Farmaceutisch onderzoek

834 artikelen

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

22 jun 2018

Omzetten intraveneus midazolam naar oraal lorazepam bij afbouwen sedatie van pediatrische IC-patiënten

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1663
  • Auteur(s):
    András Vermes

Omzetten intraveneus midazolam naar oraal lorazepam bij afbouwen sedatie van pediatrische IC-patiënten

19 jun 2018

Farmacokinetiek van vitamine C in kritiek zieke patiënten

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1662
  • Auteur(s):
    András Vermes

Farmacokinetiek van vitamine C in kritiek zieke patiënten

06 jun 2018

Hoge treosulfanblootstelling is geassocieerd met vroege toxiciteit bij stamceltransplantatie bij kinderen

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1675
  • Auteur(s):
    M.Y.E.C. van der Stoep a*, M.H. ten Brink b, D.J.A.R. Moes a, H.J. Guchelaar a, J. Zwaveling a en A.C. Lankester c

Hoge treosulfanblootstelling is geassocieerd met vroege toxiciteit bij stamceltransplantatie bij kinderen

High treosulfan exposure is associated with early toxicity in paediatric hematopoietic stem cell transplantation

BACKGROUND

Treosulfan-based conditioning is increasingly employed in paediatric hematopoietic stem cell transplantation (HSCT). Data on treosulfan pharmacokinetics in children are scarce, and the relationship between treosulfan exposure, toxicity and clinical outcome is unclear.

OBJECTIVE

To study treosulfan pharmacokinetics in relation to regimen-related toxicity and early clinical outcome in paediatric patients.

DESIGN

This research was conducted in a multicentre prospective observational study.

METHODS

Patients undergoing a transplantation in the paediatric transplant units in Leiden and Rome between June 2011 and July 2016 and receiving a treosulfan-based conditioning regimen for malignant and non-malignant indications, were included. Two blood samples were collected on day 1 to determine the area under the concentration-time curve (AUC) of treosulfan, calculated with a two-compartment pharmacokinetic model. The relationship between AUC and early toxicity was characterised using logistic regression.

RESULTS

A total of 77 patients were included. Mean treosulfan exposure on day 1 was 1744 ± 795 mg*hr/L (for children < 1 year of age receiving 10 g/m2) and 1561 ± 511 mg*hr/L (for children ≥ 1 year of age receiving 14 g/m2), with an inter-individual variability of 56% and 33%, respectively. High treosulfan exposure (> 1650 mg*hr/L) was associated with an increased risk of mucosal (odds ratio [OR] 4.40; 95% confidence interval [95% CI] 1.19-16.28, P = 0.026) and skin toxicity (OR 4.51; 95% CI 1.07-18.93, P = 0.040). No correlation was found between treosulfan exposure and the early clinical outcome parameters engraftment and acute graft-versus-host disease.

CONCLUSION

Our study provides the first evidence in a large cohort of paediatric patients for high variability in treosulfan pharmacokinetics and an association between treosulfan exposure and early toxicity. Ongoing studies will reveal whether treosulfan exposure is related to long-term disease-specific outcome and late treatment-related toxicity.

06 jun 2018

Dossiervoering van farmacogenetische uitslagen: een implementatieonderzoek in de Haagse regio

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1674
  • Auteur(s):
    H.L. van den Hoek ab*, E.E. Roelofsen ab, R. Verheul cd, M. Veuger ce, E.B. Wilms af en L.E. Visser af

Dossiervoering van farmacogenetische uitslagen: een implementatieonderzoek in de Haagse regio

Pharmacogenetic results in the patient’s record: an implementation survey in The Hague

BACKGROUND

Pharmacogenetic testing is becoming increasingly important as it is used in prevention of severe adverse drug reactions, and for optimization of pharmacological therapy for patients with an unexpected response to drugs. In our health care system pharmacogenetics has been introduced since a couple of years. However, the traceability of the pharmacogenetics status in electronic patient files is limited.

