the way forward. In this short review, we particularly discuss the importance of benchmarking stem cell-derived hepatocyte-like cells to their terminally differentiated human counterparts using defined phenotyping, to make sure the cells are relevant and comparable between labs, and outline why this process is essential before the cells are introduced into chemical safety assessment. (Hepatology 2017;65:710-721).
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Affiliation(s)
- Christopher Goldring
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Daniel J. Antoine
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Jonathan Crozier
- European Partnership for Alternative Approaches to Animal Testing (EPAA), Brussels, Belgium
| | - Chris Denning
- Department of Stem Cell Biology, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Robert J. Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil A. Hanley
- Centre for Endocrinology & Diabetes, University of Manchester; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, UK
| | - David C. Hay
- MRC Centre for Regenerative Medicine, University of Edinburgh, UK
| | | | - Satu Juhila
- R&D, In Vitro Biology, Orion Pharma, Espoo, Finland
| | - Neil Kitteringham
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Alan Norris
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Chris Pridgeon
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - James A. Ross
- MRC Centre for Regenerative Medicine, University of Edinburgh, UK
| | - Rowena Sison Young
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Danilo Tagle
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Belen Tornesi
- Abbvie Global Pharmaceutical Research and Development, North Chicago, IL, USA
| | - Bob van de Water
- Faculty of Science, Leiden Academic Centre for Drug Research, Gorlaeus Laboratories, University of Leiden, Netherlands
| | - Richard J. Weaver
- Institut de Recherches Internationales Servier (I.R.I.S), Suresnes, 92284, Cedex France
| | - Fang Zhang
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - B. Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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29
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Beuscart JB, Pont LG, Thevelin S, Boland B, Dalleur O, Rutjes AWS, Westbrook JI, Spinewine A. A systematic review of the outcomes reported in trials of medication review in older patients: the need for a core outcome set. Br J Clin Pharmacol 2017; 83:942-952. [PMID: 27891666 DOI: 10.1111/bcp.13197] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022] Open
Abstract
AIM Medication review has been advocated as one of the measures to tackle the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. This study aimed to assess outcome reporting in trials of medication review in older patients. METHODS Randomized controlled trials (RCTs), prospective studies and RCT protocols involving medication review performed in patients aged 65 years or older in any setting of care were identified from: (1) a recent systematic review; (2) RCT registries of ongoing studies; (3) the Cochrane library. The type, definition, and frequency of all outcomes reported were extracted independently by two researchers. RESULTS Forty-seven RCTs or prospective published studies and 32 RCT protocols were identified. A total of 327 distinct outcomes were identified in the 47 published studies. Only one fifth (21%) of the studies evaluated the impact of medication reviews on adverse events such as drug reactions or drug-related hospital admissions. Most of the outcomes were related to medication use (n = 114, 35%) and healthcare use (n = 74, 23%). Very few outcomes were patient-related (n = 24, 7%). A total of 248 distinct outcomes were identified in the 32 RCT protocols. Overall, the number of outcomes and the number and type of health domains covered by the outcomes varied largely. CONCLUSION Outcome reporting from RCTs concerning medication review in older patients is heterogeneous. This review highlights the need for a standardized core outcome set for medication review in older patients, to improve outcome reporting and evidence synthesis.
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Affiliation(s)
- Jean-Baptiste Beuscart
- Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
| | - Lisa G Pont
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Stefanie Thevelin
- Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
| | - Benoit Boland
- Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Olivia Dalleur
- Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.,Pharmacy department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Anne W S Rutjes
- CTU Bern, Department of Clinical Research, University of Bern, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Anne Spinewine
- Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.,Pharmacy department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
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30
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Chan SL, Ang X, Sani LL, Ng HY, Winther MD, Liu JJ, Brunham LR, Chan A. Prevalence and characteristics of adverse drug reactions at admission to hospital: a prospective observational study. Br J Clin Pharmacol 2016; 82:1636-1646. [PMID: 27640819 PMCID: PMC5099543 DOI: 10.1111/bcp.13081] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 01/11/2023] Open
Abstract
Aims Adverse drug reactions (ADRs) contribute to poorer patient outcomes and additional burden to the healthcare system. However, data on the true burden, relevant types and drugs causing ADRs are lacking. The aim of this study was to determine the prevalence of ADR‐related hospitalization in the general adult population in Singapore and to investigate their characteristics. Methods We prospectively recruited 1000 adult patients with unplanned admission to a large tertiary‐care hospital. Two independent reviewers evaluated all suspected ADRs for causality, type, severity and avoidability. The prevalence of ADR‐related hospitalization was calculated based on ‘definite’ and ‘probable’ ADRs. Logistic regression was used to evaluate predictors for having an ADR at admission. Results The prevalence of all ADRs at admission was 12.4% (95% CI: 10.5–14.6%) and ADRs causing admission was 8.1% (95% CI: 6.5–10.0%). The most common ADRs were gastrointestinal‐related. The most common drug category causing ADRs were cardiovascular drugs. Patients with ADRs had a longer length of stay than those who did not (median 4 vs. 3 days, P = 1.70 × 10−3). About 30% of ADRs at admission were caused by at least one drug with a clinical annotation in the Pharmacogenomics KnowledgeBase (PharmGKB), suggesting that some of these ADRs may have been predicted by pharmacogenetic testing. Conclusions We have quantified the burden and characteristics of clinically impactful ADRs in the Singaporean general adult population. Our results will provide vital information for efforts in reducing ADRs through targeted vigilance, patient education and pharmacogenomics in Singapore.
