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Xia J, Wang Z, Becker R, Li F, Wei F, Yang S, Rich J, Li K, Rufo J, Qian J, Yang K, Chen C, Gu Y, Zhong R, Lee PJ, Wong DTW, Lee LP, Huang TJ. Acoustofluidic Virus Isolation via Bessel Beam Excitation Separation Technology. ACS NANO 2024. [PMID: 39132820 DOI: 10.1021/acsnano.4c09692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
The isolation of viruses from complex biological samples is essential for creating sensitive bioassays that assess the efficacy and safety of viral therapeutics and vaccines, which have played a critical role during the COVID-19 pandemic. However, existing methods of viral isolation are time-consuming and labor-intensive due to the multiple processing steps required, resulting in low yields. Here, we introduce the rapid, efficient, and high-resolution acoustofluidic isolation of viruses from complex biological samples via Bessel beam excitation separation technology (BEST). BEST isolates viruses by utilizing the nondiffractive and self-healing properties of 2D, in-plane acoustic Bessel beams to continuously separate cell-free viruses from biofluids, with high throughput and high viral RNA yield. By tuning the acoustic parameters, the cutoff size of isolated viruses can be easily adjusted to perform dynamic, size-selective virus isolation while simultaneously trapping larger particles and separating smaller particles and contaminants from the sample, achieving high-precision isolation of the target virus. BEST was used to isolate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from human saliva samples and Moloney Murine Leukemia Virus from cell culture media, demonstrating its potential use in both practical diagnostic applications and fundamental virology research. With high separation resolution, high yield, and high purity, BEST is a powerful tool for rapidly and efficiently isolating viruses. It has the potential to play an important role in the development of next-generation viral diagnostics, therapeutics, and vaccines.
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Affiliation(s)
- Jianping Xia
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Zeyu Wang
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Ryan Becker
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Feng Li
- School of Dentistry, University of California, Los Angeles, California 90095, United States
| | - Fang Wei
- School of Dentistry, University of California, Los Angeles, California 90095, United States
| | - Shujie Yang
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Joseph Rich
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Ke Li
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Joseph Rufo
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Jiao Qian
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Kaichun Yang
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Chuyi Chen
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Yuyang Gu
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Ruoyu Zhong
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
| | - Patty J Lee
- Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - David T W Wong
- School of Dentistry, University of California, Los Angeles, California 90095, United States
| | - Luke P Lee
- Renal Division and Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts 02115, United States
| | - Tony Jun Huang
- The Thomas Lord Department of Mechanical Engineering and Materials, Duke University, Durham, North Carolina 27708, United States
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Zaidi AS, Peterson GM, Curtain CM, Salahudeen MS. Predictors of Adverse Drug Reaction-Related Hospitalisations Among People with Dementia: A Retrospective Case-Control Study. Drug Saf 2024; 47:771-781. [PMID: 38739234 PMCID: PMC11286664 DOI: 10.1007/s40264-024-01435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are common among people with dementia; however, little is known about the magnitude and predictors associated with ADR-related hospitalisation among these individuals. This study aimed to determine the magnitude, types, drugs implicated and predictors of ADRs associated with hospitalisation among people with dementia. METHODS This retrospective case-control study analysed medical records of individuals aged ≥ 65 years with dementia admitted to major public hospitals in Tasmania, Australia, from July 2010 to July 2021. Adverse drug reactions and implicated drugs were identified using administrative data and cross-checked with hospital medical records, with consensus reached among the research team. RESULTS Of the 7928 people admitted to hospital at least once within the study period, 1876 (23.7%) experienced at least one ADR-related hospitalisation. Of these, 300 case patients with 311 ADRs and 300 control patients were randomly selected. The most common types of ADRs were renal (acute kidney injury; AKI) (36.0%), followed by neuropsychiatric (17.6%), cardiovascular (16.0%) and haematological (13.1%). Diuretics, renin-angiotensin system (RAS) inhibitors and anti-thrombotics constituted the main implicated drug classes. The ADR-related hospitalisation was associated with: chronic kidney disease (CKD) (OR 8.00, 95% CI 2.63-24.28, p < 0.001), Australian-born (OR 1.62, 95% CI 1.08-2.43, p = 0.019), hypertension (OR 1.48, 95% CI 1.01-2.17, p = 0.044) and the number of medicines (OR 1.06, 95% CI 1.00-1.12, p = 0.022). Potentially inappropriate medication use and anticholinergic burden did not predict ADR-related hospitalisation. CONCLUSIONS These predictors could help identify the individuals at the highest risk and enable targeted interventions to be designed.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia.
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
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Vogel JB, Neyer M, Elsner P, Vonbank A, Plattner T, Saely CH, Leiherer A, Drexel H. Current Practices of Medication Plans in Austrian Patients Undergoing Coronary Angiography: An In-Depth Analysis. J Clin Med 2024; 13:3187. [PMID: 38892897 PMCID: PMC11172892 DOI: 10.3390/jcm13113187] [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: 04/19/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
A complete medication plan (MPlan) increases medication safety and adherence and is crucial in care transitions. Countries that implemented a standardized MPlan reported benefits on patients' understanding and handling of their medication. Austria lacks such a standardization, with no available data on the issue. Objective: This study aimed to investigate the current state of all medication documentations (MDocs) at hospital admission in a population at high risk for polypharmacy in Austria. Methods: We enrolled 512 consecutive patients undergoing elective coronary angiography. Their MDocs and medications were recorded at admission. MDocs were categorized, whereby a MPlan was defined as a tabular list including medication name, dose, route, frequency and patient name. Results: Out of 485 patients, 55.1% had an MDoc (median number of drugs: 6, range 2-17), of whom 24.7% had unstructured documentation, 18.0% physicians' letters and 54.3% MPlans. Polypharmacy patients did not have a MDoc in 31.3%. Crucial information as the patients's name or the originator of the MDoc was missing in 31.1% and 20.4%, respectively. Patients with MDoc provided more comprehensive medication information (p = 0.019), although over-the-counter-medication was missing in 94.5% of MDocs. A discrepancy between the MPlan and current medication at admission existed in 64.4%. In total, only 10.7% of our patient cohort presented an MPlan that was in accordance with their current medication. Conclusion: The situation in Austria is far from a standardized MPlan generated in daily routine. Numerous MPlans do not represent the current medication and could pose a potential risk for the effectiveness and safety of pharmacotherapy.
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Affiliation(s)
- Johannes B. Vogel
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Magdalena Neyer
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Pascal Elsner
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Alexander Vonbank
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Thomas Plattner
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Christoph H. Saely
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Leiherer
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Medical Central Laboratories, 6800 Feldkirch, Austria
| | - Heinz Drexel
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Medical Central Laboratories, 6800 Feldkirch, Austria
- Landeskrankenhaus-Betriebsgesellschaft, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Zaidi AS, Peterson GM, Curtain CM, Salahudeen MS. Adverse clinical outcomes associated with drug-related hospitalizations in people with dementia. Expert Rev Clin Pharmacol 2024; 17:73-78. [PMID: 38078438 DOI: 10.1080/17512433.2023.2294007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND This study aimed to determine the clinical impact associated with adverse drug reactions (ADRs) in patients with dementia. RESEARCH DESIGN AND METHODS This case-control, propensity score-matched study utilized administrative data of people with dementia admitted to major public hospitals in Tasmania, Australia, from July 2010 to December 2019. RESULTS Acute renal failure constituted the most common ADR. The length of hospital stay was greater for people with an ADR index admission, versus non-ADR index admission (median [IQR]: 9 [4-18] versus 6 [2-12]; p < 0.001). In-hospital mortality and combined in-hospital and post-hospital mortality within 30, 60 and 90 days were higher for those whose index admission was ADR-related (in-hospital: HR 1.40, 95% CI 1.11-1.77, p-value <0.001; 30 days: HR 1.25, 95% CI 1.05-1.49, p-value <0.001; 60 days: HR 1.27, 95% CI 1.08-1.49, p-value <0.001; 90 days: HR 1.29, 95% CI 1.10-1.50, p-value <0.001). Subsequent ADR admission within 30, 60 and 90 days of index discharge was 9 to 10 times greater for people with dementia (30 days: OR 10.0, 95% CI 6.04-16.8, p-value <0.001; 60 days: OR 8.96, 95% CI 5.57-14.4, p-value <0.001; 90 days: OR 9.31, 95% CI 5.79-14.9, p-value <0.001). CONCLUSION Safe prescribing and vigilant monitoring of ADRs is pivotal to mitigate adverse outcomes in people with dementia.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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Schönenberger N, Meyer-Massetti C. Risk factors for medication-related short-term readmissions in adults - a scoping review. BMC Health Serv Res 2023; 23:1037. [PMID: 37770912 PMCID: PMC10536731 DOI: 10.1186/s12913-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. METHODS We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. RESULTS After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems-especially underprescribing and suboptimal drug selection-and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. CONCLUSIONS This study's findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.
