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Al Musawi A, Hellström L, Axelsson M, Midlöv P, Rämgård M, Cheng Y, Eriksson T. Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions. Int J Clin Pharm 2024:10.1007/s11096-024-01702-4. [PMID: 38340241 DOI: 10.1007/s11096-024-01702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home. AIM In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions. METHOD Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed. RESULTS Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores. CONCLUSION Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.
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Affiliation(s)
- Ahmed Al Musawi
- Department of Biomedical Science and Biofilm - Research Center for Biointerfaces, Faculty of Health and Society, Malmö University, Malmö, Sweden.
| | - Lina Hellström
- Department of Medicine and Optometry, eHealth Institute, Linnaeus University, Kalmar, Sweden
- Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Yuanji Cheng
- Department of Materials Science and Applied Mathematics, Faculty of Technology and Society, Malmo University, Malmo, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science and Biofilm - Research Center for Biointerfaces, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Eriksson T, Polidori C. The Granada Statements: An opportunity for the hospital pharmacist to make more impact in the publication world, part 2. Eur J Hosp Pharm 2023; 30:309. [PMID: 37399272 PMCID: PMC10647853 DOI: 10.1136/ejhpharm-2023-003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Tommy Eriksson
- Department of Biomedical Science, Malmö Universitet, Malmo, Sweden
- Biofilm - Research Center for Biointerfaces, Malmö Universitet, Malmo, Sweden
| | - Carlo Polidori
- Experimental medicine and Public health, University of Camerino, Camerino, MC, Italy
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3
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Polidori C, Eriksson T. The Granada Statements: an impact boost to clinical and social pharmacy publications, part 1. Eur J Hosp Pharm 2023; 30:187. [PMID: 37286310 PMCID: PMC10359779 DOI: 10.1136/ejhpharm-2023-003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Carlo Polidori
- Experimental medicine and Public health, University of Camerino, Camerino, Italy
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö Universitet, Malmo, Sweden
- Biofilm - Research Center for Biointerfaces, Malmö Universitet, Malmo, Sweden
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Meyer E, Kruglov D, Krivic M, Tanveer M, Argaez-Ramirez R, Zhang Y, Briseno Ojeda A, Smirnova K, Alekseev K, Safari Mugisho M, Cimbili B, Farid N, Dang Y, Shahid M, Ensan M, Banar J, Bao H, Matters-Kammerer M, Gustavsson U, Demuynck F, Zwick T, Acar M, Fager C, van der Heijden M, Ivashina M, Caratelli D, Hasselblad M, Ulusoy C, Smolders A, Eriksson K, Johannson M, Maaskant R, Quay R, Floriot D, Bao M, Bronckers L, Fridén J, van Beurden M, de Hon B, Kolitsidas C, Blanco D, Willems F, Eriksson T, Filippi A, Ponzini F, Johannsen U. The state of the art in beyond 5G distributed massive multiple-input multiple-output communication system solutions. Open Res Eur 2022; 2:106. [PMID: 37982077 PMCID: PMC10654493 DOI: 10.12688/openreseurope.14501.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/21/2023]
Abstract
Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal pro- cessing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on be- yond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.