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Affiliation(s)
- Sze Ling Chan
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore and the National University of Singapore
| | - Xiaohui Ang
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Levana L Sani
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Hong Yen Ng
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Michael D Winther
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Jian Jun Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Liam R Brunham
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore and the National University of Singapore.,Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore.,Oncology Pharmacy, National Cancer Centre Singapore, Singapore
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31
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Knecht C, Fretter C, Rosenstiel P, Krawczak M, Hütt MT. Distinct metabolic network states manifest in the gene expression profiles of pediatric inflammatory bowel disease patients and controls. Sci Rep 2016; 6:32584. [PMID: 27585741 PMCID: PMC5009330 DOI: 10.1038/srep32584] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022] Open
Abstract
Information on biological networks can greatly facilitate the function-orientated interpretation of high-throughput molecular data. Genome-wide metabolic network models of human cells, in particular, can be employed to contextualize gene expression profiles of patients with the goal of both, a better understanding of individual etiologies and an educated reclassification of (clinically defined) phenotypes. We analyzed publicly available expression profiles of intestinal tissues from treatment-naive pediatric inflammatory bowel disease (IBD) patients and age-matched control individuals, using a reaction-centric metabolic network derived from the Recon2 model. By way of defining a measure of 'coherence', we quantified how well individual patterns of expression changes matched the metabolic network. We observed a bimodal distribution of metabolic network coherence in both patients and controls, albeit at notably different mixture probabilities. Multidimensional scaling analysis revealed a bisectional pattern as well that overlapped widely with the metabolic network-based results. Expression differences driving the observed bimodality were related to cellular transport of thiamine and bile acid metabolism, thereby highlighting the crosstalk between metabolism and other vital pathways. We demonstrated how classical data mining and network analysis can jointly identify biologically meaningful patterns in gene expression data.
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Affiliation(s)
- Carolin Knecht
- Institute of Medical Informatics and Statistics, Christian-Albrechts University Kiel, Kiel, Germany
| | - Christoph Fretter
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Center for Molecular Biosciences, Christian-Albrechts University Kiel, Kiel, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Christian-Albrechts University Kiel, Kiel, Germany
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany
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Naz M, Kodamullil AT, Hofmann-Apitius M. Reasoning over genetic variance information in cause-and-effect models of neurodegenerative diseases. Brief Bioinform 2016; 17:505-16. [PMID: 26249223 PMCID: PMC4870396 DOI: 10.1093/bib/bbv063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/09/2015] [Indexed: 12/18/2022] Open
Abstract
The work we present here is based on the recent extension of the syntax of the Biological Expression Language (BEL), which now allows for the representation of genetic variation information in cause-and-effect models. In our article, we describe, how genetic variation information can be used to identify candidate disease mechanisms in diseases with complex aetiology such as Alzheimer's disease and Parkinson's disease. In those diseases, we have to assume that many genetic variants contribute moderately to the overall dysregulation that in the case of neurodegenerative diseases has such a long incubation time until the first clinical symptoms are detectable. Owing to the multilevel nature of dysregulation events, systems biomedicine modelling approaches need to combine mechanistic information from various levels, including gene expression, microRNA (miRNA) expression, protein-protein interaction, genetic variation and pathway. OpenBEL, the open source version of BEL, has recently been extended to match this requirement, and we demonstrate in our article, how candidate mechanisms for early dysregulation events in Alzheimer's disease can be identified based on an integrative mining approach that identifies 'chains of causation' that include single nucleotide polymorphism information in BEL models.