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Affiliation(s)
- N Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
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Laroche ML, Gautier S, Polard E, Rabier MB, Chouchana L, Lebrun-Vignes B, Faillie JL, Petitpain N, Lagarce L, Jonville-Bera AP. Incidence and preventability of hospital admissions for adverse drug reactions in France: A prospective observational study (IATROSTAT). Br J Clin Pharmacol 2023; 89:390-400. [PMID: 36002314 PMCID: PMC10087906 DOI: 10.1111/bcp.15510] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS In the last French study in 2007, the incidence of hospital admissions (HAs) related to adverse drug reactions (ADRs) was 3.6%. The objective was to assess the current ADR-HA incidence in France and to describe both its characteristics and preventability. METHODS A prospective multicentre study was conducted among randomly selected French public hospital medical wards (April-July 2018). Patients admitted during a week period were included. ADR-HA cases were collected by the French Regional Pharmacovigilance Centres network. An independent committee validated potential cases and ADR preventability. RESULTS ADR-HA incidence was 8.5% (95% confidence interval [CI]: 7.6-9.4%), increasing with age (3.3% [95%CI: 1.8-5.5%] ≤16 y vs. 10.6% [95%CI: 9.3-12.0%] ≥65 y). The most common ADRs were haemorrhagic events (8.8%), haematological disorders (6.5%), acute renal failure (6.3%), fluid and electrolyte disorders (6.0%), and falls (5.2%). New drugs were involved: targeted therapies (22.8% of antineoplastics), direct oral anticoagulants (29.6% of antithrombotics) and incretin-based drugs (20.0% of antidiabetics). ADRs were preventable in 16.1% of cases because the drugs involved had not been used in accordance with monographies, package leaflets or other therapeutic guidelines. The main situations of noncompliance addressed either dose or duration of use (27.9%), warning (23.2%), use precaution (18.6%) and inappropriate self-medication or misuse by patients (11.6%). CONCLUSION In France, ADR-HA incidence dramatically increased over the last decade. A significant proportion was related to new pharmacological classes and considered as preventable. These findings should lead to in-depth thought on preventive actions on at-risk drug classes.
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Affiliation(s)
- Marie-Laure Laroche
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France.,UR 24134 (VieSanté- Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
| | - Sophie Gautier
- Regional Pharmacovigilance Centre of Lille, Pharmacology Department, CHU Lille, Lille, France
| | - Elisabeth Polard
- Regional Pharmacovigilance Centre of Rennes, CHU Rennes, Rennes, Francie, France
| | | | - Laurent Chouchana
- Regional Pharmacovigilance Centre of Cochin, Pharmacology Department, AP-HP. Centre - Université Paris Cité, Paris, France
| | - Bénédicte Lebrun-Vignes
- Regional Pharmacovigilance Centre of Pitié and Saint Antoine Hospital, APHP Sorbonne Université, Paris, France
| | - Jean-Luc Faillie
- Regional Pharmacovigilance Centre of Montpellier, CHU Montpellier, Montpellier, France.,IDESP, Univ. Montpellier, INSERM, Montpellier, France
| | - Nadine Petitpain
- Regional Pharmacovigilance Centre of Nancy, CHRU Nancy, Nancy, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Angers, Regional Pharmacovigilance Centre of Angers, Angers, France
| | - Annie-Pierre Jonville-Bera
- Regional Pharmacovigilance Centre - Centre-Val de Loire, Pharmacosurveillance Unit, CHRU Tours, Tours, France
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Martins ACM, Giordani F, Gonçalves MDC, Guaraldo L, Rozenfeld S. [Deaths from adverse drug events in Brazil: Mortality Information System as a source of information]. CAD SAUDE PUBLICA 2022; 38:e00291221. [PMID: 36169445 DOI: 10.1590/0102-311xpt291221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/11/2022] [Indexed: 08/30/2023] Open
Abstract
Adverse drug events (ADEs) are harmful events caused by medication, and some of which can lead to death. Death records are an important source of information when using codes from the 10th revision of the International Classification of Diseases (ICD-10) suggestive of ADE. This study aimed to identify the ADEs registered in Brazililian Mortality Information System (SIM), analyzing data distribution by year, age group, and type of event. This is an ecological study with retrospective data collection, identifying ADEs in the SIM, using the ICD-10 codes. The study included deaths that occurred in Brazil from 2008 to 2016. An increase in the number of deaths associated with ADE was observed from 2008 to 2016, with a mortality rate per 1 million inhabitants ranging from 8.70 to 14.40 in the period. Most events corresponded to mental and behavioral disorders due to the use of psychotropic drugs. Most deaths (12,311) related to ADE codes were identified in several chapters of the ICD-10. Chapter XX, about adverse events, allowed the identification of a smaller number of deaths (4,893). Higher event rates were observed among individuals aged 60 years and over (39.8/1 million) and children younger than one year (22.0/1 million). The identification of ADE-related deaths on the SIM is an important strategy for addressing undesirable drug-related events. Deaths related to the use of psychotropic drugs were the most frequent ADE-related deaths and the elderly were the age group most affected by ADEs.
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Affiliation(s)
| | | | | | - Lusiele Guaraldo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Suely Rozenfeld
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Silva LT, Modesto ACF, de Oliveira RA, Amaral RG, Lopes FM. Hospitalizations and adverse drug events in the Brazilian unified health system: a ten-year retrospective analysis of routine data. Rev Saude Publica 2022; 56:86. [PMID: 36228231 PMCID: PMC9529208 DOI: 10.11606/s1518-8787.2022056003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 12/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the frequency and characteristics of hospitalizations for/with adverse drug events in the Brazilian unified health system routine data. METHODS Nationwide retrospective study using data obtained from a period of ten years from the Brazil Hospital Information System (SIH-SUS), an administrative database that registers hospitalizations in the unified health system. We selected hospitalizations with primary and/or secondary diagnosis related to adverse drug events according to a list of validated International Classification Disease 10th edition (ICD-10) codes. These events were described according to year, age group, sex, length of hospital stay, mortality, hospital costs, Brazilian geographical region, and category of ICD-10 codes. Crude hospitalization rates of adverse drug events per 100,000 inhabitants were obtained and Joinpoint Regression was used to analyze temporal changes in these rates along the years. The most frequent ICD-10 codes were also identified. RESULTS Over ten years, 603,663 hospitalizations in Brazil were found in the database, out of which 2.5% of the patients died. Though 2009 had the highest prevalence of hospitalization per 100,000 inhabitants (32.57), no significant annual change in rates was found for the entire period. All age groups and sexes presented a jointpoint in temporal series; however, only women had a significative increase trend. The most frequent codes were from the chapter of mental and behavioral disorders (F19.2, F19.0, and F19.5 codes). CONCLUSIONS The database methodology can be useful to estimate frequencies of adverse drug events and perform characterization nationwide and to help monitor morbidity along the years.
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Affiliation(s)
- Lunara Teles Silva
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil
| | - Ana Carolina Figueiredo Modesto
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilUniversidade Federal de Goiás. Hospital das Clínicas. Goiânia, GO, Brasil
| | - Rodrigo Alves de Oliveira
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilUniversidade Federal de Goiás. Hospital das Clínicas. Goiânia, GO, Brasil
| | - Rita Goreti Amaral
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil,Universidade Federal de GoiásFaculdade de FarmáciaGoiâniaGOBrasilUniversidade Federal de Goiás. Faculdade de Farmácia. Goiânia, GO, Brasil
| | - Flavio Marques Lopes
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil,Universidade Federal de GoiásFaculdade de FarmáciaGoiâniaGOBrasilUniversidade Federal de Goiás. Faculdade de Farmácia. Goiânia, GO, Brasil
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Alsheikh MY, Alasmari MM. A National Survey of Community Pharmacists’ Viewpoints About Pharmacovigilance and Adverse Drug Reaction Reporting in Saudi Arabia. Front Pharmacol 2022; 13:819551. [PMID: 35721182 PMCID: PMC9204278 DOI: 10.3389/fphar.2022.819551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
This study assessed the knowledge, attitudes, and practices of community pharmacists regarding pharmacovigilance and adverse drug reaction (ADR) reporting system in Saudi Arabia. A cross-sectional survey of community pharmacists from different regions in Saudi Arabia was performed through convenience sampling between November 2020 and January 2021. The responses were received from 1,172 community pharmacists. Most respondents (86.7%) were familiar with the National Pharmacovigilance and Drug Safety Center, and 830 (70.8%) knew about the ADR reporting form. The majority (94%) of the respondents agreed with the importance of reporting ADRs for patient care and national health. Although 92.2% of the participants asked their patients about ADRs, 90.2% agreed that more training programs are required to be organized by the Saudi Food and Drug Authority for healthcare professionals on the ADR detection and reporting system. Analgesic agents were the most common drug category for which ADRs were reported (67.4%). The majority (92.1%) of ADRs reportedly occurred in patients with chronic diseases. The study concluded that most community pharmacists in Saudi Arabia are knowledgeable and have good attitudes and practices regarding pharmacovigilance and ADR reporting.
