scholarly journals Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs

2017 ◽  
Vol 31 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Giulia Busa ◽  
Alessandro Burlina ◽  
Vera Damuzzo ◽  
Marco Chiumente ◽  
Angelo C. Palozzo
Keyword(s):  
Drug Interactions ◽  
Multidisciplinary Approach ◽  
Drug Prescription ◽  
Neurological Patient ◽  
Team Meetings ◽  
Drug Classes ◽  
Few Data ◽  
Multidisciplinary Team Meetings ◽  
Linear Correlations ◽  
Neurological Unit

Purpose: A high number of adverse drug reactions (ADRs), mainly caused by drug–drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated—(1) the prevalence of drug–drug and drug–disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug–drug and drug–disease interactions. Methods: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge. Results: About half of the patients were discharged with 5 or more prescribed drugs, and 72% of patients showed potential, clinically relevant DDIs. Linear correlations were observed between age and number of prescribed drugs ( P < .01) and between age and number of interactions ( P < .01). The number of prescribed drugs was associated with the number of detected DDIs ( P < .01). The application of drug interaction alerts and the use of medication inappropriateness criteria (ie, Beers criteria) were not satisfactory in choosing the best therapy for each patient. Therefore, multidisciplinary discussions of each clinical case was required. Conclusion: The study demonstrated that the neurological patient, especially if elderly, has a high risk of DDI and ADRs and that many of these can be avoided by case discussion in multidisciplinary team meetings, in which the presence of a dedicated clinical pharmacist is crucial.

scholarly journals Does Multidisciplinary Care Enhance the Management of Advanced Breast Cancer?: Evaluation of Advanced Breast Cancer Multidisciplinary Team Meetings

2010 ◽  
Vol 6 (6) ◽  
pp. 294-300 ◽  
Author(s):  
Jacquie Chirgwin ◽  
Melinda Craike ◽  
Christine Gray ◽  
Kathy Watty ◽  
Linda Mileshkin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Advanced Breast ◽  
Team Meetings ◽  
Cancer Management ◽  
Multidisciplinary Team Meetings

In recent years, the multidisciplinary approach has become the standard of care in cancer management. However, evidence demonstrating the value of multidisciplinary care and team meetings remains scarce.

scholarly journals Impact of the COVID-19 pandemic urology trainees in the West of Scotland

2021 ◽  
pp. 205141582098767
Author(s):  
Ashley Carrera ◽  
Je Song Shin ◽  
Holly Bekarma
Keyword(s):  
Multidisciplinary Team ◽  
Online Teaching ◽  
The West ◽  
Level Of Evidence ◽  
Team Meetings ◽  
Educational Benefit ◽  
Teaching Modules ◽  
The Impact ◽  
Training Opportunities ◽  
Multidisciplinary Team Meetings

Hospitals worldwide have taken unprecedented steps to cope with the coronavirus disease 2019 (COVID-19) pandemic. Changes to services created challenges for delivering training in urology. Statutory education bodies implemented processes addressing trainee progression, but the extent of training disruption has not been quantified. To establish the impact on urology trainees in the West of Scotland, online questionnaires were sent to trainees and educational supervisors. Twenty-five trainees working at six hospitals across four health boards responded. Elective operating was significantly reduced, with 64% of trainees having no weekly sessions. Before the pandemic, the majority of trainees (92%) had one or two clinic sessions or more per week, but with new measures, 76% of trainees did not attend clinics. Trainee attendance at multidisciplinary team meetings halved during the pandemic. Sixteen per cent ( n=4) of trainees were redeployed, with 50% ( n=2) reporting no educational benefit. Commonly used alternative educational resources included webinars (52%) and online teaching modules (28%). Thirty-two per cent ( n=8) of trainees had examinations postponed. COVID-19 has impacted urology training in the West of Scotland, with a significant reduction in training opportunities across elective theatre, clinic exposure and education. However, trainees will be more adaptable, learn to work remotely, have opportunities to develop leadership and may help redesign services for the future of urology. Level of evidence: Not applicable.

scholarly journals POS1203 EFFECT OF THE COVID19 PANDEMIC ON RHEUMATOLOGIST PRESCRIPTION BEHAVIOUR OF NEW ADVANCED THERAPY: DATA OF THE TARDIS-RA REGISTRY, A NATIONWIDE BELGIAN BIOLOGIC REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 884.1-884
Author(s):  
D. De Cock ◽  
P. Durez ◽  
V. Badot ◽  
R. Westhovens ◽  
P. Verschueren
Keyword(s):  
T Cell ◽  
Cell Therapy ◽  
Drug Prescription ◽  
Monthly Basis ◽  
T Cell Therapy ◽  
Drug Classes ◽  
Advanced Therapy ◽  
Advanced Therapies ◽  
Catch Up ◽  
Second Wave

