P14 Discord between patients’ general practitioner repeat prescriptions and the medication list held by a paediatric cf centre

2018 ◽  
Vol 103 (2) ◽  
pp. e2.16-e2
Author(s):  
Helen Cunliffe ◽  
Rachel Smith

AimTo audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions.MethodBetween October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted.The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information.Pharmacist interventions requiring further action were recorded.ResultsDrugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers.25 patients were identified as having adherence issues.Only 35/232 (15%) prescriptions matched identically.ConclusionsThis audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs.A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.

2010 ◽  
Vol 55 (3) ◽  
pp. 1135-1141 ◽  
Author(s):  
Matthew H. Samore ◽  
Claude Tonnerre ◽  
Elizabeth Lyon Hannah ◽  
Gregory J. Stoddard ◽  
Robert J. Borotkanics ◽  
...  

ABSTRACTStudies about the relationship between antibiotic consumption and carriage of antibiotic-resistantEscherichia coliin individual patients have yielded conflicting results. The goal of this study was to identify individual- and household-level factors associated with carriage of ampicillin (AMP)-resistantE. coliduring consumption of a course of oral antibiotics. We enrolled outpatients and their families in a prospective household study of AMP-resistant or AMP-susceptibleE. colicarriage. Two kinds of index patients were identified. Group 1 consisted of outpatients who were being initiated on a new antibiotic course at the time of a clinic visit, and group 2 consisted of outpatients not starting antibiotics. Each participant was asked to submit three stool swab samples (at baseline, week 1, and week 4) and to complete a questionnaire. Antimicrobial susceptibility testing was performed on each phenotypically distinctE. colicolony. The study included 149 group 1 households (total, 570 participants) and 38 group 2 households (total, 131 participants). AMP-resistantE. coliwas recovered from 29% of stool samples. Observed associations with antibiotic exposure varied by drug class. Penicillins, which were the most frequently prescribed drug class, were associated with a modest increase in AMP-resistantE. colicarriage and a modest decrease in AMP-susceptibleE. colicarriage. Neither change by itself was statistically significant. Macrolides were associated with reduced carriage of both AMP-resistantE. coliand AMP-susceptibleE. coli(P< 0.05). Both AMP-resistant and AMP-susceptibleE. colidemonstrated household clustering (P< 0.001). In summary, the overall effect of antibiotics on individual risk of carriage of AMP-resistantE. coliwas small. However, even a modest alteration of the competitive balance between AMP-resistant and AMP-susceptibleE. colimay promote population spread of resistantE. coli. Examining changes in both resistant and susceptible organisms in antibiotic-treated individuals and their close contacts improves understanding of antibiotic selection pressure.


Pharmacy ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 2 ◽  
Author(s):  
Rohan A. Elliott ◽  
Yixin Tan ◽  
Vincent Chan ◽  
Belinda Richardson ◽  
Francine Tanner ◽  
...  

Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2–16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.


2019 ◽  
pp. 204-209 ◽  
Author(s):  
M. V. Leonova ◽  
E. E. Alimova

NSAIDs are the most commonly used drugs in clinical practice for pain relief in various diseases. To date, considerable scientific material has been accumulated on the pharmacogenetics of NSAIDs and the role of genetic factors that can influence the pharmacokinetics and pharmacodynamics of drugs, changing the efficacy and toxicity profile. The most clinically significant changes in pharmacokinetics in carriers of slow alleles of CYP2C9*3 have been identified for celecoxib and flurbiprofen, which determines the need for testing and lowering of drug doses. Studies were carried out to study the role of polymorphism of the metabolizing enzymes CYP2C9, CYP2C8, UGT in the development of gastrotoxicity and gastrointestinal bleeding during application NSAIDs, as well as diclofenac’s hepatotoxicity. The association of «slow» alleles CYP2C8*3 and CYP2C9*2,*3 with the risk of gastrointestinal bleeding associated with NSAID use, which are substrates of CYP2C9 and CYP2C8, is shown. The effect of variants of alleles PTGS1 (gene COX-1) and PTGS2 (gene COX-2) on pharmacodynamics, efficacy and toxicity of NSAIDs, in particular, the severity of the analgesic effect and cardiotoxicity of the drugs, was studied. In this way, pharmacogenetic predictors of adverse effects that patients can experience, and the need for dose adjustment based on the patient’s genotype, or individualizing the choice of alternative NSAIDs to increase the effectiveness of analgesia, have been determined.


Author(s):  
Nir Shimony ◽  
Travis Dailey ◽  
David Barrow ◽  
Anh Bui ◽  
Mohammad Hassan A. Noureldine ◽  
...  