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Affiliation(s)
- Mona Y. Alsheikh
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Moudi M. Alasmari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
- *Correspondence: Moudi M. Alasmari,
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Friebel R, Maynou L. Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study. J R Soc Med 2022; 115:173-185. [PMID: 35114090 PMCID: PMC9066666 DOI: 10.1177/01410768221077360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the trends and characteristics of opioid-related hospital admissions in England over 10 years, and its burden for the National Health Service and public finances. Design Patient-level data from the Hospital Episode Statistics database to examine all opioid-related hospitalisations from 2008 to 2018, stratified by type of opioid admission and patient demographics. Setting All National Health Service hospitals in England. Participants Patients hospitalised from the harmful use of opioids. Main outcome measures The number of opioid-related hospitalisations, length of stay, in-hospital mortality, 30-day readmission rate and treatment costs. Results Opioid-related hospitalisations increased by 48.9%, from 10,805 admissions in 2008 to 16,091 admissions in 2018, with total treatment costs of £137 million. The growth in opioid-related hospitalisations was 21% above the corresponding rate for all other emergency admissions in England. Relative changes showed that hospitalisations increased most for individuals older than 55 years (160%), those living in the most affluent areas of England (93.8%), and suffering from four co-morbidities (627.6%) or more. Hospitals reduced mean patient length of stay from 2.8 days to 1.1 days over 10 years. Mean in-hospital mortality was 0.4% and mean 30-day readmission risk was 16.6%. Conclusion Opioid use is an increasing public health concern in England, though hospitalisation and mortality rates are less pronounced than in other countries. There are concerns about significant rises in hospitalisations from older, less deprived and sicker population groups. Our findings should prompt policymakers to go beyond monitoring mortality statistics when assessing the impacts of harmful use of opioids.
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Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, Houghton Street, WC2A 2AE, UK.,Center for Global Development Europe, London, Abbey Gardens, SW1P 3SE, UK
| | - Laia Maynou
- Department of Health Policy, The London School of Economics and Political Science, London, Houghton Street, WC2A 2AE, UK.,Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, 08034 Barcelona, Spain.,Center for Research in Health and Economics, University of Pompeu Fabra, 08005 Barcelona, Spain
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11
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Silva LT, Modesto ACF, Amaral RG, Lopes FM. Hospitalizations and deaths related to adverse drug events worldwide: Systematic review of studies with national coverage. Eur J Clin Pharmacol 2021; 78:435-466. [PMID: 34716774 DOI: 10.1007/s00228-021-03238-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Adverse drug events are related to negative outcomes in healthcare, including hospitalization, increased duration of hospital stay and death. The aim of this study was to conduct a systematic review to evaluate hospitalizations and deaths related to adverse drug events worldwide, reported in studies with national coverage. METHODS The protocol was registered in PROSPERO (CRD42020157008). We performed a systematic search on Medline, Embase, CINAHL, LILACS, and the Cochrane Library (until March 2020) using pre-specified terms. We included published studies that reported data on hospitalizations and/or deaths related to adverse drug events from a national perspective and the use of secondary data as a source of information. Two reviewers independently extracted and synthesized data. The quality of the studies was assessed using an adapted version of the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Narrative summaries of findings were undertaken. RESULTS Among 59,336 citations, 62 studies were included for data extraction and synthesis. Among these studies, 41 studies included the outcome of hospitalization, 16 included the death outcome, and five included both outcomes. Administrative databases regarding discharges and registries of vital statistics were the most common sources of information. The relative frequency of hospitalizations ranged from 0.03% to 7.3%, and from 9.7 to 383.0/100,000 population, whereas mortality rate ranged from 0.1 to 7.88/100,000 population. CONCLUSION Our study highlights information about adverse drug events using large administrative databases in a national scenario and provides an overview of databases and methods implemented to detect adverse drug events.
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Affiliation(s)
- Lunara Teles Silva
- Postgraduate Program On Health Sciences, School of Medicine, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil
| | | | - Rita Goreti Amaral
- School of Pharmacy, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil
| | - Flavio Marques Lopes
- School of Pharmacy, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil.
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12
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Ceballos M, Llano Y, Salazar-Ospina A, Madrigal-Cadavid J, Pino-Marín D, Amariles P. Skills and practices of pharmacy staff for dispensing of drugs with fiscalized substances in drugstores and pharmacies. Rev Saude Publica 2021; 55:44. [PMID: 34231824 PMCID: PMC8244815 DOI: 10.11606/s1518-8787.2021055003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.
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Affiliation(s)
- Mauricio Ceballos
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Yaqueline Llano
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Andrea Salazar-Ospina
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Juliana Madrigal-Cadavid
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Daniel Pino-Marín
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
| | - Pedro Amariles
- Universidad de Antioquia. Facultad de Ciencias Farmacéuticas y Alimentarias. Departamento de Farmacia. Medellín, Antioquia, Colombia
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13
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Khalili M, Mesgarpour B, Sharifi H, Golozar A, Haghdoost AA. Estimation of adverse drug reaction reporting in Iran: Correction for underreporting. Pharmacoepidemiol Drug Saf 2021; 30:1101-1114. [PMID: 33772938 DOI: 10.1002/pds.5235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
PROPOSE Underreporting of Adverse Drug Reactions (ADRs) reduces the sensitivity of pharmacovigilance systems. We described ADR reporting and its trend from 1999 to 2017 and estimated the ADR underreporting in the Iranian Pharmacovigilance Center. METHODS We expressed the number of ADR reporting per inhabitants and admissions and their possible trends. Finally, ADR underreporting percentages were estimated by three approaches: prospective studies, literature review, stratification of the country; and the trend of the proportion of ADR per inhabitants was corrected. RESULTS The proportion of ADR reporting was 15.3 per 100 000 inhabitants (95% CI: 15.2, 15.8) and 10.0 per 100 000 admissions (95% CI: 9.8, 10.2) in 2017, and its trend was increasing with 16.3% average change per annum during 19 years. The median of estimated percentages of underreporting was 76.0% (IQR: 64.32-81.35). After the correction, the mean proportion of ADR reporting for 19 years reached from 5.87 to 10.33 per 100 000 inhabitants. CONCLUSIONS The trend of ADRs reporting has been increasing over the 19 years but is still low. This study showed a considerable underreporting of ADR, and about one of four detected ADRs were reported to the pharmacovigilance center from 1999 to 2017.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- Department of Public and International Affairs, National Institute for Medical Research Development, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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14
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Bui A, Han S, Alexander M, Toner G, Irving L, Manser R. Pulmonary function testing for the early detection of drug-induced lung disease: a systematic review in adults treated with drugs associated with pulmonary toxicity. Intern Med J 2021; 50:1311-1325. [PMID: 31588628 DOI: 10.1111/imj.14647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
Pulmonary function tests (PFT) are sometimes monitored during treatment with known pulmonary toxic drugs to detect asymptomatic drug-induced interstitial lung disease (DILD). We conducted a systematic review to assess the accuracy of PFT, including the diffusing capacity for carbon monoxide (DLCO), for early detection of DILD in a range of drugs. Using a pre-specified, registered review protocol, OvidMEDLINE and EMBASE were searched from 1946 to February 2018. Two reviewers independently screened abstracts and reviewed full-text articles for inclusion. Included studies were assessed for risk of bias using adapted QUADAS-2 domains and primary outcome data were extracted and entered into RevMan5 to estimate sensitivity and specificity with 95% confidence intervals (CI). The search identified 4065 citations and included 42 studies. The most commonly studied drugs were bleomycin and amiodarone. Due to clinical heterogeneity between studies, a pooled analysis was not performed. Sensitivity of monitoring with DLCO varied between 0 and 100%, with the majority of studies finding a sensitivity of <80%. CI were wide for the majority of studies. Specificity was less than 90% in all studies. Risk of bias was high for the majority of studies for the quality domain of reference standard. The findings of this review do not support routine PFT for early detection of DILD. Due to methodological limitations, the relatively small number of participants and the low prevalence of DILD in the included studies, there remains significant uncertainty about the sensitivity of PFT to screen for DILD.
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Affiliation(s)
- Allan Bui
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sangjin Han
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Guy Toner
- Department of Medical Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lou Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medical Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medical Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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15
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Abstract
Acute kidney injury (AKI) and chronic kidney disease are common interconnected syndromes that represent a public health problem. Acute kidney disease (AKD) is defined as the post-AKI status of acute or subacute kidney damage/dysfunction manifested by persistence of AKI beyond 7 to 90 days after the initial AKI diagnosis. Limited clinical data exist regarding AKD epidemiology but its incidence is observed in ∼25% of AKI survivors. Useful risk-stratification tools to predict risk of AKD and its prognosis are needed. Interventions on fluid management, nephrotoxic exposure, and follow-up care hold promise to ameliorate the burden of AKD and its complications.
