The Effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on Blood Pressure in Patients with Hypertension

Dysregulation of blood pressure control in hypertensive patients using nonsteroidal anti-inflammatory drugs (NSAIDs) could increase morbidity, mortality, and health care costs. The aims of this research were to examine the association between NSAIDs and blood pressure in hypertensive patients, compare the effects of various NSAIDs on blood pressure, and determine if NSAIDs were associated with changes in antihypertensive therapy. This retrospective cohort study included hypertensive patients who received their first prescription for any NSAID and met the inclusion criteria. Patients included in this research received their care from the medicine practice clinics at Wishard Health Services in Indianapolis, Indiana between 1993 and 2006. Patients were followed for one year after the first prescription or 30 days after the last prescription that was dispensed, whichever was less. Patients meeting the same criteria but who were prescribed acetaminophen formed the control group. The primary outcomes were first systolic blood pressure and intensification of antihypertensive therapy. Covariates affecting blood pressure or the prescribing of NSAIDs were included in the statistical models. Propensity score matching techniques were used to balance background characteristics between comparison groups. A total of 3,928 eligible patients were prescribed NSAIDs or acetaminophen. Compared to acetaminophen, prescription for NSAID was associated with a 2 mmHg increase in systolic blood pressure (P = 0.004), and a 6 mmHg increase in those concurrently prescribed beta-adrenergic blocker (P = 0.008). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (P = 0.015), and a 5 mmHg increase compared to celecoxib (P = 0.035). Ibuprofen was associated with a higher risk of systolic blood pressure increase of ≥ 20 mmHg compared to naproxen (odds ratio, 1.57; 95% confidence interval, 1.10 to 2.25; P = 0.014). Dose effects were not observed for either ibuprofen or naproxen. There was no evidence of intensification in antihypertensive therapy in patients prescribed NSAIDs. In conclusion, NSAIDs were associated with a small increase in systolic blood pressure in hypertensive patients compared to acetaminophen. The increase in systolic blood pressure from NSAIDs did not increase the risk of intensification of antihypertensive treatment. Confirmatory studies will be needed to affirm these results.Doctor of Philosoph

What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Objective To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients’ homes. Design Systematic review. Data source Six international databases were searched for publications between 1 January 2006 and 31 December 2015. Data extraction and analysis Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines’ management process and the conceptual framework from the International Classification for Patient Safety. Results 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug–drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients’ care and care being provided by family physicians/general practitioners. Conclusion A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.Peer reviewe

Healthcare professionals’ consensus on prescribing errors in hospital settings in Riyadh, Saudi Arabia

Purpose: To create a consensus on definition and scenarios of prescribing errors in Saudi Arabia hospital practice.Methods: A two-round Delphi technique was used to reach a consensus on a definition and 42 scenarios of prescribing errors. Thirty-five evaluators  (healthcare professionals) were asked to indicate the extent to which they agree or disagree with the definition and scenarios of prescribing errors in a score of 1 (“total disagreement”) to 9 (“total agreement”) and were given a space to comment or modify the content of the survey.Results: The study tool was initially given to 35 evaluators of whom 31 (88.6 %) responded in the first round. In the second round only 24 (77.4 %) evaluators responded. A consensus was reached to accept the definition of prescribing error modified from a previous study conducted in the UK. Regarding the types of prescribing errors, a consensus was reached to include 34 scenarios, to exclude 5 scenarios and to include 3 scenarios depending on the individual clinical situation.Conclusion: The evaluators agreed to the definition of prescribing errors developed in the United Kingdom (UK) with minor modifications. However, some types of prescribing errors might be considered as errors in Saudi Arabia but not in the UK and vice versa. It is anticipated that this definition could be utilized in future studies, particularly in Saudi Arabia, and act as a guide for future research on prescribing errors.Keywords: Prescribing error scenario, Hospital settings, Consensus, Delphi techniqu

Pharmacy education in Saudi Arabia: A vision of the future

Background: Pharmacy education in developing countries faces many challenges. An assessment of the challenges and opportunities for the future of pharmacy education in Saudi Arabia has not been conducted. Objectives: The purpose of the study was to ascertain the views and opinions of pharmacy education stakeholders regarding the current issues challenging pharmacy education, and to discuss the future of pharmacy education in Saudi Arabia. Methods: A total of 48 participants attended a one-day meeting in October 2011, designed especially for the purpose of this study. The participants were divided into six round-table discussion sessions with eight persons in each group. Six major themes were explored in these sessions, including the need to improve pharmacy education, program educational outcomes, adoption of an integrated curriculum, the use of advanced teaching methodologies, the need to review assessment methods, and challenges and opportunities to improve pharmacy experiential training. The round-table discussion sessions were videotaped and transcribed verbatim and analyzed by two independent researchers. Results: Participants agreed that pharmacy education in the country needs improvement. Participants agreed on the need for clear, measureable, and national educational outcomes for pharmacy programs in the Kingdom. Participants raised the importance of collaboration between faculty members and departments to design and implement an integrated curriculum. They also emphasized the use of new teaching methodologies focusing on student self-learning and active learning. Assessments were discussed with a focus on the use of new tools, confidentiality of examinations, and providing feedback to students. Several points were raised regarding the opportunities to improve pharmacy experiential training, including the need for more experiential sites and qualified preceptors, addressing variations in training quality between experiential sites, the need for accreditation of experiential sites, and the use of technology to track experiential activities and assessments. Conclusion: Several challenges for improving pharmacy education in Saudi Arabia were discussed by stakeholders. To tackle these challenges facing most pharmacy schools in the Kingdom, national efforts need to be considered by involving all stakeholders