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Affiliation(s)
- E. Meyer
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - D. Kruglov
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - M. Krivic
- Keysight Technologies, Kortrijksesteenweg 1093B, 9051 Gent, Belgium
| | - M. Tanveer
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - R. Argaez-Ramirez
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - Y. Zhang
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | | | - K. Smirnova
- Karlsruhe Institute of Technology, 6131 Karlsruhe, Germany
| | - K. Alekseev
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - M. Safari Mugisho
- Fraunhofer Institute for Applied Solid State Physics, IAF, Tullastraße 72, 79108 Freiburg, Germany
| | - B. Cimbili
- Fraunhofer Institute for Applied Solid State Physics, IAF, Tullastraße 72, 79108 Freiburg, Germany
| | - N. Farid
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - Y. Dang
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - M. Shahid
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - M. Ensan
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - J. Banar
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - H. Bao
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - M. Matters-Kammerer
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - U. Gustavsson
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - F. Demuynck
- Keysight Technologies, Kortrijksesteenweg 1093B, 9051 Gent, Belgium
| | - T. Zwick
- Karlsruhe Institute of Technology, 6131 Karlsruhe, Germany
| | - M. Acar
- NXP Semiconductors, High Tech Campus 60, 5656 AG Eindhoven, The Netherlands
| | - C. Fager
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - M. van der Heijden
- NXP Semiconductors, High Tech Campus 60, 5656 AG Eindhoven, The Netherlands
| | - M. Ivashina
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - D. Caratelli
- The Antenna Company, High Tech Campus 29, 5656 AE Eindhoven, The Netherlands
| | - M. Hasselblad
- Gapwaves, Nellickevagen 22, 412 63 Gothenburg, Sweden
| | - C. Ulusoy
- Karlsruhe Institute of Technology, 6131 Karlsruhe, Germany
| | - A.B. Smolders
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - K. Eriksson
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - M. Johannson
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - R. Maaskant
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - R. Quay
- Fraunhofer Institute for Applied Solid State Physics, IAF, Tullastraße 72, 79108 Freiburg, Germany
| | - D. Floriot
- United Monolithic Semiconductors SAS, Bâtiment Charmille, Mosaic parc de Courtaboeuf, 10 avenue du Québec, 91140, Villebon-sur-Yvette, France
| | - M. Bao
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - L.A. Bronckers
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - J. Fridén
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - M.C. van Beurden
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - B.P. de Hon
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - C. Kolitsidas
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - D. Blanco
- Ericsson AB, Lindholmspiren 11, 417 56 Göteborg, Sweden
| | - F.M.J. Willems
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - T. Eriksson
- Chalmers University of Technology, Chalmersplatsen 4, 412 96 Göteborg, Sweden
| | - A. Filippi
- NXP Semiconductors, High Tech Campus 60, 5656 AG Eindhoven, The Netherlands
| | - F. Ponzini
- Ericsson Telecomunicazioni SpA, Via Anagnina 203, 00118 Rome, Italy
| | - U. Johannsen
- Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
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Stollenwerk MM, Gustafsson A, Edgren G, Gudmundsson P, Lindqvist M, Eriksson T. Core competencies for a biomedical laboratory scientist - a Delphi study. BMC Med Educ 2022; 22:476. [PMID: 35725406 PMCID: PMC9208704 DOI: 10.1186/s12909-022-03509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND After completing university education, biomedical laboratory scientists work in clinical laboratories, in biomedical research laboratories, in biotech, and in pharmaceutical companies. Laboratory diagnostics have undergone rapid development over the recent years, with the pace showing no signs of abatement. This rapid development challenges the competence of the staff and will most certainly influence the education of future staff. This study aimed to examine what was considered the necessary competencies needed to pursue a career as a biomedical laboratory scientist. METHODS A modified Delphi technique was used, with the panel of experts expressing their views in a series of three questionnaire. Consensus was defined as the point which 75 % or more of the panel participants agreed that a particular competency was necessary. RESULTS The study highlights the perceived importance of mostly generic competencies that relate to quality, quality assurance, and accuracy, as well as different aspects of safety, respect, trustworthiness (towards patients/clients and colleagues), and communication skills. The results also stress the significance of self-awareness and professionality. CONCLUSIONS We identified important competencies for biomedical laboratory scientists. Together with complementary information from other sources, i.e., guidelines, laws, and scientific publications, the competencies identified can be used as learning outcomes in a competency-based education to provide students with all the competencies needed to work as professional biomedical laboratory scientists.
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Affiliation(s)
- Maria M Stollenwerk
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Biofilms Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Anna Gustafsson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
- Biofilms Research Center for Biointerfaces, Malmö University, Malmö, Sweden.
| | - Gudrun Edgren
- Center for Teaching and Learning, Faculty of Medicine, Lund University, Lund, Sweden
| | - Petri Gudmundsson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Biofilms Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | | | - Tommy Eriksson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Biofilms Research Center for Biointerfaces, Malmö University, Malmö, Sweden
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6
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial. BMC Cardiovasc Disord 2021; 21:367. [PMID: 34334142 PMCID: PMC8327441 DOI: 10.1186/s12872-021-02178-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence. Methods This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use. Results 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors. Conclusions Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health. Trial registration: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02178-0.