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Affiliation(s)
- Javier A Neyra
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY 40536, USA.
| | - Lakhmir S Chawla
- Department of Medicine, Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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16
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Horodnycha O, Zimenkovsky A. Antibiotic allergy as a cause of hospitalization in adults: a hospital-based study in Ukraine. Pharm Pract (Granada) 2021; 19:2055. [PMID: 33520036 PMCID: PMC7819703 DOI: 10.18549/pharmpract.2021.1.2055] [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: 06/30/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Antibiotic allergy is an important clinical and social-economical issue. Objective:
The main objectives of this study were to determine the incidence, causative
drugs, and risk groups of antibiotic allergy as a reason for
hospitalization. The secondary objective was to evaluate the treatment of
antibiotic allergy through the identification of drug related problems
(DRPs).
Methods:
This retrospective hospital-based study was carried out in one of Lviv city
hospitals (Ukraine) from January 2015 to December 2017. Patients with
antibiotic allergy as a cause for hospitalization were included in this
study.
Results:
In this study the incidence of antibiotic allergy was 2.0%
(95%CI 1.6:2.4) of all admissions to the Unit that provides special
medical care for adult inpatients with allergy diseases and allergy
reactions. The mean age of patients was 48.5 years (SD=17.0; range 18-83
years) with female predominance (78.2%; 95%CI 68.9:85.2).
Antibiotic hypersensitivity reactions manifested as urticaria with
angioedema (52.5%; 95%CI 42.3:62.5), urticaria (36.6%;
95%CI 27.8:46.8) or angioedema (10.9%; 95%CI 5.6:18.7).
Beta-lactams (48.5%; 95%CI 38.5:58.7), fluoroquinolones
(13.9%; 95%CI 7.8%:22.2%) and macrolides
(7.9%; 95%CI 3.5:15.0) were specified as the main causative
drugs. All patients during hospitalization (a mean of 8.2 days; SD=2.2;
range 2-13 days) took at least 3 medicines (a mean of 5.4 medicines per
patient; SD=1.2; range 3-12 medicines). The total number of identified DRPs
was 400, a mean of 4.0 DRPs per patient (SD=1.8). The most frequently
identified type of DRPs was inappropriate route of drug administration
(25.0%; 95%CI 20.8:29.5). This was followed by duplicate
prescriptions (23.5%; 95%CI 19.4:28.0) and insufficient
frequency of drug administration (19.0%; 95%CI 15.3:23.2).
Potential drug-drug interactions and inappropriate drug prescriptions each
accounted for 16.0% (95% CI 12.6:20.0) of all DRPs. Comparing
all above items in 2015, 2016 and 2017 showed no statistically significant
changes (p>0.05).
Conclusions:
Antibiotic allergy is a common reason for admissions. The treatment of
antibiotic allergy is associated with numerous DRPs. Our results could be
useful for development of strategies for improving the safety and quality of
pharmacotherapy.
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Affiliation(s)
- Oksana Horodnycha
- PhD. Assistant professor. Department of Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
| | - Andriy Zimenkovsky
- MD, PhD, DSc. Professor, Chief of Department. Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
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17
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Jordan S, Prout H, Carter N, Dicomidis J, Hayes J, Round J, Carson-Stevens A. Nobody ever questions-Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative. PLoS One 2021; 16:e0244519. [PMID: 33411824 PMCID: PMC7790299 DOI: 10.1371/journal.pone.0244519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nurse-led monitoring of patients for signs and symptoms associated with documented 'undesirable effects' of medicines has potential to prevent avoidable harm, and optimise prescribing. INTERVENTION The Adverse Drug Reaction Profile for polypharmacy (ADRe-p) identifies and documents putative adverse effects of medicines commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p to pharmacists and prescribers for review, in conjunction with prescriptions. OBJECTIVES We investigated changes in: the number and nature of residents' problems as recorded on ADRe-p; prescription regimens; medicines optimisation: and healthcare costs. We explored aetiologies of problems identified and stakeholders' perspectives. SETTING AND PARTICIPANTS In three UK care homes, 19 residents completed the study, December 2018 to May 2019. Two service users, three pharmacists, six nurses gave interviews. METHODS This mixed-method process evaluation integrated data from residents' ADRe-ps and medicines charts, at the study's start and 5-10 weeks later. RESULTS We recruited three of 27 homes approached and 26 of 45 eligible residents; 19 completed ADRe-p at least twice. Clinical gains were identified for 17/19 residents (mean number of symptoms 3 SD 1.67, range 0-7). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two of five able to stand). One or more medicine was de-prescribed or dose reduced for 12/19 residents. ADRe administration and review cost ~£30 in staff time. ADRe-p helped carers and nurses bring residents' problems to the attention of prescribers. IMPLICATIONS ADRe-p relieved unnecessary suffering. It supported carers and nurses by providing a tool to engage with pharmacists and prescribers, and was the only observable strategy for multidisciplinary team working around medicines optimisation. ADRe-p improved care by: a) regular systematic checks and problem documentation; b) information transfer from care home staff to prescribers and pharmacists; c) recording changes. REGISTRATION NLM Identifier NCT03955133; ClinicalTrials.gov.
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Affiliation(s)
- Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Hayley Prout
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Neil Carter
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - John Dicomidis
- Care Home Governance and National Lead Pharmacy Informatics, Pontypool, Wales, United Kingdom
| | - Jamie Hayes
- School of Pharmacy and Pharmaceutical Sciences, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Jeffrey Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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18
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Charan J, Kaur RJ, Bhardwaj P, Haque M, Sharma P, Misra S, Godman B. Rapid review of suspected adverse drug events due to remdesivir in the WHO database; findings and implications. Expert Rev Clin Pharmacol 2021; 14:95-103. [PMID: 33252992 PMCID: PMC7784780 DOI: 10.1080/17512433.2021.1856655] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Objectives: Remdesivir has shown promise in the management of patients with COVID-19 although recent studies have shown concerns with its effectiveness in practice. Despite this there is a need to document potential adverse drug events (ADEs) to guide future decisions as limited ADE data available before the COVID-19 pandemic. Methods: Interrogation of WHO VigiBase® from 2015 to 2020 coupled with published studies of ADEs in COVID-19 patients. The main outcome measures are the extent of ADEs broken down by factors including age, seriousness, region and organ. Results: A total 1086 ADEs were reported from the 439 individual case reports up to July 19, 2020, in the VigiBase®, reduced to 1004 once duplicates were excluded. Almost all ADEs concerned COVID-19 patients (92.5%), with an appreciable number from the Americas (67.7%). The majority of ADEs were from males > 45 years and were serious (82.5%). An increase in hepatic enzymes (32.1%), renal injury (14.4%), rise in creatinine levels (11.2%), and respiratory failure (6.4%) were the most frequently reported ADEs. Conclusions: Deterioration of liver and kidney function are frequently observed ADEs with remdesivir; consequently, patients should be monitored for these ADEs. The findings are in line with ADEs included in regulatory authority documents.
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Affiliation(s)
- Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rimple Jeet Kaur
- Department of Pharmacology, S.N. Medical College, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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19
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Chiou BL, Ho CC, Yang CC. Hematologic adverse drug reactions leading to hospitalization among cancer patients: A retrospective case-control study. J Chin Med Assoc 2020; 83:784-790. [PMID: 32168075 DOI: 10.1097/jcma.0000000000000298] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of death worldwide. Despite the rapid evolution of cancer treatment, chemotherapy remains the mainstay in the management of cancer. Chemotherapy can result in various adverse drug reactions (ADRs), which may lead to hospitalization and even life-threatening side-effects. Hematologic ADRs are among the most severe forms of ADR following chemotherapy, as they generally lead to hospitalization. It is important to realize the predictors and outcome of hematologic ADRs in cancer patients. METHODS We conducted a hospital-based case-control study to include all the cancer patients who were hospitalized to receive chemotherapy in Taipei Veterans General Hospital during 2013. Among them the patients rehospitalized after chemotherapy due to neutropenia, leucopenia, or pancytopenia were identified as the study group. Control subjects consisted of hospitalized cancer patients who did not display the aforementioned ADRs. The study and control groups were numbered in the ratio of 1:4 and were age- and gender-matched. Their demographic and clinical characteristics were collected through chart review. Determinants of hematologic ADRs were then analyzed. RESULTS During the study period, we collected a total of 64 patients into the study group and 256 as control subjects. The mean length of hospitalization was 11 days in the study group of patients, which was 5 days longer than that in the control group (p < 0.001). Predictors of hematologic ADR-related hospitalization included history of hematologic ADRs, hypertension, cisplatin treatment, and a Charlson comorbidity score of 2 to 3. CONCLUSION Severe outcomes of hematologic ADRs may increase healthcare costs and decrease patient productivity. Therefore, the determinants of ADR-related hospitalization identified in this study may help improve the quality of healthcare for cancer patients.