Factors Contributing to Medicine-Related Problems in Adult Patients with Diabetes and/or Cardiovascular diseases in Saudi Arabia: A qualitative study

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives To investigate the factors contributing to medicine related problems among cardiovascular and diabetic patients in Saudi Arabia. Design Qualitative semi-structured interviews were conducted. Interviews were audio-recorded then transcribed into Microsoft Word. The transcribed interviews were then imported into the qualitative analysis software NVivo where thematic analysis was applied. Thematic synthesis was achieved by coding and developing subthemes/themes from the findings of the interviews. Setting Five healthcare centres in Najran, Saudi Arabia. Participants 25 adult patients with diabetes and/or cardiovascular diseases. Results The study cohort included 16 males and nine females with a median age of 61.8 years (40 – 85 years). Diabetes was the main condition encountered among 23 patients and cardiovascular diseases were reported among 18 patients. Perceived factors leading to medicine related problems were of four types and related to: patient-, healthcare system-, clinical (condition-), and medicine-related factors. Patient-related factors were related to living situation, religious practices, diet/exercise and patients’ behaviour towards the condition and medicines. Healthcare system related factors comprised sources and availability of medicines, ease of access to healthcare system, and patient satisfaction with healthcare providers. Clinical (condition-) related factors associated with both the knowledge and control over condition, and effects of the condition among medicines intake. Medicine-related factors included lack of knowledge about medicines and medicine use. Conclusions The results of this study uncovered many factors associated with medicine related problems among cardiovascular and diabetic patients in Saudi Arabia, especially in reference to lifestyle and medicine use. Improving communication with healthcare professional alongside the introduction of national clinical guidance would mitigate the unwanted health complications related to medicine use.Peer reviewedFinal Published versio

Investigating the epidemiology of medication errors and error-related adverse drug events (ADEs) in primary care, ambulatory care and home settings:a systematic review protocol

INTRODUCTION: There is a need to better understand the epidemiology of medication errors and error-related adverse events in community care contexts. METHODS AND ANALYSIS: We will systematically search the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Eastern Mediterranean Regional Office of the WHO (EMRO), MEDLINE, PsycINFO and Web of Science. In addition, we will search Google Scholar and contact an international panel of experts to search for unpublished and in progress work. The searches will cover the time period January 1990–December 2015 and will yield data on the incidence or prevalence of and risk factors for medication errors and error-related adverse drug events in adults living in community settings (ie, primary care, ambulatory and home). Study quality will be assessed using the Critical Appraisal Skills Program quality assessment tool for cohort and case–control studies, and cross-sectional studies will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Descriptive Studies. Meta-analyses will be undertaken using random-effects modelling using STATA (V.14) statistical software. ETHICS AND DISSEMINATION: This protocol will be registered with PROSPERO, an international prospective register of systematic reviews, and the systematic review will be reported in the peer-reviewed literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Relevance of pharmacoepidemiology to Nepal

Drug-related problems such as overuse of injectable drug products and antimicrobials, increased cost of drug therapy, polypharmacy, and adverse drug reactions (ADRs) are prevalent in the healthcare settings of Nepal. To date, no new drug development processes or clinical trials have been conducted in Nepal, despite the fact that studies of real life situations are an essential tool for monitoring medicine use. Pharmacoepidemiology (PE) is an important area that evaluates the effects of drug use in large populations.Data obtained from pharmacoepidemiological studies may highlight ways to reduce certain drug-related problems and provide reliable information on the safety profile of a drug. Moreover, clinicians and regulatory authorities may also use the data to make drug therapy decisions, drug regulation and policy development. Therefore, there is a great need to conduct appropriate pharmacoepidemiological studies that involve multiple regions and in various groups of the population of Nepal, to collect unbiased and reliable information on drug use

Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals

OBJECTIVES: To determine the frequency of clinical decision support system (CDSS) medication-related alerts generated, accepted, or overridden, to assess appropriateness of alert display and overrides, and to characterise the documentation of clinician justification for these overrides in an academic medical centre in Saudi Arabia. MATERIALS AND METHODS: System-generated CDSS reports for the period June 2015 to December 2017 were retrospectively reviewed and analysed. Alerts were classified into different types, and rates of alert overrides calculated as percentages of all generated alerts. A subset of 307 overridden alerts was assessed for appropriateness of display and override by two clinical pharmacists. Physician documentation of reasons for overriding alerts were categorised. RESULTS: A total of 4,446,730 medication-related alerts were generated from both inpatient and outpatient settings, and 4,231,743 (95.2%) were overridden. The most common alert type was 'duplicate drug', accounting for 3,549,736 (79.8%) of alerts. Of 307 alerts assessed for appropriateness, 246 (80%) were judged to be appropriately displayed and 244 (79%) were overridden appropriately. New drug allergy and drug allergy alerts had the highest percentage of being judged as inappropriately overridden. For 1,594,313 alerts (37.7%), 'no overridden reason selected' was chosen from the drop-down menu. CONCLUSIONS: The alert generation and override rate were higher than reported previously in the literature. The small sample size of 307 alerts assessed for appropriateness of alert display and override is a potential limitation. Revision of the CDSS rules for alerts (focusing on specificity and relevance for the local context) is now recommended. Future research should prospectively assess providers' perspectives, and determine patient harm associated with overridden alerts