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Blin P, Dureau-Pournin C, Lassalle R, Abouelfath A, Droz-Perroteau C, Moore N. A population database study of outcomes associated with vitamin K antagonists in atrial fibrillation before DOAC. Br J Clin Pharmacol 2015; 81:569-78. [PMID: 26493768 PMCID: PMC4767200 DOI: 10.1111/bcp.12807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/07/2015] [Accepted: 10/14/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS This study aimed to describe the real-life incidence of bleeding, arterial thrombotic events and death during vitamin K antagonist (VKA) treatment in atrial fibrillation (AF). METHODS This was a cohort study in Echantillon Généraliste de Bénéficiaires, the 1/97 sample of the French national healthcare claims and hospitalization database, of new VKA users with definite or probable AF and no other indication, and of patients without AF, from 2007 to 2011. Prespecified outcomes were all-cause death, hospitalization for bleeding, arterial thrombotic event (ATE), or acute coronary syndrome (ACS) or any of the above (composite outcome). RESULTS Of 8894 new VKA users, 3345 had probable or certain AF, 51.7% were male, mean age was 75.1 years, 87.1% had a CHA2 DS2 -VASc score ≥ 2 and 11.6% a HAS-BLED score > 3. Among AF patients, during VKA exposure the incidence rate of bleeding was 2.8 [95% confidence interval (CI) 2.2, 3.4] per 100 patient-years, including 0.6 (95% CI 0.3, 0.8) cerebral, 1.0 (95% CI 0.7, 1.3) digestive and 1.4 (95% CI 1.0, 1.7) other bleeds. There were 1.6 (95% CI 1.2, 2.0) ACS, 1.5 (95% CI 1.1, 1.8) ATE and 3.8 (95% CI 3.2, 4.4) deaths per 100 patient-years. The incidence rate of the composite outcome was 9.1 per 100 patient-years (95% CI 8.2, 10.0). When patients stopped VKA, bleeding decreased (RR 0.67, 95% CI 0.43, 1.04)), but death or thrombosis increased (RR 3.06, 95% CI 2.46, 3.81 and 1.75, 95% CI 1.14, 2.70, respectively). During VKA exposure non-AF patients had similar rates of bleeding, but fewer deaths, ACS and ischaemic events. CONCLUSIONS Real-life rates for bleeding, arterial thrombotic events, ACS and deaths in AF patients treated with VKA were similar to those observed in clinical trials.
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Affiliation(s)
- Patrick Blin
- Bordeaux Pharmacoepi, Inserm CIC1401, Bordeaux.,Adera, Bordeaux
| | | | - Regis Lassalle
- Bordeaux Pharmacoepi, Inserm CIC1401, Bordeaux.,Adera, Bordeaux
| | | | | | - Nicholas Moore
- Bordeaux Pharmacoepi, Inserm CIC1401, Bordeaux.,University of Bordeaux, F33076, Bordeaux, France
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Turner RM, Park BK, Pirmohamed M. Parsing interindividual drug variability: an emerging role for systems pharmacology. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2015; 7:221-41. [PMID: 25950758 PMCID: PMC4696409 DOI: 10.1002/wsbm.1302] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022]
Abstract
There is notable interindividual heterogeneity in drug response, affecting both drug efficacy and toxicity, resulting in patient harm and the inefficient utilization of limited healthcare resources. Pharmacogenomics is at the forefront of research to understand interindividual drug response variability, but although many genotype-drug response associations have been identified, translation of pharmacogenomic associations into clinical practice has been hampered by inconsistent findings and inadequate predictive values. These limitations are in part due to the complex interplay between drug-specific, human body and environmental factors influencing drug response and therefore pharmacogenomics, whilst intrinsically necessary, is by itself unlikely to adequately parse drug variability. The emergent, interdisciplinary and rapidly developing field of systems pharmacology, which incorporates but goes beyond pharmacogenomics, holds significant potential to further parse interindividual drug variability. Systems pharmacology broadly encompasses two distinct research efforts, pharmacologically-orientated systems biology and pharmacometrics. Pharmacologically-orientated systems biology utilizes high throughput omics technologies, including next-generation sequencing, transcriptomics and proteomics, to identify factors associated with differential drug response within the different levels of biological organization in the hierarchical human body. Increasingly complex pharmacometric models are being developed that quantitatively integrate factors associated with drug response. Although distinct, these research areas complement one another and continual development can be facilitated by iterating between dynamic experimental and computational findings. Ultimately, quantitative data-derived models of sufficient detail will be required to help realize the goal of precision medicine.