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Affiliation(s)
- Be-Ling Chiou
- International Health Program, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chin-Chin Ho
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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20
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Liu K, Ding RF, Xu H, Qin YM, He QS, Du F, Zhang Y, Yao LX, You P, Xiang YP, Ji ZL. Broad-Spectrum Profiling of Drug Safety via Learning Complex Network. Clin Pharmacol Ther 2019; 107:1373-1382. [PMID: 31868917 PMCID: PMC7325315 DOI: 10.1002/cpt.1750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
Abstract
Drug safety is a severe clinical pharmacology and toxicology problem that has caused immense medical and social burdens every year. Regretfully, a reproducible method to assess drug safety systematically and quantitatively is still missing. In this study, we developed an advanced machine learning model for de novo drug safety assessment by solving the multilayer drug‐gene‐adverse drug reaction (ADR) interaction network. For the first time, the drug safety was assessed in a broad landscape of 1,156 distinct ADRs. We also designed a parameter ToxicityScore to quantify the overall drug safety. Moreover, we determined association strength for every 3,807,631 gene‐ADR interactions, which clues mechanistic exploration of ADRs. For convenience, we deployed the model as a web service ADRAlert‐gene at http://www.bio-add.org/ADRAlert/. In summary, this study offers insights into prioritizing safe drug therapy. It helps reduce the attrition rate of new drug discovery by providing a reliable ADR profile in the early preclinical stage.
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Affiliation(s)
- Ke Liu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Ruo-Fan Ding
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Han Xu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yang-Mei Qin
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Qiu-Shun He
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Fei Du
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Yun Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Li-Xia Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Pan You
- Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Yan-Ping Xiang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhi-Liang Ji
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China.,The Key Laboratory for Chemical Biology of Fujian Province, Xiamen University, Xiamen, Fujian, China
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21
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De Pretis F, Landes J, Osimani B. E-Synthesis: A Bayesian Framework for Causal Assessment in Pharmacosurveillance. Front Pharmacol 2019; 10:1317. [PMID: 31920632 PMCID: PMC6929659 DOI: 10.3389/fphar.2019.01317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Evidence suggesting adverse drug reactions often emerges unsystematically and unpredictably in form of anecdotal reports, case series and survey data. Safety trials and observational studies also provide crucial information regarding the (un-)safety of drugs. Hence, integrating multiple types of pharmacovigilance evidence is key to minimising the risks of harm. Methods: In previous work, we began the development of a Bayesian framework for aggregating multiple types of evidence to assess the probability of a putative causal link between drugs and side effects. This framework arose out of a philosophical analysis of the Bradford Hill Guidelines. In this article, we expand the Bayesian framework and add “evidential modulators,” which bear on the assessment of the reliability of incoming study results. The overall framework for evidence synthesis, “E-Synthesis”, is then applied to a case study. Results: Theoretically and computationally, E-Synthesis exploits coherence of partly or fully independent evidence converging towards the hypothesis of interest (or of conflicting evidence with respect to it), in order to update its posterior probability. With respect to other frameworks for evidence synthesis, our Bayesian model has the unique feature of grounding its inferential machinery on a consolidated theory of hypothesis confirmation (Bayesian epistemology), and in allowing any data from heterogeneous sources (cell-data, clinical trials, epidemiological studies), and methods (e.g., frequentist hypothesis testing, Bayesian adaptive trials, etc.) to be quantitatively integrated into the same inferential framework. Conclusions: E-Synthesis is highly flexible concerning the allowed input, while at the same time relying on a consistent computational system, that is philosophically and statistically grounded. Furthermore, by introducing evidential modulators, and thereby breaking up the different dimensions of evidence (strength, relevance, reliability), E-Synthesis allows them to be explicitly tracked in updating causal hypotheses.
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Affiliation(s)
- Francesco De Pretis
- Dipartimento di Scienze biomediche e Sanità pubblica, Università Politecnica delle Marche, Ancona, Italy.,Dipartimento di Comunicazione ed Economia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Jürgen Landes
- Munich Center for Mathematical Philosophy, Ludwig-Maximilians-Universtät München, München, Germany
| | - Barbara Osimani
- Dipartimento di Scienze biomediche e Sanità pubblica, Università Politecnica delle Marche, Ancona, Italy.,Munich Center for Mathematical Philosophy, Ludwig-Maximilians-Universtät München, München, Germany
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Ayalew MB, Tegegn HG, Abdela OA. Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures. Bull Emerg Trauma 2019; 7:339-346. [PMID: 31857995 PMCID: PMC6911719 DOI: 10.29252/beat-070401] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: To derive findings from different studies done on drug related hospital admissions and comprehensively express the incidence and preventability of drug related hospital admissions; identify the common types of drug related problems that caused hospital admission, and identify factors associated with drug related hospital admission. Methods: Literatures that assessed hospitalization due to drug related problems were searched online using Pub Med and Google Scholar databases. The relevant reference lists of retrieved articles were also searched manually on Google. Prospective and retrospective studies conducted anywhere in the world on drug related hospitalization, published from January 2012 to January 2017 as an original article and written in English language were included. Result: The prevalence of drug related hospital admission varies from 1.3% to 41.3% with the average rate of 15.4%. Among hospitalized patients 2.7% were died due to drug-related problems (DRPs). Drugs that were frequently reported as causing drug related admission were antithrombotic drugs, antihypertensive drugs, analgesics, anti-diabetics, antipsychotics, and anti-neoplastic drugs. Poly pharmacy, old age and female sex were mentioned as determinants for drug related hospitalization by a number of studies. About one third of drug related hospital admissions were definitely preventable and more than 40% were also potentially preventable. Conclusion: Drug related problems contribute for more than 15% of hospital admissions. Higher risk of admission due to DRPs was observed in patients who were on poly pharmacy and those who were old. As most of drug related hospital admissions were preventable an emphasis should be given for preventive strategies to avoid complications and costs associated with admission.
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Affiliation(s)
- Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| | - Ousman Abubeker Abdela
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
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23
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Panes G, Round J, Snelgrove S, Storey M, Hughes D. Nurse-led medicines' monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study. PLoS One 2019; 14:e0220885. [PMID: 31509537 PMCID: PMC6738583 DOI: 10.1371/journal.pone.0220885] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Timothy Banner
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | | | - Jane M. Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Hywel Dda University Health Board, Wales, United Kingdom
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Kinetics of Urinary Cell Cycle Arrest Markers for Acute Kidney Injury Following Exposure to Potential Renal Insults. Crit Care Med 2019; 46:375-383. [PMID: 29189343 PMCID: PMC5821475 DOI: 10.1097/ccm.0000000000002847] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is available in the text. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 predict the development of acute kidney injury following renal insults of varied aetiology. To aid clinical interpretation, we describe the kinetics of biomarker elevations around an exposure.
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Lapointe-Shaw L, Bell CM, Austin PC, Abrahamyan L, Ivers NM, Li P, Pechlivanoglou P, Redelmeier DA, Dolovich L. Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study. BMJ Qual Saf 2019; 29:41-51. [DOI: 10.1136/bmjqs-2019-009545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023]
Abstract
BackgroundIn-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.ObjectiveTo determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.DesignPropensity score-matched cohort study.SettingOntario, CanadaParticipantsPatients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.ExposureMedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.Main outcomeThe primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.ResultsMedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).Conclusions and relevanceAmong older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.
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Johnson CF, Liddell K, Guerri C, Findlay P, Thom A. Medicines reconciliation at the community mental health team-general practice interface: quality improvement study. BJPsych Bull 2019; 44:12-18. [PMID: 31288874 DOI: 10.1192/bjb.2019.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodTo increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)-general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs. RESULTS: One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: 'fatal' (0%), 'serious' (17%) and 'negligible/minor harm' (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.Clinical implicationsImprovements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.Declaration of interestNone.
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De Pretis F, Osimani B. New Insights in Computational Methods for Pharmacovigilance: E-Synthesis, a Bayesian Framework for Causal Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2221. [PMID: 31238543 PMCID: PMC6617215 DOI: 10.3390/ijerph16122221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022]
Abstract
Today's surge of big data coming from multiple sources is raising the stakes that pharmacovigilance has to win, making evidence synthesis a more and more robust approach in the field. In this scenario, many scholars believe that new computational methods derived from data mining will effectively enhance the detection of early warning signals for adverse drug reactions, solving the gauntlets that post-marketing surveillance requires. This article highlights the need for a philosophical approach in order to fully realize a pharmacovigilance 2.0 revolution. A state of the art on evidence synthesis is presented, followed by the illustration of E-Synthesis, a Bayesian framework for causal assessment. Computational results regarding dose-response evidence are shown at the end of this article.
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Affiliation(s)
- Francesco De Pretis
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy.
- Department of Communication and Economics, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy.
| | - Barbara Osimani
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy.
- Munich Center for Mathematical Philosophy, Ludwig-Maximilians-Universität München, 80539 München, Germany.