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Affiliation(s)
- Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden. .,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden.
| | - Tommy Eriksson
- Department of Biomedical Science, and Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden
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7
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Eriksson T. The CLEO assessment tool for pharmacist interventions. Eur J Hosp Pharm 2021; 28:181. [PMID: 34162669 PMCID: PMC8239272 DOI: 10.1136/ejhpharm-2021-002882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tommy Eriksson
- Department of Biomedical Science, Malmö Universitet, Malmo, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö Universitet, Malmo, Sweden
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Eriksson T, Melander AC. Clinical pharmacists' services, role and acceptance: a national Swedish survey. Eur J Hosp Pharm 2021; 28:e203-e206. [PMID: 34117089 DOI: 10.1136/ejhpharm-2020-002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/11/2021] [Indexed: 11/03/2022] Open
Abstract
AIM Describe, and between regions, compare the services provided, and the pharmacists' perceptions of their role and its importance. METHOD Online survey involving active clinical pharmacists in Sweden. RESULT The survey was completed by 118 pharmacists (66%), half of whom had at least 1 year's formal training in clinical pharmacy, and work experience in excess of 5 years. Admission medication reconciliation and medication review are provided in most regions and often on a daily basis. The most important services were: making suggestions to physicians regarding drug changes, medication review, medication reconciliation, and patient communication. On a five-point Likert-scale (where 1 = negative and 5 = positive) very few respondents scored less than 4 on the role, acceptance and skills questions. DISCUSSION Our study confirms the strong position of clinical pharmacy and clinical pharmacists in Sweden. There were some differences regarding the services provided between regions but clinical pharmacists' patient-centred work in the clinical setting as part of the care team is well established, accepted and important. Respondents believed they could take on additional responsibilities for prescription changes without the need for further education. CONCLUSION Patient-centred clinical pharmacy work in a clinical setting as part of the care team is well established, accepted and important.
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Affiliation(s)
- Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
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Hellström L, Eriksson T, Bondesson Å. Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems. Eur J Hosp Pharm 2020; 28:e128-e133. [PMID: 33199398 DOI: 10.1136/ejhpharm-2020-002492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process. OBJECTIVE To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs. METHOD Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken. RESULTS A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations. CONCLUSION DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.
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Affiliation(s)
- Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, Skåne County Council, Kristianstad, Sweden
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Kismul H, Spörndly E, Höglind M, Eriksson T. Nighttime pasture access: Comparing the effect of production pasture and exercise paddock on milk production and cow behavior in an automatic milking system. J Dairy Sci 2019; 102:10423-10438. [PMID: 31477290 DOI: 10.3168/jds.2019-16416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022]
Abstract
With increasing intensification of the dairy sector in many countries and with the introduction of automatic milking, exercise paddocks combined with full indoor feeding, as an alternative to production pasture, are being used as a compromise between farm economics and cow welfare. This study examined whether there are production benefits for high-producing dairy cows in an alternative system that uses pasture at a level of approximately 50% of the total roughage intake in the diet. In an automatic milking system with 12-h night access to the outdoor environment, we compared milk production and behavior of cows in 2 systems: an exercise paddock combined with ad libitum grass silage indoor feeding and a production pasture combined with a restricted daytime grass silage ration. There were 20 cows in the former and 21 cows in the latter system, with the treatments running in parallel. The experiment started in late June with no complete darkness during the night, and lasted for 12 wk, with 5.6 h of darkness at the end. We therefore also explored the effect of night length on milk production and behavior parameters. All cows showed strong motivation for going outdoors and grazing when pasture access was given in early evening, but after a few hours both groups went to the barn and did not return to the pasture area during the remaining night. As the season progressed and nights became longer, cows on the exercise paddock treatment reduced time spent outdoors and grazing time, whereas they increased time spent resting outdoors. The group on exercise paddock had a greater milk yield (kg of milk) over the experimental period than the production pasture group. The latter group also showed a greater drop in milk yield over the duration of the trial. Thus, for cows milked in an automatic milking system and offered nighttime outdoor access, no milk production benefits were observed in offering production pasture with restricted indoor silage allowance instead of an exercise paddock with ad libitum silage. We therefore suggest that automatic milking farmers with similar production levels and automatic milking-management systems as in the present experiment, who wish to include grazed grass as part of the dairy cow diet, should ensure that cows have pasture access in the afternoon and evening.
