Farmaceutisch onderzoek

855 artikelen

31 jan 2019

Een praktische gids voor probiotica ter preventie van antibiotica-gerelateerde diarree in Nederland

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1689
  • Auteur(s):
    Valeria Agamennone a, Cyrille A.M. Krul a, Ger Rijkers b en Remco Kort acd*

Een praktische gids voor probiotica ter preventie van antibiotica-gerelateerde diarree in Nederland

A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands

BACKGROUND

Antibiotic-associated diarrhea (AAD) is a side-effect frequently associated with the use of broad spectrum antibiotics. Although a number of clinical studies show that co-administration of specific probiotics reduces the risk for AAD, there is still unclarity among healthcare professionals on the recommendation of probiotic products.

OBJECTIVE

This paper aims to provide a practical guide to inform healthcare professionals, patients and consumers about the exact product characteristics of available probiotics with a proven efficacy to prevent AAD.

DESIGN and METHODS

The workflow in this paper includes three consecutive steps: a systematic review of relevant clinical studies for effective probiotics by a meta-analysis, compilation of a list of available probiotic products, and recommendation of probiotic products that match effective formulations. Our systematic review on the efficacy of probiotics for the prevention of AAD included only studies with randomized, double blind placebo-controlled trials, a clear definition of antibiotic associated diarrhea, and a probiotic administration regime for at least the duration of the antibiotic therapy.

RESULTS

Using our inclusion criteria, we selected 32 out of 128 identified trials and pooled the results of these studies for each specific dairy product and food supplement. The results indicate a total of seven single or multiple-strain formulations favoring the probiotic treatment group, with the strain Lactobacillus rhamnosus GG being the most effective (relative risk ratio of probiotic versus placebo 0.30 with 95% CI 0.16 - 0.5). We selected products for recommendation from a compiled list of all probiotic dairy products and food supplements available in The Netherlands and categorized them into groups of products showing effects against the incidence of AAD in at least one, two, or three independent clinical studies. We excluded all products which did not unambiguously declare on the label the specific probiotic strain(s) and the number of colony forming units.

CONCLUSION

Here, we present a practical guide that informs healthcare professionals and patients on the availability of probiotic products with a proven efficacy for the prevention of AAD.

25 jan 2019

Dankbetuiging 2018

  • Rubriek:
    Redactioneel
  • Identificatie:
    2019;4:e1679
  • Auteur(s):
    Redactiebureau NPFO

Dankbetuiging 2018

16 jan 2019

Impact van CYP3A4*22 op pazopanibfarmacokinetiek bij patiënten met kanker

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1676
  • Auteur(s):
    André Wieringa

Impact van CYP3A4*22 op pazopanibfarmacokinetiek bij patiënten met kanker

11 jan 2019

Hoe om te gaan met genotypeergegevens van dragers van twee verschillende DPD-genvariaties

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1675
  • Auteur(s):
    Bob Wilffert

Hoe om te gaan met genotypeergegevens van dragers van twee verschillende DPD-genvariaties

03 jan 2019

Prisma Symposium, 15 mei 2018

  • Rubriek:
    Congresabstracts
  • Identificatie:
    2019;4:a1688
  • Auteur(s):
    Redactiebureau NPFO - verscheidene auteurs

Prisma Symposium, 15 mei 2018

27 dec 2018

Sekseverschillen in gemelde bijwerkingen van SSRI’s

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1674
  • Auteur(s):
    Bob Wilffert

Sekseverschillen in gemelde bijwerkingen van SSRI’s

19 dec 2018

Veilig switchen naar infliximab biosimilars

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1673
  • Auteur(s):
    André Wieringa

Veilig switchen naar infliximab biosimilars

13 dec 2018

Medicatiegerelateerde heropnames binnen 30 dagen na ontslag

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1686
  • Auteur(s):
    Elien B. Uitvlugt a*, dr. Marjo J.A. Janssen b, dr. Eva L. Kneepkens c, dr. Bart J.F. van den Bemt d, prof. dr. Patricia M.L.A. van den Bemt e en dr. Fatma Karapinar f

Medicatiegerelateerde heropnames binnen 30 dagen na ontslag

Medication-related readmissions within 30 days after discharge

OBJECTIVE

Primary aim: to identify the percentage and preventability of unplanned readmissions ≤ 30 days of discharge due to medication related problems. Secondary aims: to assess which types of medication were responsible for potentially preventable readmissions and potential causes of these readmissions.