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Affiliation(s)
- Richard M Turner
- The Wolfson Centre for Personalised Medicine, Institute for Translational Medicine, University of Liverpool, Liverpool, UK
| | - B Kevin Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- The Wolfson Centre for Personalised Medicine, Institute for Translational Medicine, University of Liverpool, Liverpool, UK
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Zaniello B, Phillips‐Caesar E. Over‐the‐Counter Medication Overuse and Bowel Obstruction. J Am Geriatr Soc 2014; 62:400-2. [DOI: 10.1111/jgs.12641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Benjamin Zaniello
- Division of Allergy and Infectious Diseases University of Washington Medical Center Seattle Washington
| | - Erica Phillips‐Caesar
- Division of Clinical Epidemiology and Evaluative Sciences Research Weill Cornell Medical College New York New York
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Malik M, Hassali MAA, Shafie AA, Hussain A, Sandhu G, Dionysopoulos D, Phillips CJ, Tomlin AC, Doherty P, Whitfield K, Polasek TM, Lin FPY, Doogue MP, Amir M, Ellis DP, Hassali MAA, Shafie AA, Palaian S. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2011. [DOI: 10.1002/j.2055-2335.2011.tb00071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Madeeha Malik
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Mohamed AA Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Asrul A Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Azhar Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia Penang Malaysia
- Hamdard Institute of Pharmaceutical SciencesHamdard University Islamabad Pakistan
| | - Geeta Sandhu
- Specialist Pharmacist – Cancer Services Ambulatory Care, Princess Alexandra Hospital, The School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | | | | | - Angela C Tomlin
- Surgical Preadmission ClinicFlinders Medical Centre Bedford Park Adelaide SA 5042
| | - Paula Doherty
- Drug Usage Evaluation, Medication Safety Project PharmacistJohn Hunter Hospital, Hunter New England Local Health Network New Lambton NSW 2305
| | - Karen Whitfield
- Quality Use of Medicines, School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | - Thomas M Polasek
- Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Frank PY Lin
- Centre of Health InformaticsUniversity of New South Wales Sydney NSW 2052
| | - Mathew P Doogue
- Clinical Pharmacologist and Endocrinologist, Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Muhammad Amir
- Ziauddin College of PharmacyZiauddin University Clifton, Karachi 75600 Pakistan
| | - David P Ellis
- Women's and Children's HospitalChildren, Youth and Women's Health Service North Adelaide SA 5006
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
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Peterson GM. Drug Interaction Dilemmas. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2011. [DOI: 10.1002/j.2055-2335.2011.tb00052.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory M Peterson
- Unit for Medication Outcomes Research and Education, School of PharmacyUniversity of Tasmania Hobart Tas. 7001
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Strunin L, Stone M, Jack B. Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization? J Hosp Med 2007; 2:297-304. [PMID: 17935257 DOI: 10.1002/jhm.206] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A high rate of unnecessary rehospitalization has been shown to be related to a poorly managed discharge processes. OBJECTIVE A qualitative study was conducted in order to understand the phenomenon of frequent rehospitalization from the perspective of discharged patients and to determine if activities at the time of discharge could be designed to reduce the number of adverse events and rehospitalization. DESIGN Semistructured, open-ended interviews were conducted with 21 patients during their hospital stay at Boston Medical Center. Interviews assessed continuity of care after discharge, need for and availability of social support, and ability to obtain follow-up medical care. RESULTS Difficult life circumstances posed a greater barrier to recuperation than lack of medical knowledge. All participants were able to describe their medical condition, the reasons they were admitted to the hospital, and the discharge instructions they received. All reported the types of medications being taken or the conditions for which the medications were prescribed. Recuperation was compromised by factors that contribute to undermining the ability of patients to follow their doctors' recommendations including support for medical and basic needs, substance use, and limitations in the availability of transportation to medical appointments. Distress, particularly depression, further contributed to poor health and undermined the ability to follow doctors' recommendations and the discharge plans. CONCLUSIONS Discharge interventions that assess the need for social support and provide access and services have the potential to reduce chronic rehospitalization.
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Affiliation(s)
- Lee Strunin
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA 02118, USA
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