Farmaceutisch onderzoek

808 artikelen

15 nov 2018

Effectiviteit en efficiëntie van antibioticaswitch in de ziekenhuisapotheek

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1684
  • Auteur(s):
    D. Mitrovic a*, S. Begari b, K. Waar c en R. de Vries d

Effectiviteit en efficiëntie van antibioticaswitch in de ziekenhuisapotheek

Efficacy and efficiency of antibiotics switch at the hospital pharmacy

OBJECTIVE

An earlier switch to oral antibiotics (AB po) can reduce inappropriate use of intravenous antibiotics (AB iv) and comes with certain benefits: decreased workload, reduced risk of complications, and decreased patient discomfort. Therefore, we examined how an earlier switch from AB iv to AB po can be executed optimally in a hospital setting.

DESIGN

Prospective, explorative intervention study.

METHODS

Besides the self-developed decision support system to detect AB iv, three intervention phases have been set up. Phase 1: pharmacist reports to the microbiologist in the Antimicrobial stewardship team (A-Team). Afterwards, the microbiologist discusses the option of switching to AB po with the treating physician. Phase 2: the pharmacist discusses the option of switching to AB po with the treating physician. Phase 3: the pharmacist only checks required data for earlier switch to AB po.

RESULTS

713 AB iv have been prescribed for 555 patients during the three phases and follow-up. For phase 1, 2 and 3 effectiveness was 39%, 48% and 50%, respectively, and pharmacist spent 3.2, 1.4 and 1.0 hours per day, respectively, on AB Switch. Phase 3 has been performed during follow-up thus achieving better effectiveness (67%) and better efficiency (0.9 hours per day).

CONCLUSION

These improvements are due to trainings provided by the A-Team, improved documentation of physicians (including indication and antibiotics policy), and increased awareness to switch earlier to AB po.

08 nov 2018

Begeleiding door artsen en apothekers tijdens antidepressivagebruik: behoeften van patiënten en suggesties ter verbetering

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1682
  • Auteur(s):
    M. Nederlof ab, D.C. Cath cd, L.J. Stoker a, A.C.G. Egberts ae en E.R. Heerdink aef*

Begeleiding door artsen en apothekers tijdens antidepressivagebruik: behoeften van patiënten en suggesties ter verbetering

Guidance by physicians and pharmacists during antidepressant therapy: patients’ needs and suggestions for improvement

OBJECTIVE

Guidance of patients treated with antidepressants is paramount for successful therapy. The aim was to assess patients’ needs and suggestions for improvement of guidance by physicians and pharmacists during second generation antidepressant (SGA) therapy.

DESIGN

Five focus group discussions were held with a total of 34 patients using an SGA.

METHODS

The discussions were conducted flexibly and responsively using a semistructured topic list. All focus group discussions were video-recorded and transcripts were analysed using ATLAS.ti for coding, thematic and open analysis.

RESULTS

Participants stated they were in need of better guidance. They suggested improving content of information during decisional moments, patient-health care professional communication and communication in-between health care professionals, and finally, organisation of guidance. Barriers to achieving improved guidance were cited.

CONCLUSION

Content, communication and organisation of guidance are pivotal for achieving optimal guidance. Participants mentioned that their current experienced guidance had limitations and brought up solutions for improvement. A next step would be to discuss the suggested solutions with health care professionals to assess their views and to discuss the possibility for implementation. After implementation, future studies could be aimed at determination of its impact on patients’ treatment efficacy, quality of life, treatment satisfaction and healthcare costs.

06 nov 2018

Fluoropyrimidines altijd op basis van DPYD-genotypering doseren

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1655
  • Auteur(s):
    Lonneke Timmers

Fluoropyrimidines altijd op basis van DPYD-genotypering doseren

02 nov 2018

De oudere migrant als klant in de openbare apotheek

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1681
  • Auteur(s):
    Bas Steunenberg *

De oudere migrant als klant in de openbare apotheek

The elderly migrant as customer at the pharmacy

BACKGROUND

Non-Western older immigrants experience poorer health outcomes than their Western counterparts, potentially due to limited access to health care services. A majority of the non-Western older immigrants has language problems and low health skills. As a consequence, they experience problems in their medication adherence and compliance.

OBJECTIVE

We tried to get more insight in how the older Moroccan-Dutch migrants and their next of kin at the pharmacy value their medication, how they adhere to medication and safe medication use.

DESIGN and METHODS

Semi-structured interviews were conducted with 20 older Moroccan-Dutch migrants (55 years or older, using five or more prescribed medicines) and 20 next of kin who support an older migrant for medication intake. Interviews were analysed using a qualitative research methodology. To reach the older migrants we deployed a so-called ethnic community health worker (CHW) at the pharmacy. She speaks the same language as the older migrants and has knowledge of the barriers they experience in medication adherence.