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Affiliation(s)
- H Kismul
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden; Faculty of Biosciences and Aquaculture, Nord University, 7713 Steinkjer, Norway.
| | - E Spörndly
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
| | - M Höglind
- Norwegian Institute of Bioeconomy Research, 1431, Ås, Norway
| | - T Eriksson
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
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Eriksson T. What is a hospital pharmacist, our competencies?: What should be the focus for EJHP, and how can we stimulate research and publication in it? Eur J Hosp Pharm 2019; 26:185-186. [PMID: 31338164 DOI: 10.1136/ejhpharm-2019-001969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tommy Eriksson
- Biomedical Sciences, Malmö University, Faculty of Health and Society, Malmö 211 19, Sweden
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12
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Wilhelmsen NC, Eriksson T. Medication adherence interventions and outcomes: an overview of systematic reviews. Eur J Hosp Pharm 2018; 26:187-192. [PMID: 31338165 DOI: 10.1136/ejhpharm-2018-001725] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/30/2022] Open
Abstract
Objective To present evidence for healthcare-provided medication adherence interventions on clinical, economic and humanistic outcomes among patients. Methods Literature search of systematic reviews in Medline, Embase and CINAHL (2007-2017), validation of quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses questionnaires and, finally, extraction, combination and tabulation of results for included studies. Results From eight systematic reviews with medium to high AMSTAR 2 score, 37 randomised controlled studies involving 28 600 participants were extracted. Patient education and counselling showed some positive effects on medication adherence. Patient education also showed some positive effects on morbidity, healthcare utilities and patient satisfaction. Counselling had some benefit on mortality and healthcare utilisation. Simplifying doses was shown to have some benefit on morbidity and patient satisfaction. Interventions delivered by pharmacists and nurses showed a better result in improving adherence and outcomes than interventions delivered by general practitioners. Conclusions Some interventions were found to have positive effect on adherence and outcomes, but no single strategy showed improvement in all settings. For future research patients should be screened for non-adherence to reveal both if they are non-adherent and type of non-adherence, as well as bigger sample sizes and longer duration of follow-up.
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Affiliation(s)
- Nina C Wilhelmsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tommy Eriksson
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Al-Hashar A, Al-Zakwani I, Eriksson T, Sarakbi A, Al-Zadjali B, Al Mubaihsi S, Al Za'abi M. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. Int J Clin Pharm 2018; 40:1154-1164. [PMID: 29754251 DOI: 10.1007/s11096-018-0650-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Abstract
Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study's limitations.
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Affiliation(s)
- Amna Al-Hashar
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tommy Eriksson
- Department of Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Alaa Sarakbi
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Badriya Al-Zadjali
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Saif Al Mubaihsi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Za'abi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Bartmann W, Belochitskii P, Breuker H, Butin F, Carli C, Eriksson T, Oelert W, Ostojic R, Pasinelli S, Tranquille G. The ELENA facility. Philos Trans A Math Phys Eng Sci 2018; 376:rsta.2017.0266. [PMID: 29459416 PMCID: PMC5829171 DOI: 10.1098/rsta.2017.0266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
The CERN Antiproton Decelerator (AD) provides antiproton beams with a kinetic energy of 5.3 MeV to an active user community. The experiments would profit from a lower beam energy, but this extraction energy is the lowest one possible under good conditions with the given circumference of the AD. The Extra Low Energy Antiproton ring (ELENA) is a small synchrotron with a circumference a factor of 6 smaller than the AD to further decelerate antiprotons from the AD from 5.3 MeV to 100 keV. Controlled deceleration in a synchrotron equipped with an electron cooler to reduce emittances in all three planes will allow the existing AD experiments to increase substantially their antiproton capture efficiencies and render new experiments possible. ELENA ring commissioning is taking place at present and first beams to a new experiment installed in a new experimental area are foreseen in 2017. The transfer lines from ELENA to existing experiments in the old experimental area will be installed during CERN Long Shutdown 2 (LS2) in 2019 and 2020. The status of the project and ring commissioning will be reported.This article is part of the Theo Murphy meeting issue 'Antiproton physics in the ELENA era'.
