Zoekresultaten

828 artikelen gevonden

15 mrt 2019

Redenen van patiënten om geen laxans te gebruiken bij opioïden

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1678
  • Auteur(s):
    Marcel Kooij

Redenen van patiënten om geen laxans te gebruiken bij opioïden

07 mrt 2019

Therapeutic drug monitoring van adalimumab bij patiënten met inflammatoire darmziekten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1692
  • Auteur(s):
    W. van ’t Geloof a*, P.J. Boekema b, L.P.L. Gilissen c, M.A.C. Broeren d en L.J.J. Derijks a

Therapeutic drug monitoring van adalimumab bij patiënten met inflammatoire darmziekten

Therapeutic drug monitoring of adalimumab in inflammatory bowel disease patients

OBJECTIVE

Adalimumab (ADA) trough levels correlate with clinical remission. Despite suggestions that therapeutic drug monitoring of ADA can optimize treatment in this population, it is not yet implemented in clinical practice. This study was conducted to provide more insight in ADA trough levels and antibodies to adalimumab (ATA) in an inflammatory bowel disease (IBD) population already treated with adalimumab.

DESIGN

We carried out a prospective cohort study in IBD outpatients already treated with adalimumab.

METHODS

Patient demographics were collected from the electronic hospital information system. Blood was drawn for determination of ADA trough levels and ATAs. Disease activity indices for Crohn’s disease and ulcerative colitis and quality of life scores were obtained by a questionnaire.

RESULTS

A total of 92 patients was included. ADA levels varied from < 0.1 to 20.2 mg/L. Mean ADA level was 7.7 mg/L (SD = 4.5), 4 patients developed ATAs. ADA levels ≤ 5 mg/L were demonstrated in 27 patients (29%). The ADA level was not significantly associated with remission (P = 0.391). Quality of life score correlated with ADA level (P = 0.031).

CONCLUSION

Therapeutic drug monitoring in inflammatory bowel disease outpatients revealed large interindividual differences in adalimumab trough levels. These levels were subtherapeutic in nearly a third of patients. We think, despite no significant correlation was found between adalimumab trough level and disease activity, therapeutic drug monitoring has the potential to individualize treatment in inflammatory bowel disease patients using adalimumab.

28 feb 2019

Nierfunctie en ernstige bloedingen bij patiënten behandeld met cumarines

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1691
  • Auteur(s):
    Eline Houben a*, Elisabeth Smits a, Jetty A. Overbeek ab, dr. Fernie J.A. Penning-van Beest a, dr. Ron M.C. Herings a, dr. Myrthe P.P. van Herk-Sukel a, dr. Martina Teichert cde en prof. dr. Peter A.G.M. de Smet cd

Nierfunctie en ernstige bloedingen bij patiënten behandeld met cumarines

No evidence for an association between renal function and serious bleeding events in patients treated with coumarins

BACKGROUND

Although anticoagulation therapy is closely monitored in the Netherlands, coumarin-induced serious bleeding events are still observed. Current literature suggests that renal impairment may contribute to this.

OBJECTIVE

To explore the association between renal function and bleeding events during coumarin treatment.

DESIGN

A nested case-control study was conducted using data from the PHARMO Database Network.

METHODS

Patients hospitalised for a bleeding event during coumarin treatment were selected as cases and matched on sex, birth year, and geographic region with a maximum of two controls using coumarins without hospitalisation for bleeding. All values of estimated glomerular filtration rates (eGFRs) in the year before index date (case hospitalisation date) were selected and compared between cases and controls using logistic regression analyses.

RESULTS

In total, 2224 cases were matched to 4398 controls (61% male; mean age ± SD = 75 ± 11 and 78 ± 11 years for cases and controls, respectively). Availability of eGFR values was higher among cases compared with controls (mean eGFR values ± SD = 4.5 ± 7.1 versus 3.2 ± 5.5), reflected in the significantly shorter time since last eGFR value (at index date, mean ± SD = 2.7 ± 3.0 versus 3.8 ± 3.1 months; odds ratio [OR] = 0.91, 95%CI = 0.89-0.92). No statistically significant difference was found for the mean eGFR value in the year before index date (mean ± SD 65.7 ± 22.8 versus 64.6 ± 20.9 mL/min/1.73 m; OR per 10 units = 0.99, 95%CI = 0.96-1.02).

CONCLUSION

No association between renal function and serious bleeding events during coumarin treatment was observed.

18 feb 2019

De openbaar apotheker op huisbezoek na ontslag uit het ziekenhuis

  • Rubriek:
    Referaat
  • Identificatie:
    2019;4:e1677
  • Auteur(s):
    Marcel Kooij

De openbaar apotheker op huisbezoek na ontslag uit het ziekenhuis

06 feb 2019

Therapeutic drug monitoring van adalimumab bij reumatologische patiënten

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1690
  • Auteur(s):
    A.H. Kylstra a*, S. Benoy-de Keuster b, R.A.M. Traksel b, M.A.C. Broeren c en L.J.J. Derijks a

Therapeutic drug monitoring van adalimumab bij reumatologische patiënten

Therapeutic drug monitoring of adalimumab in rheumatic patients

OBJECTIVE and DESIGN

Adalimumab (ADA) is effective in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Despite suggestions that therapeutic drug monitoring (TDM) of ADA can optimize treatment of this population, it is not routinely implemented in clinical practice. We therefore carried out a prospective observational cohort study by measuring ADA levels in a population of patients with rheumatic diseases and related those levels to disease activity.

METHODS

Patient demographics were collected from the electronic hospital information system. Blood drawn before the regular outpatient visit was used for determination of ADA trough levels and antibodies against ADA (ATA). Objectified disease activity measurements were obtained at the appointment: DAS28 for RA, ASDAS for AS, and clinical assessment for SpA.

RESULTS

A total of 174 patients was included. ADA levels varied from less than 0.1 to 22.0 mg/L. The mean ADA level was 6.8 mg/L (standard deviation = 4.2). 5 patients (2,9%) developed ATA. The ADA level was significantly associated with remission (P = 0.002). The mean ADA level was 7.6 mg/L in patients in remission and 5.1 mg/L in patients with active disease. Use of immunosuppressants, frequency of administration, and body mass index were identified as significant covariates.

CONCLUSION

TDM of ADA demonstrated large interindividual differences in ADA levels. ADA trough levels were significantly associated with disease activity. TDM has the potential to individualize treatment and further research needs to show if it increases cost-effectiveness of this expensive therapy.

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