Background:Belgium suffered considerably from the COVID19 pandemic with high hospitalisation rates during 2 periods: a first wave in March and April 2020, and a second starting from October until the end of 2020. Measures of lowering social interaction were taken throughout 2020 and intensified during the first and second wave when needed. This pandemic could have influenced the access to care and advanced therapies for patients with Rheumatoid Arthritis (RA). In the electronic platform “Tool for Administrative Reimbursement Drug Information Sharing” (TARDIS), data from all Belgian RA patients on biologic and targeted therapy are collected during the submission of a request for initiation and prolongation of reimbursement for these drugs.Objectives:to investigate the effect of the COVID19 pandemic on the monthly prescription behaviour of a new advanced therapy in 2020 by comparing it to 2019.Methods:Patients were selected for this analysis if they started a new TNFi, B/T cell therapy, IL6 inhibitors or tsDMARD therapy in the TARDIS registry in 2019 or in 2020. Rheumatologists request reimbursement via the online TARDIS tool, which is considered here as a new drug prescription. Prescription behaviour was compared between 2019 and 2020, between bionaive and bioexperienced patients, and between the different drug classesResults:In 2019, 2949 patients were prescribed any new advanced therapy, including 1153 TNFi, 469 B/T cell therapy, 436 IL6 inhibitors and 891 tsDMARDs. In 2020, 2998 patients were prescribed any new advanced therapy including 1233 TNFi, 382 B/T cell therapy, 496 IL6 inhibitors and 887 tsDMARDs.On a monthly basis, on average 246 and 250 new advanced therapies were prescribed in 2019 and 2020 respectively. Monthly deviations from this average in 2019 ranged from -19% to +16%. Monthly deviations from this average in 2020 ranged from -50% to +30%. Figure 1A shows the monthly prescription of new advanced therapies in 2019 and 2020.For bionaive and bioexperienced patients, the same trend can be noted. Monthly deviations in bionaive patients in 2020 ranged from -60% to +38%, compared to -18% to +21% in 2019. Monthly deviations in bioexperienced patients ranged from -40% to +25%, compared to -19% to +17% in 2019.Comparison per drug class in 2020 show similar trends. IL6 inhibitors show a slightly different timeline than other drugs classes with other periods of less or more prescriptions changes compared to the other drugs classes. See Figure 1B.Conclusion:The COVID19 pandemic did affect reimbursement requests for patients starting new advanced therapies in March and April 2020, especially for bionaive patients. The latter half of 2020 was apparently used to catch up with reimbursement requests for patients in need for advanced therapies resulting in similar total numbers of patients treated with advanced therapy in 2019 and 2020. The choice for a particular drug type was not clearly influenced by the pandemic. IL6 inhibitor use did seem to be affected differently by the pandemic, yet caution is warranted as these relatively large differences in proportional changes parallel small differences in actual drug numbers.In sum, the observed effect of the pandemic on initiating advanced therapy during the first wave corresponds with Belgian governmental measures that restricted non-essential care which was less observed in the latter half of 2020.Disclosure of Interests:None declared.

PP45 Developing Recommendations to Improve the Effectiveness of Multidisciplinary Team Meetings for Patients with Chronic Diseases

2013 ◽  
Vol 67 (Suppl 1) ◽  
pp. A66.2-A67
Author(s):  
C Nic a’ Bháird ◽  
I Wallace ◽  
P Xanthopoulou ◽  
J Barber ◽  
A Clarke ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Multidisciplinary Team ◽  
Team Meetings ◽  
Multidisciplinary Team Meetings

scholarly journals Antihyperglycaemic therapies and cancer risk

2014 ◽  
Vol 11 (6) ◽  
pp. 371-389 ◽  
Author(s):  
Stefan Z Lutz ◽  
Harald Staiger ◽  
Andreas Fritsche ◽  
Hans-Ulrich Häring
Keyword(s):  
Cancer Risk ◽  
Large Scale ◽  
Tumour Growth ◽  
Molecular Mechanisms ◽  
Growth Promotion ◽  
Protective Effects ◽  
Antidiabetic Drug ◽  
Safety Issues ◽  
Drug Classes ◽  
Few Data

Aims: This review is aimed at highlighting the potential mitogenic/tumour growth–promoting or antimitogenic/tumour growth–inhibiting effects of the main antihyperglycaemic drug classes. Methods: We review and discuss the most current studies evaluating the association between antidiabetic medications used in clinical practice and malignancies as described so far. Results: Metformin seems to be the only antidiabetic drug to exert protective effects both on monotherapy and also when combined with other oral antidiabetic drugs or insulins in several site-specific cancers. In contrast, several other drug classes may increase cancer risk. Some reason for concern remains regarding sulphonylureas and also the incretin-based therapies regarding pancreas and thyroid cancers and the sodium glucose cotransporter-2 inhibitors as well as pioglitazone regarding bladder cancer. The majority of meta-analyses suggest that there is no evidence for a causal relationship between insulin glargine and elevated cancer risk, although the studies have been controversially discussed. For α-glucosidase inhibitors and glinides, neutral or only few data upon cancer risk exist. Conclusion: Although the molecular mechanisms are not fully understood, a potential risk of mitogenicity and tumour growth promotion cannot be excluded in case of several antidiabetic drug classes. However, more large-scale, randomized, well-designed clinical studies with especially long follow-up time periods are needed to get reliable answers to these safety issues.

Recurrent transient loss of airway secondary to regurgitated pedunculated hypopharyngeal liposarcoma

2021 ◽  
Vol 14 (5) ◽  
pp. e240503
Author(s):  
Craig John Hickson ◽  
Omar Ahmed ◽  
Juliet Laycock ◽  
Robert Hone
Keyword(s):  
Airway Obstruction ◽  
Multidisciplinary Team ◽  
Rare Case ◽  
Atypical Presentation ◽  
Team Meetings ◽  
Acute Airway Obstruction ◽  
History Of ◽  
Transient Loss ◽  
Multidisciplinary Team Meetings

We describe a rare case of hypopharyngeal liposarcoma with an atypical presentation. The patient presented with a 3-month history of intermittent, transient acute airway obstruction. In between episodes, he was asymptomatic. A pedunculated tumour originating in the postcricoid region was seen to be suspended into the oesophagus and intermittently regurgitated into the larynx to cause airway obstruction. The lesion was endoscopically removed and examined histologically to confirm the diagnosis. On-going management of rare lesions such as this should be through multidisciplinary team meetings at a tertiary sarcoma centre.

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