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Affiliation(s)
| | | | | | | | | | | | - Walter Oelert
- Johannes Gutenberg University Mainz, 55099 Mainz, Germany
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15
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Gillespie U, Eriksson T. Medication reconciliation activities among pharmacists in Europe. Eur J Hosp Pharm 2018; 25:100-102. [DOI: 10.1136/ejhpharm-2016-000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 11/04/2022] Open
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life. JMIR Res Protoc 2018; 7:e57. [PMID: 29463490 PMCID: PMC5840476 DOI: 10.2196/resprot.8659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients' adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. OBJECTIVE This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. METHODS The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient's medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. RESULTS The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. CONCLUSIONS The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy).
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norweigan University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation. JMIR Res Protoc 2018; 7:e21. [PMID: 29382630 PMCID: PMC5811650 DOI: 10.2196/resprot.8660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. OBJECTIVE This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. METHODS The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients' beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients' overall experience of care after coronary heart disease. RESULTS The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. CONCLUSIONS This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norwegian University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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18
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Bertilsson J, Åkerlind M, Eriksson T. The effects of high-sugar ryegrass/red clover silage diets on intake, production, digestibility, and N utilization in dairy cows, as measured in vivo and predicted by the NorFor model. J Dairy Sci 2017; 100:7990-8003. [DOI: 10.3168/jds.2017-12874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/11/2017] [Indexed: 11/19/2022]
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19
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Andersson M, Kolodziej B, Andersson RE, Andersson M, Eriksson T, Ramsing A, Westman L, Björkman J, Håkansson HO, Lundström T, Björkman H, Johansson P, Hjert O, Edin R, Ekström A, Wenander C, Wallon C, Andersson P, Frisk J, Arvidsson B, Lantz R, Wallin G, Wickberg Å, Stenberg E, Erixon C, Schmidt W, Räntfors J, Göthberg G, Styrud J, Elias K, Boström L, Kretschmar G, Jonsson M, Brav C, Nilsson I, Kamran F, Hammarqvist F, Rutqvist J, Almström M, Hedberg M, Lindh V, Rosemar A, Wangberg H, Gustafsson J, Neovius G, Juhlin C, Christofferson R, Månsson C, Zittel T, Fagerström N. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis. Br J Surg 2017; 104:1451-1461. [PMID: 28730753 DOI: 10.1002/bjs.10637] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/23/2017] [Accepted: 05/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment. METHOD Patients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment. RESULTS The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P < 0·001), fewer admissions (29·5 versus 42·8 per cent; P < 0·001), and fewer negative explorations (1·6 versus 3·2 per cent; P = 0·030) and operations for non-perforated appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020). CONCLUSION AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- M Andersson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Surgery, Ryhov County Hospital, County Council of Jönköping, Jönköping, Sweden
| | - B Kolodziej
- Department Pathology, Ryhov County Hospital, County Council of Jönköping, Jönköping, Sweden
| | - R E Andersson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Surgery, Ryhov County Hospital, County Council of Jönköping, Jönköping, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | - R Edin
- Varbergs Sjukhus, Varberg
| | | | | | - C Wallon
- Universitetssjukhuset, Linköping
| | | | - J Frisk
- Norrköpings Lasarett, Norrköping
| | | | - R Lantz
- Västerviks Sjukhus, Västervik
| | - G Wallin
- Universitetssjukhuset Örebro, Örebro
| | | | | | | | | | - J Räntfors
- Drottning Silvias barn- och ungdomssjukhus, Göteborg
| | - G Göthberg
- Drottning Silvias barn- och ungdomssjukhus, Göteborg
| | | | | | | | | | | | - C Brav
- Södersjukhuset, Stockholm
| | | | - F Kamran
- Capio St Göans Sjukhus, Stockholm
| | | | - J Rutqvist
- Astrid Lindgrens Barnsjukhuset, Karolinska Universitetssjukhuset, Stockholm
| | - M Almström
- Astrid Lindgrens Barnsjukhuset, Karolinska Universitetssjukhuset, Stockholm
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Affiliation(s)
- Tommy Eriksson
- Department of Clinical Pharmacology, Laboratory Medicine, Lund University, Lund, Sweden