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Kivoto PM, Mulaku M, Ouma C, Ferrario A, Kurdi A, Godman B, Oluka M. Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care. Front Pharmacol 2018; 9:1348. [PMID: 30618729 PMCID: PMC6295578 DOI: 10.3389/fphar.2018.01348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed. Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent years. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, and Control), VEN (Vital, Essential, and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data was extracted from the Medical Records. Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2–14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9–17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% of medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines where major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries.
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Affiliation(s)
- Patrick M Kivoto
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Mercy Mulaku
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Charles Ouma
- Health Commodities and Services Management (HCSM) Program, Management Sciences for Health (MSH), Nairobi, Kenya
| | - Alessandra Ferrario
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Healthcare Institute, Boston, MA, United States
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, Management School, University of Liverpool, Liverpool, United Kingdom
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
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Martins AC, Giordani F, Guaraldo L, Tognoni G, Rozenfeld S. Adverse drug events identified in hospitalized patients in Brazil by International Classification of Diseases (ICD-10) code listings. CAD SAUDE PUBLICA 2018; 34:e00222417. [DOI: 10.1590/0102-311x00222417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.
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Chávez-Iñiguez JS, Medina-Gonzalez R, Aguilar-Parra L, Torres-Vázquez EJ, Maggiani-Aguilera P, Cervantes-Pérez E, García-García G. Oral acyclovir induced hypokalemia and acute tubular necrosis a case report. BMC Nephrol 2018; 19:324. [PMID: 30428841 PMCID: PMC6236899 DOI: 10.1186/s12882-018-1121-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background Acyclovir is one of the most common prescribed antiviral drugs. Acyclovir nephrotoxicity occurs in approximately 12–48% of cases. It can present in clinical practice as acute kidney injury (AKI), crystal-induced nephropathy, acute tubulointerstitial nephritis, and rarely, as tubular dysfunction. Electrolytes abnormalities like hypokalemia, were previously described only when given intravenously. Case presentation A 54 year-old female presented with weakness and lower extremities paresis, nausea and vomiting after receiving oral acyclovir. Physical examination disclosed a decrease in the patellar osteotendinous reflexes (++ / ++++). Laboratory data showed a serum creatinine level of 2.1 mg/dL; serum potassium 2.1 mmol/L. Kidney biopsy was obtained; histological findings were consistent with acute tubular necrosis and acute tubulointerstitial nephritis. The patient was advised to stop the medications and to start with oral and intravenous potassium supplement, symptoms improved and continued until serum potassium levels were > 3.5 meq/L. Conclusions The case reported in this vignette is unique since it is the first one to describe hypokalemia associated to acute tubular necrosis induced by oral acyclovir.
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Affiliation(s)
- Jonathan S Chávez-Iñiguez
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico. .,Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Mexico.
| | - Ramón Medina-Gonzalez
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - Lilia Aguilar-Parra
- Servicio de Medicina Interna, Hospital General de Occidente, Guadalajara, Mexico
| | - Eduardo J Torres-Vázquez
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | - Pablo Maggiani-Aguilera
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | - Enrique Cervantes-Pérez
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Mexico
| | - Guillermo García-García
- Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud CUCS, Universidad de Guadalajara, Guadalajara, Mexico
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Mota DM, Vigo Á, Kuchenbecker RDS. [Recommendation of ICD-10 codes for surveillance of adverse drug reactions and drug intoxication]. CIENCIA & SAUDE COLETIVA 2018; 23:3041-3054. [PMID: 30281741 DOI: 10.1590/1413-81232018239.20692016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
Abstract
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Associations between variables were evaluated using Pearson's chi-squared test and multiple correspondence analysis. Six hundred and ninety-one (691) codes were identified related to adverse drug reactions (52.1%) and drug poisoning (47.9%). A total of 687 (99.4%) and 511 (73.9%) codes were validated in 1st and 2nd validation, respectively. There were statistically significant differences (p <0.05) between adverse reactions and drug poisoning in the variables used to characterize the reference list. The association between drug and hospital admission and death was statistically significant when stratified by type of adverse event (p <0.001). Three groupings of codes were identified in multiple correspondence analysis where there are associations between categories of response assessed. The reference list can be a useful tool in pharmacovigilance actions in Brazil.
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Affiliation(s)
- Daniel Marques Mota
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Álvaro Vigo
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Ricardo de Souza Kuchenbecker
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
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Terblanche A, Meyer JC, Godman B, Summers RS. Impact of a pharmacist-driven pharmacovigilance system in a secondary hospital in the Gauteng Province of South Africa. Hosp Pract (1995) 2018; 46:221-228. [PMID: 30092683 DOI: 10.1080/21548331.2018.1510708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Under-reporting of adverse drug reactions (ADRs) by health-care professionals (HCPs) is a worldwide problem. Spontaneous reporting in hospitals is scarce and several obstacles have been identified for this. Improved hospital-based reports could make important contributions to future care. Consequently, the objective of this study was to develop, implement and evaluate a structured pharmacist-driven pharmacovigilance (PV) system for in-patient ADR reporting in a leading public hospital in South Africa for future use in South Africa and wider. METHOD Descriptive, operational intervention study with a pre-post design. Pharmacist-driven interventions targeted at ADR reporting were implemented. Convenience sampling was used to recruit HCPs [medical practitioners, pharmacists, pharmacist assistants, and nurses] to complete a self-administered questionnaire. The principal outcome measures were the number of the ADRs reported for inpatients, 18 months prior to and 18 months during the intervention period, as well as an evaluation of the intervention program in terms of continuous information and training. RESULTS There was a significant increase in the number of HCPs reporting an ADR post-intervention (33.8% up from 12.1%; p < 0.0001). Reasons for non-reporting decreased significantly, e.g. 'How, where and when to report' an ADR (p = 0.0027) and 'Concern that the report may be wrong' (p = 0.0041). HCPs' knowledge of the ADR reporting system also improved appreciably. This was apart from pharmacists who were already knowledgeable. CONCLUSION The results showed the benefits of pharmacist-driven interventions on HCPs' knowledge and awareness of PV and the number of the ADRs reported. Hospital management and policy makers should consider the important role pharmacists can play in improving rational and safe use of medicines among inpatients, based on appropriate training of HCPs and proper systems. As a result, help achieve the standards established by the Department of Health in South Africa.
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Affiliation(s)
- Antionette Terblanche
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , South Africa.,b Department of Pharmacy, Sebokeng Hospital Pharmacy , Sebokeng Hospital , Gauteng , South Africa
| | - Johanna Catharina Meyer
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , South Africa
| | - Brian Godman
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , South Africa.,c Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,e Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - Robert Stanley Summers
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , South Africa
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Ock M, Kim HJ, Jeon B, Kim YJ, Ryu HM, Lee MS. Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study. J Prev Med Public Health 2018; 51:15-22. [PMID: 29397642 PMCID: PMC5797717 DOI: 10.3961/jpmph.17.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. Methods We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. Results Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). Conclusions Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.
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Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Bomin Jeon
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ye-Jee Kim
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyun Mi Ryu
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Moo-Song Lee
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Realo A, van Middendorp H, Kööts-Ausmees L, Allik J, Evers AWM. Role of personality traits in reporting the development of adverse drug reactions: a prospective cohort study of the Estonian general population. BMJ Open 2018; 8:e022428. [PMID: 29991635 PMCID: PMC6089302 DOI: 10.1136/bmjopen-2018-022428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To examine the role of the Five Factor Model (FFM) personality traits in reporting the development of adverse drug reactions (ADRs) when controlling for sociodemographic variables and health status. DESIGN Prospective cohort study. SETTING The Estonian Biobank of the Estonian Genome Centre, University of Tartu. PARTICIPANTS 814 women and 543 men (mean age=47.9 years; SD=15.2) who after the initial enrolment in the Estonian Biobank were re-contacted for follow-up purposes about 5.3 years after the enrolment and for whom both self- and informant-reported personality data were available. MAIN OUTCOME MEASURE Participants who did not report having any ADRs at baseline but who reported ADRs at the follow-up about 5.3 years later versus participants who did not report any ADRs at either time point. The reports of developing ADRs were predicted from the FFM personality traits after statistically controlling for sociodemographic variables (age, gender and education), baseline indicators of health status (number of diagnoses and medicines taken, body mass index and blood pressure), and the change in health status between the two measurements. RESULTS The results of a hierarchical binary logistic regression analysis showed that participants who reported the development of ADRs between the two measurements had higher levels of conscientiousness, were more likely to be women, were taking more medicines at baseline and had a higher increase in the number of medicines taken during the study period than participants who did not report any ADRs at either time point (all p values <0.05). Higher neuroticism (p=0.067) and a higher number of diagnosed diseases at baseline (p=0.053) also made marginal contributions to predicting the development of ADRs. CONCLUSIONS This study shows for the first time that higher levels of conscientiousness and neuroticism are associated with reporting the development of ADRs.