RESULTS

The older migrants could name the chronic disease for which they use medication. It seems hard for them to adhere to a medication intake regime due to daily hassles. When asking for more concrete knowledge about medication compliance skills, this topic seems to be a taboo and the older migrants fall silent. The older migrants and their next of kin agree that assistance for adherence to medication is necessary. The next of kin feel responsibility for this issue.

CONCLUSION

More attention to a firm relationship with the older migrants in the pharmacy is needed to talk about the problems they experience with medication adherence. Next to this, more attention should be paid to support their next of kin.

25 okt 2018

Identificeren van micro-organismen bij aseptische handelingen

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1680
  • Auteur(s):
    Frits A. Boom a*, Tjitske Veenbaas b, Mirjam Crul c, Milenko J.A.M.P. Pavičić d en Judith M. Ris a

Identificeren van micro-organismen bij aseptische handelingen

Identification of microorganisms in aseptic handling

OBJECTIVE

Determination of the relevance of identification of microorganisms found by microbiological Environmental Monitoring (isolates from EM) during aseptic handling.

METHODS

Identification of isolates from EM by microscopical examination, gram and spore staining and/or by MALDI-TOF. Isolates from EM in five hospital pharmacies were collected during one year and subdivided in 7 groups: Gram-positive and Gram-negative cocci, Gram-positive non-spore forming rods, Gram-positive spore forming rods, Gram-negative rods, fungi and yeast.

RESULTS

Gram-positive cocci were found in most cases (70-80 %), followed by Gram-positive rods (non-spore forming and spore forming; around 20%). Our results are comparable with the cleanroom microflora found in the pharmaceutical industry. The two cases described in this article, show that auditing gives more information about possible sources and causes of contamination than identification of micro-organisms.

CONCLUSION

The aim of identification is finding sources of contamination, resulting in corrective actions if EM results exceed the alert or action levels. We believe that the added value of identification, as a routine activity during aseptic handling is doubtful. However, knowing it is important to check if the cleanroom microflora is comparable to the expected microflora, we advise to do this once by using around 100 isolates from EM out of the LAF or biosafety cabinet and to repeat this every 3 years.

Identification is also valuable while building activities are taking place in the neighborhood of the cleanroom. Deviations from the expected cleanroom microflora will be indicative for inadequate preventive measures against contamination resulting from the building activities.

18 okt 2018

Deeltjesgrootte bepaalt immunogeniciteit aggregaten van monoklonale antilichamen

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1670
  • Auteur(s):
    Herman Vromans

Deeltjesgrootte bepaalt immunogeniciteit aggregaten van monoklonale antilichamen

15 okt 2018

Wat moeder ons vertelt

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1669
  • Auteur(s):
    Herman Vromans

Wat moeder ons vertelt

10 okt 2018

Morele dilemma’s van openbaar apothekers

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1679
  • Auteur(s):
    Martine Kruijtbosch ab*, Wilma Göttgens-Jansen c, Annemieke Floor-Schreudering ab, Evert van Leeuwen c en Marcel Bouvy b

Morele dilemma’s van openbaar apothekers

Moral dilemmas of community pharmacists: a narrative study

BACKGROUND

Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing.

OBJECTIVE

To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy.

METHODS

Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure: themes of moral dilemmas.

RESULTS

Twenty-two themes were identifed in 128 narratives. These moral dilemmas arose predominantly during pharmacists contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators.

CONCLUSION

The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.

05 okt 2018

Toegang tot de behandeling met onder de Opiumwet gereguleerde geneesmiddelen: rationale en aanbevelingen voor neutraal, accuraat en respectvol taalgebruik

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1678
  • Auteur(s):
    W. Scholten a*, O. Simon b, I. Maremmani c, C. Wells d, J.F. Kelly e, R. Hämmig f en L. Radbruch g

Toegang tot de behandeling met onder de Opiumwet gereguleerde geneesmiddelen: rationale en aanbevelingen voor neutraal, accuraat en respectvol taalgebruik

Access to treatment with controlled medicines, Rationale and recommendations for neutral, respectful, and precise language

BACKGROUND and OBJECTIVE

The European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals to ensure that authors always use terminology that is neutral, precise, and respectful in relation to the use of psychoactive substances. It has been shown that language can propagate stigma; and that stigma can prevent people from seeking help and influence the effectiveness of social and public health policies. The focus of using appropriate terminology should extend to all patients who need controlled medicines, avoiding negative wording.