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Mgbeahuruike AC, Nørgaard P, Eriksson T, Nordqvist M, Nadeau E. Faecal characteristics and milk production of dairy cows in early-lactation fed diets differing in forage types in commercial herds. ACTA AGR SCAND A-AN 2016. [DOI: 10.1080/09064702.2016.1193216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. C. Mgbeahuruike
- Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
- Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden
| | - P. Nørgaard
- Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg, Denmark
| | - T. Eriksson
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M. Nordqvist
- Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden
| | - E. Nadeau
- Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden
- The Rural Economy and Agricultural Society Sjuhärad, Länghem, Sweden
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Midlöv P, Höglund P, Eriksson T, Diehl A, Edgren G. Developing a Competency-based Curriculum in Basic and Clinical Pharmacology--A Delphi Study among Physicians. Basic Clin Pharmacol Toxicol 2015; 117:413-20. [PMID: 26123372 DOI: 10.1111/bcpt.12436] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
Abstract
A new curriculum is planned for the medical school at Lund University, Sweden. Pharmacology, in a broad sense, has been identified as a subject that needs to be strengthened based on needs in the healthcare system. The aim was to identify the competencies in basic and clinical pharmacology that a newly qualified physician needs. Using a modified three-round Delphi technique, 31 physicians were invited to list necessary competencies (round 1). After content analysis, these panel members classified the list by importance on two occasions (rounds 2 and 3) using a 4-point scale (4 = necessary, 3 = desirable, 2 = useful, 1 = not necessary). Competencies with the highest ranks based on necessity were retained. Thirty physicians accepted the invitation and 25 (83%) of them completed all three rounds. Round 1 resulted in 258 suggestions, which were subsequently reduced to 95 competencies. Of these 95 competencies, 40 were considered necessary by at least 75% of the panel members. The degree of consensus increased between round 2 and round 3. Using a modified Delphi technique, we identified 40 competencies that could be transferred to learning outcomes for a new curriculum in basic and clinical pharmacology at medical school.
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Affiliation(s)
- Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmo, Lund University, Lund, Sweden
| | - Peter Höglund
- Section for Clinical Chemistry and Pharmacology, Department of Laboratory Medicine in Lund, Lund University, Lund, Sweden
| | - Tommy Eriksson
- Section for Clinical Chemistry and Pharmacology, Department of Laboratory Medicine in Lund, Lund University, Lund, Sweden
| | - Annika Diehl
- Center for Teaching and Learning, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gudrun Edgren
- Center for Teaching and Learning, Faculty of Medicine, Lund University, Lund, Sweden
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Al-Hashar A, Al-Zakwani I, Eriksson T, Al Za’abi M. Whose responsibility is medication reconciliation: Physicians, pharmacists or nurses? A survey in an academic tertiary care hospital. Saudi Pharm J 2015; 25:52-58. [PMID: 28223862 PMCID: PMC5310138 DOI: 10.1016/j.jsps.2015.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles for each profession within a standardized medication reconciliation process.
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Affiliation(s)
- Amna Al-Hashar
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
- Corresponding author at: Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 38, Al-Khod, Muscat 123, Oman. Tel.: +968 99351322; fax: +968 24141107.
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tommy Eriksson
- Department of Clinical Pharmacology, Laboratory Medicine, Lund University, Lund, Sweden
| | - Mohammed Al Za’abi
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Bartmann W, Belochitskii P, Breuker H, Butin F, Carli C, Eriksson T, Oelert W, Maury S, Pasinelli S, Tranquille G. CERN ELENA project progress report. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20159504012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
All strategies and tools to improve the potential outcomes of medications therapy are a waste of time if the clients do not take their medication as prescribed. The aim of this paper is to help pharmacists to help their clients to improve outcomes of medicines based on improving their compliance to evidence-based pharmacotherapy. To reach a good compliance (result), you have to have agreement and concordance (method) between the practitioner and the client. Barriers and strategies for this, including identifying compliance problems and reasons for it, methods for improving information and communication, the client's participation, and responsibility for their own health, are presented mainly based on Cochrane reviews. Also some general pragmatic suggestions for how pharmacists can assist their clients the best are given.