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Affiliation(s)
- Anu Realo
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Psychology, University of Tartu, Tartu, Estonia
| | | | | | - Jüri Allik
- Department of Psychology, University of Tartu, Tartu, Estonia
- The Estonian Academy of Sciences, Tallinn, Estonia
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Costa MJ, Herdeiro MT, Polónia JJ, Ribeiro-Vaz I, Botelho C, Castro E, Cernadas J. Type B adverse drug reactions reported by an immunoallergology department. Pharm Pract (Granada) 2018; 16:1070. [PMID: 29619134 PMCID: PMC5881478 DOI: 10.18549/pharmpract.2018.01.1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). Methods: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. Results: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). Conclusions: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.
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Affiliation(s)
- Maria J Costa
- Department of Community Medicine, Information and Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Maria T Herdeiro
- Institute for Research in Biomedicine - iBiMED, Department of Medical Sciences, University of Aveiro. Aveiro (Portugal).
| | - Jorge J Polónia
- Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research; & Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Cármen Botelho
- Immunoallergology Department, Hospital São João. Porto (Portugal).
| | - Eunice Castro
- Immunoallergology Department, Hospital São João. Porto (Portugal).
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Sullivan A, Watkinson J, Waddington J, Park BK, Naisbitt DJ. Implications of HLA-allele associations for the study of type IV drug hypersensitivity reactions. Expert Opin Drug Metab Toxicol 2018; 14:261-274. [DOI: 10.1080/17425255.2018.1441285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A. Sullivan
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, The University of Liverpool, Liverpool, England
| | - J. Watkinson
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, The University of Liverpool, Liverpool, England
| | - J. Waddington
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, The University of Liverpool, Liverpool, England
| | - B. K. Park
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, The University of Liverpool, Liverpool, England
| | - D. J. Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, The University of Liverpool, Liverpool, England
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Parrot A, Gibelin A, Issoufaly T, Voiriot G, Djibré M, Naccache J, Cadranel J, Fartoukh M. Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Terblanche A, Meyer JC, Godman B, Summers RS. Knowledge, attitudes and perspective on adverse drug reaction reporting in a public sector hospital in South Africa: baseline analysis. Hosp Pract (1995) 2017; 45:238-245. [PMID: 28914115 DOI: 10.1080/21548331.2017.1381013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Adverse drug reactions (ADRs) can cause significant harm in patients; however, ADRs are under-reported in many countries, including South Africa, where evidence of a pharmacovigilance (PV) system to monitor and manage ADRs is a requirement for compliance with norms and standards for quality healthcare delivery. We conducted an analysis amongst health care professionals (HCPs) at Sebokeng Hospital to assess the situation there and make recommendations. METHODS Data were collected using a structured self-administered questionnaire, targeting all medical practitioners, nurses, pharmacists and pharmacist assistants in the hospital. Current procedures for reporting of ADRs were documented. Records were reviewed to determine the number of ADR reports submitted for the 18-month period prior to the study. Data were analysed with SAS. Ethical clearance was obtained. RESULTS The questionnaire was completed by 132 HCPs (nurses: 58.3%; medical practitioners: 23.5%; pharmacist assistants: 11.4%; pharmacists: 6.8%). The vast majority indicated ADR reporting is necessary (96.2%) and their professional obligation (89.4%). Only 18.9% were aware of an existing PV system in the hospital, 15.2% had an ADR form available and 18.9% knew to whom the form should be submitted. The vast majority had never reported an ADR, had never received training in PV, but wanted training on ADR reporting. Factors discouraging ADR reporting included not knowing how to report them (53.8%), lack of time (37.1%), additional work load (22.0%), uncertainty about the outcome of reporting (32.6%), and lack of confidence to discuss ADRs with colleagues (22.0%). Only 2.3% knew how many ADRs were reported, that ADRs are discussed by a committee (6.1%) and that internal feedback is received on reported ADRs (6.1%). CONCLUSION There is an extensive need in Sebokeng Hospital for training on ADR reporting and implementation of systems to facilitate relevant processes; a need which may also exist in other public hospitals in South Africa.
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Affiliation(s)
- Antionette Terblanche
- a School of Pharmacy, Faculty of Health Sciences , Sefako Makgatho Health Sciences University , Pretoria , South Africa
- b Department of Pharmacy, Sebokeng Hospital Pharmacy , Sebokeng Hospital , Pretoria , South Africa
| | - Johanna Catharina Meyer
- a School of Pharmacy, Faculty of Health Sciences , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Brian Godman
- c Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , United Kingdom
- d Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Stockholm , Sweden
- e Health Economics Centre , University of Liverpool Management School , Liverpool , UK
| | - Robert Stanley Summers
- a School of Pharmacy, Faculty of Health Sciences , Sefako Makgatho Health Sciences University , Pretoria , South Africa
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Filkova M, Carvalho J, Norton S, Scott D, Mant T, Molokhia M, Cope A, Galloway J. Polypharmacy and Unplanned Hospitalizations in Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44:1786-1793. [PMID: 28966210 DOI: 10.3899/jrheum.160818] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Polypharmacy (PP), the prescribing of multiple drugs for an individual, is rising in prevalence. PP associates with an increased risk of adverse drug reactions (ADR) and hospital admissions. We investigated the relationship between PP, characteristics of rheumatoid arthritis (RA), and the risk of unplanned hospital admissions. METHODS Patients from a hospital RA cohort were retrospectively analyzed. Information was collected from electronic medical records. Cox proportional hazards were used to compare hospitalization risk according to levels of PP. Admissions were adjudicated to determine whether an ADR was implicated. RESULTS The study included 1101 patients; the mean number of all medications was 5. PP correlated with increasing age, disease duration, disease activity, and disability. At least 1 unplanned admission occurred for 16% of patients. Patients taking ≥ 10 medications had an adjusted HR for hospitalization of 3.1 (95% CI 2.1-4.5), compared to those taking 0-5 medications. Corticosteroid use associated with a doubling in adjusted risk of admission of 1.7 (95% CI 1.2-2.4). The most common reason for hospitalization was infection (28%). While in half of all admissions an ADR was a possible contributing factor, only 2% of admissions were found to directly result from an ADR. CONCLUSION PP is common in RA and is a prognostic marker associated with increased risk of acute hospitalizations. Our data suggest that PP may be an indicator of comorbidity burden rather than a contributing cause of a drug-related toxicity. PP should be monitored to minimize inappropriate combination of prescribed medications. PP may be a useful predictor of clinical outcomes in epidemiologic studies.
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Affiliation(s)
- Maria Filkova
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - João Carvalho
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Sam Norton
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - David Scott
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Tim Mant
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Mariam Molokhia
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Andrew Cope
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - James Galloway
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal. .,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London.
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In silico methods for design of biological therapeutics. Methods 2017; 131:33-65. [PMID: 28958951 DOI: 10.1016/j.ymeth.2017.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/21/2017] [Accepted: 09/23/2017] [Indexed: 12/18/2022] Open
Abstract
It has been twenty years since the first rationally designed small molecule drug was introduced into the market. Since then, we have progressed from designing small molecules to designing biotherapeutics. This class of therapeutics includes designed proteins, peptides and nucleic acids that could more effectively combat drug resistance and even act in cases where the disease is caused because of a molecular deficiency. Computational methods are crucial in this design exercise and this review discusses the various elements of designing biotherapeutic proteins and peptides. Many of the techniques discussed here, such as the deterministic and stochastic design methods, are generally used in protein design. We have devoted special attention to the design of antibodies and vaccines. In addition to the methods for designing these molecules, we have included a comprehensive list of all biotherapeutics approved for clinical use. Also included is an overview of methods that predict the binding affinity, cell penetration ability, half-life, solubility, immunogenicity and toxicity of the designed therapeutics. Biotherapeutics are only going to grow in clinical importance and are set to herald a new generation of disease management and cure.
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Nimmesgern E, Norstedt I, Draghia-Akli R. Enabling personalized medicine in Europe by the European Commission's funding activities. Per Med 2017; 14:355-365. [DOI: 10.2217/pme-2017-0003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Personalized medicine (PM) is an emerging approach to prevention, diagnosis, treatment and care. It helps to address the challenge of the aging of the population, an increase in chronic disease and increasing healthcare costs. The EU is developing policies to move toward PM. This is underpinned by a sustained and significant investment starting in 2010. So far, a total of €3.2 billion has been invested in PM research across the medical innovation cycle ‘from bench to bedside’. This investment has come from the research framework programs FP7 and Horizon 2020. About a third of the total investment has been made in the context of the Innovative Medicines Initiative, the largest public–private partnership in life sciences globally.