OBJECTIVE

To assess, improve and evaluate the process of recording information on the patient’s pharmacogenetic status within the hospital setting.

METHODS

This implementation survey was conducted in two hospitals in The Hague, with an assessment before implementation of structural recording of the pharmacogenetic status in 2015 and an evaluation after implementation in 2017. All patients with a request for pharmacogenetic testing by a physician affiliated with one of the hospitals were included. For each patient we collected data in electronic patient files. The primary outcome was the percentage of patients with a registration of the pharmacogenetic result, both wild-type and mutation, in the hospital information system on patient level.

RESULTS

Of the 193 patients included, none (0%) had their pharmacogenetic results reported in the hospital information system prior to implementation, compared to respectively 94,4% (17 of 18 patients) of the Haaglanden Medisch Centrum and 58,3% (42 of 72 patients) of the HagaZiekenhuis after implementation.

CONCLUSION

In this study 94,4% of the patients from the Haaglanden Medisch Centrum and 58,3% of the patients from the HagaZiekenhuis, had their pharmacogenetic status available in the hospital information system after implementation. Further revisions and research is needed to optimise the process and determine the influence on medication safety.

06 jun 2018

Meerderheid van de intensivecarepatiënten behandeld met ciprofloxacine bereikt de farmacodynamische streefwaarde niet

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2018;3:a1672
  • Auteur(s):
    A. Abdulla a*, N.G.M. Hunfeld ab, A. Dijkstra c, S. Duran c, D.A.M.P.J. Gommers b, J.W. Mouton d, T. van Gelder ae en B.C.P. Koch a

Meerderheid van de intensivecarepatiënten behandeld met ciprofloxacine bereikt de farmacodynamische streefwaarde niet

A majority of the ICU patients treated with ciprofloxacin does not achieve the pharmacodynamic target

BACKGROUND

Traditional antibiotic dosing is not designed for patients at the intensive care unit, as the extreme pharmacokinetic behaviour of drugs in critically ill patients threatens the achievement of optimal antibiotic treatment outcomes. For severe infections, the pharmacodynamic target (PDT) of ƒAUC0-24/MIC ≥ 100 has been proposed.

OBJECTIVE

In this study, we examine the PDT attainment of empirical dosing regimens of ciprofloxacin in critical ill patients and patient characteristics associated with the failure to achieve the PDT.

DESIGN

A prospective observational PK/PD study was performed at the ICUs of Erasmus MC and Maasstad Hospital, Rotterdam.

METHODS

Based on optimal sampling, five separate 5 mL samples were taken at various time points. Non-compartmental PK analysis was performed. The percentage PDT attainment was the primary endpoint. As a secondary endpoint, patient characteristics associated with the non-achievement of the PDT were evaluated using multivariate analysis.

RESULTS

A total of 43 ICU patients receiving intravenous ciprofloxacin were included in this study. The median age was 66 years, APACHE II score was 22 and creatinine clearance rate was 58 mL/min. The median ƒAUC0-24 and Cmax were 29.9 mg•h/L and 3.0 mg/L, respectively. The proportion of patients achieving the PDT was 16.3%. Using multivariate analysis, an increase of the body mass index, creatinine clearance rate and albumin were found to be predictive of a decreased ƒAUC0-24/MIC ratio.

CONCLUSION

An empirical approach of ciprofloxacin dosing results in poor target attainment in the majority of the ICU patients. At present, TDM of ciprofloxacin is not used as a routine intervention. We believe that should be changed, because of the high variability in PK parameters in critically ill patients.

04 mei 2018

De invloed van een veranderde Thyrax-verpakking op kwaliteit van leven

  • Rubriek:
    Referaat
  • Identificatie:
    2018;3:e1659
  • Auteur(s):
    Bob Wilffert

De invloed van een veranderde Thyrax-verpakking op kwaliteit van leven