DESIGN

We conducted a cross-sectional observational study.

METHODS

Patients (≥ 18 years) with a 30-day unplanned readmission after discharge from a participating department were included. Residents of these departments and a pharmacist reviewed files of readmitted patients. During multidisciplinary meetings, potentially preventable cases were discussed and consensus was reached. The percentage of readmissions that were medication related, and potential preventability were assessed. For potentially preventable readmissions, types of medication responsible for the readmission and potential causes were assessed. Potential causes were categorized into three categories: problems due to transitions in care, prescribing, and adherence.

RESULTS

426 readmissions were included. Nineteen percent was medication related and 38% of these were potentially preventable. Most common types of medication responsible for potentially preventable readmissions were: diuretics (20%), drugs used to treat diabetes (17%) and cardiac therapy/beta blocking agents (13%). Potential causes of these readmissions were problems due to prescribing (43%), transitions in care (23%), and adherence (33%).

CONCLUSION

Thirty-eight percent of medication related readmissions is potentially preventable. Problems with prescribing, transitions in care and adherence might be good starting points for implementing interventions to reduce medication related readmissions.

11 dec 2018

Taperingstrips als hulpmiddel om antidepressiva verantwoord af te kunnen bouwen

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1687
  • Auteur(s):
    Peter C. Groot a* en Jim van Os abc

Taperingstrips als hulpmiddel om antidepressiva verantwoord af te kunnen bouwen

Antidepressant tapering strips to help people come off medication more safely

BACKGROUND

Antidepressants are commonly prescribed for many mental disorders, including psychosis. Withdrawal effects, resulting from inappropriately short duration of tapering or lack of flexibility in prescribing gradual reduction, are common.

OBJECTIVE and DESIGN

An observational study was conducted of the use of “tapering strips”, which allow gradual dosage reduction and minimise the potential for withdrawal effects.

METHODS

A tapering strip consists of antidepressant medication, packaged in a roll of small daily pouches, each with the same or slightly lower dose than the one before it. Strips come in series covering 28 days.

RESULTS

Of 1194 users of tapering strips, 895 (75%) wished to discontinue their antidepressant medication. In these 895, median length of antidepressant use was 2-5 years (IQR = 1-2 years ≥ 10 years). Nearly two-thirds (62%) had unsuccessfully attempted withdrawal before (median = two times before, IQR = 1-3). Almost all of these (97%) had experienced some degree of withdrawal, with 49% experiencing severe withdrawal (7 on a scale of 1-7, IQR = 6-7). The most common medications were paroxetine (n = 423, 47%) and venlafaxine (n = 386, 43%). Of the 895 wishing to discontinue, 636 (71%) succeeded in tapering their antidepressant medication completely, using a median of two tapering strips (IQR = 1-3) over a median of 56 days (IQR = 28-84).

CONCLUSION

Tapering strips represent a simple and effective method of achieving a gradual dosage reduction.