OBJECTIVE Pediatric traumatic brain injury (TBI) is the leading cause of death among children and is a significant cause of morbidity. However, the majority of injuries are mild (Glasgow Coma Scale score 13–15) without any need for neurosurgical intervention, and clinically significant neurological decline rarely occurs. Although the question of repeat imaging within the first 24 hours has been discussed in the past, the yield of short-term follow-up imaging has never been thoroughly described. In this paper, the authors focus on the yield of routine repeat imaging for pediatric mild TBI (mTBI) at the first clinic visit following hospital discharge. METHODS The authors conducted a retrospective review of patients with pediatric brain trauma who had been admitted to Johns Hopkins All Children’s Hospital (JHACH). Patients with mTBI were identified, and their presentation, hospital course, and imaging results were reviewed. Those pediatric patients with mTBI who had undergone no procedure during their initial admission (only conservative treatment) were eligible for inclusion in the study. Two distinct groups were identified: patients who underwent repeated imaging at their follow-up clinic visit and those who underwent only clinical evaluation. Each case was assessed on whether the follow-up imaging had changed the follow-up course. RESULTS Between 2010 and 2015, 725 patients with TBI were admitted to JHACH. Of those, 548 patients qualified for analysis (i.e., those with mTBI who received conservative treatment without any procedure and were seen in the clinic for follow-up evaluation within 8 weeks after the trauma). A total of 392 patients had only clinic follow-up, without any diagnostic imaging study conducted as part of their clinic visit, whereas the other 156 patients underwent repeat MRI. Only 1 patient had a symptomatic change and was admitted after undergoing imaging. For 30 patients (19.2%), it was decided after imaging to continue the neurosurgical follow-up, which is a change from the institutional paradigm after mTBI. None of these patients had a change in neurological status, and all had a good functional status. All of these patients had one more follow-up in the clinic with new MRI, and none of them required further follow-up. CONCLUSIONS Children with mTBI are commonly followed up in the ambulatory clinic setting. The authors believe that for children with mTBI, normal clinical examination, and no new symptoms, there is no need for routine ambulatory imaging since the clinical yield of such is relatively low.


1988 ◽  
Vol 16 (6) ◽  
pp. 420-427 ◽  
Author(s):  
J. E. Stroh ◽  
G. H. Ayars ◽  
I. L. Bernstein ◽  
J. P. Kemp ◽  
W. K. Podleski ◽  
...  

In this multicentre, double-blind, randomized, parallel group study, 315 patients with allergic or vasomotor rhinitis were treated on a twice daily dosing schedule with either a 60 mg terfenadine–120 mg pseudoephedrine hydrochloride combination or 120 mg pseudoephedrine hydrochloride (extended release) for 2 weeks. No clinically significant differences between the two groups were noted in body weight, temperature, respiration rate or blood pressure following the treatment period. An increase in mean heart rate of approximately 5 beats/min from entry to the final clinic visit was noted in both treatment groups. No clinically significant changes were noted in either treatment group when pre- and post-treatment electrocardiograms were compared. There were also no clinically significant alterations in laboratory values, which included serum chemistry, haematology and urinalysis, within or between either group. The adverse events profiles for both groups were similar. The most frequent adverse event was insomnia, in 40 (25.3%) patients given the terfenadine–pseudoephedrine combination and in 42 (26.8%) of those given pseudoephedrine. No unusual or unexpected adverse events were reported.


2021 ◽  
Vol 9 ◽  
pp. 232470962110140
Author(s):  
Amit Saha ◽  
Abhimanyu Garg

Statins are recommended for first-line management of elevated cholesterol in the primary and secondary prevention of atherosclerotic cardiovascular disease. Statins may occasionally be associated with mild transaminase elevations but can also result in life-threatening liver injury. Atorvastatin is the most common cause of clinically significant liver injury in this drug class. We report a case of severe, asymptomatic liver injury in a hepatocellular pattern in a 71-year-old man occurring within 3 months of switching from simvastatin to high-intensity atorvastatin therapy. Hepatitis improved rapidly with cessation of atorvastatin and did not recur after resuming simvastatin.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3130-3130
Author(s):  
Debra S. Burns ◽  
Faouzi Azzouz ◽  
Katie Hincher ◽  
Cheryl Rutledge ◽  
Patrick Monahan ◽  
...  