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Affiliation(s)
- Tommy Eriksson
- Department of Clinical Pharmacology, Institution of Laboratory Medicine Lund, Lund University, Lund, Sweden
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Schaffer P, Bénard F, Bernstein A, Buckley K, Celler A, Cockburn N, Corsaut J, Dodd M, Economou C, Eriksson T, Frontera M, Hanemaayer V, Hook B, Klug J, Kovacs M, Prato F, McDiarmid S, Ruth T, Shanks C, Valliant J, Zeisler S, Zetterberg U, Zavodszky P. Direct Production of 99mTc via 100Mo(p,2n) on Small Medical Cyclotrons. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.phpro.2015.05.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Eriksson T, Rustas BO. Effects on milk urea concentration, urine output, and drinking water intake from incremental doses of potassium bicarbonate fed to mid-lactation dairy cows. J Dairy Sci 2014; 97:4471-84. [DOI: 10.3168/jds.2013-7861] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/24/2014] [Indexed: 11/19/2022]
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Bahrani L, Eriksson T, Höglund P, Midlöv P. The rate and nature of medication errors among elderly upon admission to hospital after implementation of clinical pharmacist-led medication reconciliation. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wiffen P, Eriksson T, Lu H. The tools of evidence-based medicine. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sällström J, Eriksson T, Fredholm BB, Persson AEG, Palm F. Inhibition of sodium-linked glucose reabsorption normalizes diabetes-induced glomerular hyperfiltration in conscious adenosine A₁-receptor deficient mice. Acta Physiol (Oxf) 2014; 210:440-5. [PMID: 23901799 DOI: 10.1111/apha.12152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/07/2013] [Accepted: 07/28/2013] [Indexed: 02/05/2023]
Abstract
AIM Glomerular hyperfiltration is commonly observed in diabetics early after the onset of the disease and predicts the progression of nephropathy. Sustained hyperglycaemia is also closely associated with kidney hypertrophy and increased electrolyte and glucose reabsorption in the proximal tubule. In this study, we investigated the role of the increased tubular sodium/glucose cotransport for diabetes-induced glomerular hyperfiltration. To eliminate any potential confounding effect of the tubuloglomerular feedback (TGF) mechanism, we used adenosine A₁-receptor deficient (A1AR(-/-)) mice known to lack a functional TGF mechanism and compared the results to corresponding wild-type animals (A1AR(+/+)). METHODS Diabetes was induced by an intravenous bolus injection of alloxan. Glomerular filtration rate (GFR) was determined in conscious mice by a single bolus injection of inulin. The sodium/glucose cotransporters were inhibited by phlorizin 30 min prior to GFR measurements. RESULTS Normoglycaemic animals had a similar GFR independent of genotype (A₁AR(+/+) 233 ± 11 vs. A₁AR(-/-) 241 ± 25 μL min(-1)), and induction of diabetes resulted in glomerular hyperfiltration in both groups (A₁AR(+/+) 380 ± 25 vs. A₁AR(-/-) 336 ± 35 μL min(-1); both P < 0.05). Phlorizin had no effect on GFR in normoglycaemic mice, whereas it reduced GFR in both genotypes during diabetes (A₁AR(+/+) 365 ± 18 to 295 ± 19, A₁AR(-/-) 354 ± 38 to 199 ± 15 μL min(-1); both P < 0.05). Notably, the reduction was more pronounced in the A₁AR(-/-) (P < 0.05). CONCLUSION This study demonstrates that increased tubular sodium/glucose reabsorption is important for diabetes-induced hyperfiltration, and that the TGF mechanism is not involved in these alterations, but rather functions to reduce any deviations from a new set-point.