10 dec 2018

Het effect van de apotheker op de intensive care

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1672
  • Auteur(s):
    Ithamar Brinkman

Het effect van de apotheker op de intensive care

06 dec 2018

Valproïnezuurintoxicatie bij een oudere patiënt: let op de vrije fractie

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1671
  • Auteur(s):
    Ithamar Brinkman

Valproïnezuurintoxicatie bij een oudere patiënt: let op de vrije fractie

03 dec 2018

Het effect van geïnhaleerde glycopyrroniumbromide op ernstige speekselvloed en kwijlen bij patiënten met de ziekte van Parkinson

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1685
  • Auteur(s):
    J.B. Masselink a*, L. van Velzen b, L.D.A. Dorresteijn c, J.A.M. van der Palen de en K.L.L. Movig f

Het effect van geïnhaleerde glycopyrroniumbromide op ernstige speekselvloed en kwijlen bij patiënten met de ziekte van Parkinson

The effect of glycopyrronium inhalation on sialorrhea and drooling in patients with Parkinson’s disease

OBJECTIVE

To investigate the safety and tolerability of glycopyrronium inhalation powder using different dosing regimens and to determine the decrease of drooling in patients with Parkinson’s disease.

DESIGN

We conducted a 5-week safety study.

METHODS

Following a baseline week, each participant used glycopyrronium inhalations during four weeks, with weekly changing dosing regimes. The safety and tolerability was determined by monitoring side effects and the experience of participants. The decrease in drooling was determined by comparing the mean sialorrhea scores obtained every week. An interim analysis was performed after including seven participants.

RESULTS

Side effects occurred in 71.4% of participants, which led to discontinuation of the study in three out of seven participants. The most common side effects were coughing and headache. Side effects that caused discontinuation were a swollen tongue, dry mouth, and gastro-enteritis. No unknown side effects of glycopyrronium led to discontinuation. Four participants experienced improvement in sialorrhea and three participants continued inhalation treatment after completion of the study. Two participants mentioned an instant effect after inhalation of glycopyrronium.

CONCLUSION

Despite the reported side effects and the fact that we performed an interim analysis, we believe that glycopyrronium inhalations could be considered after failing of oral therapy.

29 nov 2018

Verloopt farmaceutische zorg bij vervolguitgiftes van cardiovasculaire medicatie volgens de richtlijnen?

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2018;3:a1683
  • Auteur(s):
    Lyda Blom *

Verloopt farmaceutische zorg bij vervolguitgiftes van cardiovasculaire medicatie volgens de richtlijnen?

Does pharmaceutical care for repeated deliveries of cardiovascular medication comply with the guidelines?

BACKGROUND

Dutch community pharmacies can subscribe to a program where a patient as mystery guest visits their pharmacy to investigate their pharmaceutical care.

OBJECTIVE

To evaluate whether the pharmaceutical care provided to patients who receive repeated deliveries of cardiovascular medication is in line with the professional guidelines.

METHODS

Observations of repeated drug deliveries of cardiovascular medication to patients, who visit their pharmacy accompanied by a mystery guest (observer). In addition, interviews with patients about their pharmacy experiences.

RESULTS

In 950 pharmacies a patient receiving one or more repeated drug deliveries of cardiovascular medication was observed. Pharmacy employees communicated with patients correctly and in almost all cases verified patient identity (93.7%) by asking at least two questions (mostly patient name and date of birth). Medication was delivered almost always with a patient package insert (93%), which includes complete drug information. As such, pharmacies complied with the professional guidelines.

In addition 5275 patients belonging to 900 pharmacies were interviewed. Most of the patients would appreciate to be asked at the pharmacy about their medication problems (77.7%), although 62% never had received this question. Similarly, the observations demonstrated that a minority of all patients were asked about their medication problems or questions (19.7%). In this respect, pharmacies do not comply with the professional guidelines.

CONCLUSION

In repeated drug delivery contacts pharmacists follow the guidelines about the verification of patient identity and the provision of drug information, but do not comply with the recommendation to ask patients about their medication problems or whether they have questions.

23 nov 2018

Stroomdiagram ECG-monitoring bij QT-verlengende antidepressiva

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1666
  • Auteur(s):
    Ciske van den Oever

Stroomdiagram ECG-monitoring bij QT-verlengende antidepressiva

20 nov 2018

Geneesmiddelgerelateerde heropnames

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1665
  • Auteur(s):
    Ciske van den Oever

Geneesmiddelgerelateerde heropnames

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.