DESIGN and METHODS

A narrow focus on a few terms and medical communication only should be avoided. The appropriateness of terms is not absolute, and indeed varies between cultures and regions, and over time. For this reason, it is important that communities establish their own consensus of what is “neutral”, “precise”, and “respectful”.

RESULTS

We identified twenty-three problematic terms – most of them we suggest avoiding – and their possible alternatives.

CONCLUSION

The use of appropriate language improves scientific quality of manuscripts, and increases chances that patients will receive the best treatment and that government policies on psychoactive substance policies will be rational.

20 sep 2018

Trends in opioïdegebruik in Australië en Nederland

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1668
  • Auteur(s):
    Martina Teichert

Trends in opioïdegebruik in Australië en Nederland

04 sep 2018

Geen associatie tussen SLC04A1-, SLC22A2- en SLC28A2-variaties en werkzaamheid of toxiciteit methotrexaat bij reuma

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1667
  • Auteur(s):
    Martina Teichert

Geen associatie tussen SLC04A1-, SLC22A2- en SLC28A2-variaties en werkzaamheid of toxiciteit methotrexaat bij reuma

22 aug 2018

Gebruik van een vaste dosering voor monoklonale antilichamen binnen de oncologie

  • Rubriek:
    Overzichtsartikel
  • Identificatie:
    2018;3:a1677
  • Auteur(s):
    Jeroen J.M.A. Hendrikx a*, John B.A.G. Haanen b, Emile E. Voest c, Jan H.M.Schellens de, Alwin D.R. Huitema af en Jos H. Beijnen ae

Gebruik van een vaste dosering voor monoklonale antilichamen binnen de oncologie

Fixed dosing of monoclonal antibodies in oncology

BACKGROUND and OBJECTIVE

Most monoclonal antibodies in oncology are administered using body size-based dosing schedules. This is believed to correct for variability in both drug distribution and elimination between patients. However, the minor effects of body size on distribution and elimination of monoclonal antibodies and their usually wide therapeutic window do not support body size-based dosing.

DESIGN and METHODS

We summarized effects of body weight on the pharmacokinetic parameters of monoclonal antibodies in oncology and show that a fixed dose for most of these drugs is justified.

RESULTS and CONCLUSION

We show that fixed dosing is justified and can improve efficiency of compounding. Moreover, drug spillage can be reduced and medication errors may become less likely.

20 aug 2018

Point-of-care testing voor drugs of abuse ten opzichte van uitbesteding aan een extern laboratorium

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1676
  • Auteur(s):
    D. Mitrovic a*, B. van Maanen b, E. ten Hoeve c, C. Bethlehem d, D. Peeters e en D. Touw f

Point-of-care testing voor drugs of abuse ten opzichte van uitbesteding aan een extern laboratorium

Point-of-care testing for drugs of abuse versus outsourcing it to an external laboratory

BACKGROUND

In recent years more point-of-care tests (POCTs) have reached the hospital market. It is often unknown what the potential of POCTs is in terms of cost reduction or improvement of patient survival.

OBJECTIVE

To estimate the potential economic gain from using point-of-care urinalysis devices to screen for drugs of abuse rather than outsourcing testing to an external laboratory.

DESIGN and METHODS

This study was based on hospital data from 2015 and 2016 concerning number and unit costs of (therapeutic) drug intoxication screenings, logistic costs, and POC urinalysis costs. The economic outcomes were calculated for the actual scenario and for a hypothetical scenario where a POC urinalysis would be used instead.

RESULTS

For the same number of (therapeutic) drug intoxication screenings, the analysis predicts that the implementation of a POC urinalysis for the emergency department of the Tjongerschans hospital would increase the costs by €396,00 per annum compared to outsourcing. The POC urinalysis test would be economically favorable compared with the actual scenario from 65 (therapeutic) drug intoxication screenings per year.

CONCLUSION

For a small general hospital, which has few hospitalizations attributable to (therapeutic) drug abuse, implementation of POC urinalysis appears not to be economically favorable compared to outsourcing it to a nearby analytical facility.

09 aug 2018

Ondersteunen zelfmanagement bij diabetespatiënten door apotheker is effectief

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1664
  • Auteur(s):
    Sander Borgsteede

Ondersteunen zelfmanagement bij diabetespatiënten door apotheker is effectief

26 jul 2018

Farmaceutische zorg voor mensen met de ziekte van Parkinson

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1658
  • Auteur(s):
    Sander Borgsteede

Farmaceutische zorg voor mensen met de ziekte van Parkinson

10 jul 2018

Opvatting over voorgeschreven medicatie door patiënt van belang bij volhouden therapie

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1657
  • Auteur(s):
    André Wieringa

Opvatting over voorgeschreven medicatie door patiënt van belang bij volhouden therapie