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Affiliation(s)
- Elmar Nimmesgern
- Directorate-General for Research & Innovation, European Commission, B-1049 Brussels, Belgium
| | - Irene Norstedt
- Directorate-General for Research & Innovation, European Commission, B-1049 Brussels, Belgium
| | - Ruxandra Draghia-Akli
- Directorate-General for Research & Innovation, European Commission, B-1049 Brussels, Belgium
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Kher V, Srisawat N, Noiri E, Benghanem Gharbi M, Shetty MS, Yang L, Bagga A, Chakravarthi R, Mehta R. Prevention and Therapy of Acute Kidney Injury in the Developing World. Kidney Int Rep 2017. [PMCID: PMC5720672 DOI: 10.1016/j.ekir.2017.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Timely recognition of patients at risk or with possible acute kidney injury (AKI) is essential for early intervention to minimize further damage and improve outcome. Initial management of patients with suspected and persistent AKI should include thorough clinical assessment of all patients with AKI to identify reversible factors, including fluid volume status, potential nephrotoxins, and an assessment of the underlying health of the kidney. Based on these assessments, early interventions to provide appropriate and adequate fluid resuscitation while avoiding fluid overload, removal of nephrotoxins, and adjustment of drug doses according to the level of kidney function derangement are important. The judicious use of diuretics for fluid overload and/or in cardiac decompensated patients and introduction of early enteral nutritional support need to be considered to improve outcomes in AKI. Although these basic principles are well recognized, their application in clinical practice in low resource settings is often limited due to lack of education, availability of resources, and lack of trained personnel, which limits access to care. We report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on strategies to evaluate patients with suspected AKI and initiate measures for prevention and management to improve outcomes, particularly in low resource settings. These recomendations provide a framework for caregivers, who are often primary care physicians, nurses, and other allied healthcare personnel, to manage patients with AKI in resource poor countries.
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Scripcaru G, Mateus C, Nunes C. Adverse drug events-Analysis of a decade. A Portuguese case-study, from 2004 to 2013 using hospital database. PLoS One 2017; 12:e0178626. [PMID: 28575013 PMCID: PMC5456097 DOI: 10.1371/journal.pone.0178626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/16/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The goal of this study was to characterise adverse drug events (ADE), including both adverse drug reaction (ADR) and accidental poisoning by drugs (AP), considering age, gender, length of stay (LOS), number of deaths and year, during the period 2004-2013. Additionally distributions of the ten's most frequent ADR and AP were characterized, considering age-group and gender. METHODS A retrospective descriptive nationwide study was conducted, based on the hospital discharges database in Portugal from 2004 to 2013, using ICD-9. Events were identified based on the following codes: from E930 to E949.9 and from E850 to E858.9. RESULTS A total of 9 320 076 patients were discharged within this period, with 133 688 patients (1.46%) having at least one ADE, 4% of them related with AP. The mean age of these patients was 63.79 years (SD 21.31), 54.50% were female and the mean LOS was 14.05 days (SD 22.19). Patient with AP had a mean age of 41.06 years (SD 34.05), 54.70% were female and LOS was 7.15 days (SD 19.42). We have identified 10.691 deaths that represent 8.00% from the total of patients with an ADE. The patients above 65 years were more affected by ADR and children below 18 were more affected by AP. CONCLUSION In the last decade an increasing trend of ADR were observed and an AP pattern relatively stable. Elderly people and children were the age groups most affected. Antibiotics (in ADR) and benzodiazepine-based tranquilizers (in AP) were the major problems. This is a huge, increasing and challenging problem. Further research, using individual and contextual risk factors should be developed to understand spatiotemporal variability, promoting tailored interventions, within and across countries.
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Affiliation(s)
- Gianina Scripcaru
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; Lisbon, Portugal
- Amgen Biofarmaceutica, Lda.,Lisbon, Portugal
| | - Ceu Mateus
- Health Economics Group Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa; Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa; Lisbon, Portugal
- * E-mail:
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Scripcaru G, Mateus C, Nunes C. A decade of adverse drug events in Portuguese hospitals: space-time clustering and spatial variation in temporal trends. BMC Pharmacol Toxicol 2017; 18:34. [PMID: 28486949 PMCID: PMC5424420 DOI: 10.1186/s40360-017-0140-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study is to identify the distribution by municipalities of adverse drug events (ADE) in Portugal, including adverse drug reactions (ADR) and accidental poisoning by drugs (AP), on municipality/years ADE rate clustering. Also we identify areas with different trends in time. Methods We used a national dataset of public hospital discharges in Continental Portugal from 2004 to 2013. Events were identified based on codes: from E930 to E949.9 (ADR) and from E850 to E858.9 (AP). Space-time clustering and spatial variation in temporal trends methods were applied in three different time-periods: globally, by year and grouped in 2 classes (periods of 5 years). Results A total of 9,320,076 patients were discharged within this period, with 133,688 patients (1.46%) having at least one ADE, 4% of them related with AP. Critical space-time identified clusters (p < 0.001) were the municipalities from Lisbon metropolitan area and Centro region area. The global rate increased at a 7.8% mean annual percentage change, with high space-time heterogeneity and variation in time trends clusters (p < 0.001). For whole period, 2004–2013, all clusters presented increasing trends. However when analyzed by period of 5 years we identified two clusters with decreasing trends in time in 2004–2008. Conclusion The impact of ADE is huge, with widely variations within country and in time, and represents an increasing challenge. Future research using individual and contextual risk factors are urgently needed to understand this spatiotemporal variability in order to promote local tailored and updated actions of prevention.
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Affiliation(s)
- Gianina Scripcaru
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Av Padre Cruz, 1600-560, Lisbon, Portugal.,AMGEN Biofarmaceutica, Lisbon, Portugal
| | - Ceu Mateus
- Health Economics Group Division of Health Research, Lancaster University, Lancaster, UK
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Av Padre Cruz, 1600-560, Lisbon, Portugal. .,Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
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Irfan O, Gilani JA, Irshad A, Irfan B, Khan JA. Pharmacological Threat to Lungs: A Case Series and Literature Review. Cureus 2017; 9:e1232. [PMID: 28620563 PMCID: PMC5467773 DOI: 10.7759/cureus.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Drug-induced organ damage stands as a prevalent yet much-neglected issue globally. Keeping in view it’s rising frequency, health care providers stand obliged to be well versed with the de-merits of the agents they prescribe. Drug therapies causing damage present with a non-specific clinical presentation, histological findings or radiology, which further elaborates on the necessity of a conscientious diagnosis. Pulmonary architecture ranging from the airways, lung parenchyma, mediastinum, pleura, pulmonary vasculature or the neuromuscular system, all can fall victim to the dreaded outcomes of this menace. In order to establish successful diagnosis, the definite temporal relation between initiation of drug therapy and the development of the respiratory symptoms needs to be drawn. The most common form of pharmacologically arising lung toxicity is drug-induced pneumonitis or interstitial lung disease. Unfortunately, there is no adequate data available to review the extensiveness of this medication-associated risk in Pakistan which further highlights the necessity of carefully monitoring this overlooked yet assessable malady. Furthermore, identification and surveillance of this drug attributed peril shall help diminish burden on healthcare resources of the country. We present three recent cases of different types of drug-induced lung damage under treatment at our University Hospital.
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Affiliation(s)
| | | | | | - Babar Irfan
- Medicine, Jinnah Sindh Medical University (SMC)
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Kumar A. Pharmacovigilance: Importance, concepts, and processes. Am J Health Syst Pharm 2017; 74:606-612. [DOI: 10.2146/ajhp151031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Atul Kumar
- Independent Pharmacovigilance Consultant, Minneapolis, MN
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Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13:241-257. [PMID: 28239173 DOI: 10.1038/nrneph.2017.2] [Citation(s) in RCA: 883] [Impact Index Per Article: 126.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.
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Poudel DR, Acharya P, Ghimire S, Dhital R, Bharati R. Burden of hospitalizations related to adverse drug events in the USA: a retrospective analysis from large inpatient database. Pharmacoepidemiol Drug Saf 2017; 26:635-641. [DOI: 10.1002/pds.4184] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Dilli Ram Poudel
- Department of Internal Medicine; Reading Health System; West Reading PA USA
| | - Prakash Acharya
- Department of Internal Medicine; Montefiore New Rochelle; New Rochelle NY USA
| | - Sushil Ghimire
- Department of Internal Medicine; Reading Health System; West Reading PA USA
| | - Rashmi Dhital
- Department of Internal Medicine; Universal College of Medical Sciences; Bhairahawa Nepal
| | - Rajani Bharati
- School of Public Health and Health Policy; City University of New York; New York NY USA
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Carrasco-Garrido P, Hernández-Barrera V, Esteban-Hernández J, Jiménez-Trujillo I, Álvaro-Meca A, López de Andrés A, de Miguel Diez J, Rodríguez Barrios JM, Muñoz Robles JA, Jiménez-García R. Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013). BMJ Open 2017; 7:e013224. [PMID: 28073793 PMCID: PMC5253537 DOI: 10.1136/bmjopen-2016-013224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN A retrospective, descriptive, epidemiological study. SETTING This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.
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Affiliation(s)
- P Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - V Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - J Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - I Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - A Álvaro-Meca
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - A López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
| | - J de Miguel Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | | | - R Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty Rey Juan Carlos University, Alcorcón, Spain
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Joubert M, Naidoo P. Knowledge, perceptions and practices of pharmacovigilance amongst community and hospital pharmacists in a selected district of North West Province, South Africa. Health SA 2016. [DOI: 10.1016/j.hsag.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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