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Affiliation(s)
- J. Sällström
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
| | - T. Eriksson
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
| | - B. B. Fredholm
- Department of Physiology and Pharmacology; Karolinska Institute; Stockholm Sweden
| | - A. E. G. Persson
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
| | - F. Palm
- Department of Medical Cell Biology; Uppsala University; Uppsala Sweden
- Division of Drug Research; Department of Medical and Health Sciences; Center for Medical Image Science and Visualization; Linköping University; Linköping Sweden
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Wiffen P, Eriksson T, Lu H. CHAPTER 3: Asking and formulating the right questions and finding useful resources in evidence-based pharmacy—2nd edition:. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Medication beliefs and self-reported adherence–results of a pharmacist's consultation: a pilot study. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eriksson T. Results from a project to develop systematic patient focused clinical pharmacy services. The Lund Integrated Medicines Management model. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eriksson T, Wallin FS, Henricson K, Lundin A, Petersson J. ApoLänk decreases patient medication discrepancies at discharge: initial experience from a Swedish bedside pharmacy service. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2012-000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ghatnekar O, Bondesson Å, Persson U, Eriksson T. Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital. BMJ Open 2013; 3:bmjopen-2012-001563. [PMID: 23315436 PMCID: PMC3553390 DOI: 10.1136/bmjopen-2012-001563] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. METHOD Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. RESULTS The total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%. CONCLUSIONS The LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.
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Affiliation(s)
- Ola Ghatnekar
- Swedish Institute for Health Economics, Lund, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, County of Skåne, Malmö, Sweden
| | - Ulf Persson
- Swedish Institute for Health Economics, Lund, Sweden
| | - Tommy Eriksson
- Department for Laboratory Medicine, Institution for Laboratory Medicine, Lund University,Lund, Sweden
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Bondesson A, Eriksson T, Kragh A, Holmdahl L, Midlöv P, Höglund P. In-hospital medication reviews reduce unidentified drug-related problems. Eur J Clin Pharmacol 2012; 69:647-55. [PMID: 22955893 DOI: 10.1007/s00228-012-1368-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting. METHODS In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were ≥ 65 years old, used ≥ 3 medications on a regular basis and had stayed on the ward for ≥ 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category. RESULTS The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st-3rd quartile 0-2), control group 9 (6-13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0-2), control group 8 (5-10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group. CONCLUSIONS A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.
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Affiliation(s)
- Asa Bondesson
- The Department of Medicines Management and Informatics, Region Skåne, Kristianstad, Sweden.
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Hellström LM, Höglund P, Bondesson A, Petersson G, Eriksson T. Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model--impact on all-cause emergency department revisits. J Clin Pharm Ther 2012; 37:686-92. [PMID: 22924464 DOI: 10.1111/jcpt.12001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death. METHODS This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention. RESULTS AND DISCUSSION No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.86-1.04]or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared with 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0.608). WHAT IS NEW AND CONCLUSION Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re-hospitalizations or mortality over 6-month follow-up.
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Affiliation(s)
- L M Hellström
- eHealth Institute, Linnaeus University, Kalmar, Sweden.
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Eberl S, Eriksson T, Svedberg O, Norling J, Henderson D, Lam P, Fulham M. High beam current operation of a PETtraceTM cyclotron for 18F− production. Appl Radiat Isot 2012; 70:922-30. [DOI: 10.1016/j.apradiso.2012.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 03/03/2012] [Accepted: 03/04/2012] [Indexed: 11/29/2022]
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Hellström LM, Bondesson Å, Höglund P, Eriksson T. Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clin Pharmacol 2012; 12:9. [PMID: 22471836 PMCID: PMC3353244 DOI: 10.1186/1472-6904-12-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/03/2012] [Indexed: 11/22/2022]
Abstract
Background An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors. Methods A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors. Results The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06-1.14; p < 0.0001) and the patient living in their own home without any care services (OR = 1.58; 95% CI 1.02-2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists' medication reconciliation carried out on days 4-11 compared to days 0-1 = 0.52; 95% CI 0.30-0.91; p=0.021). Conclusions Clinical pharmacists conducting LIMM-based medication reconciliations have a high potential for correcting errors in medication history for all patients. In an older Swedish population, those prescribed many drugs seem to benefit most from admission medication reconciliation.
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Affiliation(s)
- Lina M Hellström
- eHealth Institute and School of Natural Sciences, Linnaeus University, Kalmar, Sweden.
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