Abstract Patients with acute leukemia who receive intensive chemotherapy often require a prolonged hospitalization in a protective environment. The required isolation may increase the psychological distress related to the diagnosis and intensive chemotherapy treatment. The combination of music and imagery offers an innovative approach to reduce distress. To assess the feasibility and the potential efficacy of a music imagery intervention, we randomly assigned adults to standard care or standard care plus music imagery. The initial music imagery session with a board certified music therapist occurred within two days of admission and then twice weekly for 8 sessions. Each 45-minute session consisted of a relaxation exercise and patient created imagery while listening to music. Patients were encouraged to independently use the music imagery daily. Patients completed the State Anxiety Inventory (SAI), the FACIT-Fatigue, and the Positive Affect Negative Affect Schedule (PANAS) at baseline, then every 7 days until discharge, and at a follow-up outpatient clinic visit. Of the 78 patients approached for participation, 29 refused. The 3 most common reasons cited were: overwhelmed by treatment (9), not interested (8), and too sick (6). Forty-nine individuals were randomized to the intervention (25) or control (24) group. There were 19 men and 30 women and a majority of participants were married (65%). Average age for participants was 52 (SD 15.36) for intervention and 55 (SD 15.87) for control. The median length of stay was 28 and 26 days, respectively. For the intervention group, 8 (32%) individuals received 8 sessions, 5 (20%) received 5–7 sessions, 9 (36%) received 2–4, and 6 (24%) received 0–1 sessions. After adjusting for baseline scores, there was a main time effect in predicting Fatigue, PANAS-PA, PANAS-NA, and Anxiety (all p&lt;.001), and no interaction effects between time and group, indicating that both groups improved over time. There were no significant main effects between control and intervention group on the four outcomes. However, when we analyzed patients by level of baseline distress, patients with low negative affect at baseline who received music imagery had lower anxiety at the time of discharge compared to standard care (mean of 48 vs. 23 p=.02). The values correspond to the 80th and 20th percentile, respectively, for the general population. Thus the reduction appears to be clinically significant. In conclusion, music imagery is feasible for adults with acute leukemia in protected environments. Some patients experience significant benefit in terms of reduced anxiety at discharge. We postulate that the intervention was not powerful enough to overcome elevated levels of distress. Future trials will explore titrating the dose of the intervention based upon levels of distress at the time of hospital admission. In addition, a wider range of questionnaires will be used along with formal interviews to better understand the impact of the music imagery intervention.


Medicine ◽  
2018 ◽  
Vol 97 (9) ◽  
pp. e9865 ◽  
Author(s):  
Céline Mongaret ◽  
Pauline Quillet ◽  
Thi Ha Vo ◽  
Léa Aubert ◽  
Mathieu Fourgeaud ◽  
...  

2021 ◽  
Vol 1 (8) ◽  
Author(s):  
Reimbursement Team

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses dupilumab (Dupixent), 200 mg or 300 mg, single use syringe, solution for subcutaneous injection. Indication: As add-on maintenance treatment in patients aged 12 years and older with severe asthma with a type 2/eosinophilic phenotype or oral corticosteroid–dependent asthma Reimbursement request: For patients with type 2 or eosinophilic asthma characterized by the following: 2 or more clinically significant asthma exacerbations in the last 12 months and blood eosinophils ≥ 150 cells/µL, or fractional exhaled nitric oxide ≥ 25 parts per billion, or treatment with maintenance oral corticosteroids, or clinically allergen-driven asthma.


2018 ◽  
Vol 47 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Yixin Tan ◽  
Rohan A Elliott ◽  
Belinda Richardson ◽  
Francine E Tanner ◽  
Michael I Dorevitch

Background: Poor communication of medication information to general practitioners when patients are discharged from hospital is a widely recognised problem. There has been little research exploring the accuracy of medication information in electronic discharge summaries (EDS) linked to hospital e-prescribing systems. Objective: To evaluate the accuracy of medication lists and medication change information in EDS produced using an integrated e-prescribing and EDS system (where EDS discharge medication lists were imported from discharge e-prescription records, medication change information was manually entered, and medications were dispensed from paper copies of the patients' e-prescriptions). Method: Retrospective audit of EDSs for a random sample, representative of adult patients ( n = 87) discharged from a major teaching hospital. EDS medication lists were compared to pharmacist-verified paper discharge prescriptions (considered to be the most accurate discharge medication list) to identify discrepancies. EDS medication change information was compared to medication changes identified by comparing pharmacist-verified “Medication History on Admission” forms with pharmacist-verified paper discharge prescriptions. Results: There were 85/87 (98%) EDSs that included a discharge medication list. Of these, 50/85 (59%) contained one or more medication list discrepancies (median 1, range 0–15). The most common discrepancy was omission of medication (58%); 84/131 (64%) discrepancies were considered clinically significant (risk of adverse outcome); 162/351 (46%) clinically significant medication changes were stated in the EDS; and 153/351 (44%) changes were both stated and included a reason. Conclusion: EDS discrepancies were common despite integration with e-prescribing. Eliminating paper prescriptions, enhancing e-prescribing/EDS functionality and involving pharmacists in EDS preparation may reduce discrepancies.


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