Medication safety in patients with hepatic impairment:A survey of community pharmacists' knowledge level and their practice in caring for these patients

Aims: To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods: Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6-item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results: In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion: Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment

Территориальная организация и проблемы рекреационного лесопользования в Крыму

В статье рассмотрены ресурсный потенциал, пространственная организация, экологические проблемы рекреационного лесопользования в Крыму, предложены принципы устойчивого развития лесных рекреационных территорий.У статті розглянуто ресурсний потенціал, просторова організація, екологічні проблеми рекреаційного лісокористування в Криму, запропоновано принципи стійкого розвитку лісових рекреаційних територій.The recreational potential, the space organization, ecologic problems of the recreational forest management in Crimea are considered in this article. Principles of the sustainable development of forest recreational territories are proposed

Современные представления о супружеских конфликтах и супружеской дезадаптации

Рассмотрены современные данные о семейных конфликтах и связанной с ними супружеской дезадаптации. Сделан вывод о необходимости дальнейшей разработки этой проблемы.Modern data about family conflicts and the associated spouse deadaptation are discussed. The author concludes about the necessity of further investigation of the issue

Medication safety in patients with hepatic impairment: A survey of community pharmacists’ knowledge level and their practice in caring for these patients

Aims: To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods: Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6-item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results: In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion: Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment

The risk of acute myocardial infarction associated with non-steroidal anti-inflammatory drugs users: Impact of additional confounding control for variables collected from self-reported data

Background: Several observational studies have employed electronic health databases to study the association between non-steroidal anti-inflammatory drugs (NSAIDs) and myocardial infarction. Because some important potential confounders might not be routinely collected in such data sources, patients' reports could be utilized additionally. Objectives: This study evaluated the impact of using additional information from patients' reports when assessing the association between use of NSAIDs and the risk of acute myocardial infarction (AMI). Methods: A case-control study was conducted among adult patients with hypertension and/or hypercholesterolemia in the Utrecht Cardiovascular Pharmacogenetics study. Information was collected from the Dutch PHARMO Database Network (Pharmacy and hospitalization records) and patients' questionnaires (body mass index, alcohol use, smoking, physical activity, and familial history of cardiovascular diseases). For each case, up to 13 controls were matched based on age and gender at the date cases were hospitalized (index date). Conditional logistic regression analysis was applied to estimate odd ratios (ORs) and 95% confidence intervals (95% CI). Results: We identified 970 AMI cases and 2,974 controls during 1985-2005. Of all cases, 140 patients (14.4%) were exposed to conventional NSAIDs and 9 patients (1.0%) were exposed to selective COX-2 inhibitors at the index date. Compared to nonuse, neither conventional NSAIDs [(Adj. OR 0.98, 95% CI: 0.91-1.06) nor selective COX-2 inhibitors (Adj. OR 1.00, 95% CI: 0.74- 1.36) were associated with an increased risk of AMI after adjustment for confounders routinely collected in pharmacy records. Additional adjustment for confounders collected from patients' reports did not change the risk estimates [(Adj. OR 0.97, 95% CI: 0.90-1.05) and (Adj. OR 1.01, 95% CI: 0.75- 1.35)], respectively. Conclusions: This study showed that additional potential confounders collected from patients' reports did not significantly change the risk estimates

Борис Гесселевич (Григорьевич) Галкович как историк-картограф

Освещаются этапы жизни и творчества Б.Г. Галковича — автора или редактора около 700 исторических карт, в т. ч. в ряде атласов, в 13 томах «Всемирной истории», в 7 томах «Истории СССР с древнейших времён до наших дней» и др. Основы методологии исторической картографии изложены Б.Г. Галковичем на международных конференциях и в ряде статей. В приложении — список текстовых и картографических работ Б.Г. Галковича, опубликованных в 1950–1983 гг.The publication sheds light on the life and work of B.H. Halkovych, the author and editor of nearly 700 historical maps in atlases, 13 volumes of "The World History", 7 volumes of "The History of the USSR since Earliest Times up Today" etc. The methodological principles of historical cartography have been set out by B.H. Halkovych at international conferences and in numerous articles. The supplements contain a list of B.H. Halkovych’s text and cartographical works (published in 1950–1983)

Pharmacogenomic insights into treatment and management of statin-induced myopathy

Although statins are generally well tolerated, the most common adverse drug reaction from statin therapy is myopathy. This article reviews the current pharmacogenomic knowledge of statin-induced myopathy. Furthermore, we will discuss the importance of recent pharmacogenetic advances for the treatment and management of statin-induced myopathy. Variation in the SLCO1B1 gene is associated with increased incidence of statin-induced myopathy, particularly with simvastatin and less so with other statins. If different pharmacokinetic enzymes and transporters are responsible for susceptibility to myopathy, this may explain differences in the occurrence of statin-induced myopathy in individual patients. Genotyping in patients suffering from statin-induced myopathy may help to personalize the choice of statin for the lowest chance of developing myopathy

Patterns of antiplatelet use in patients with myocardial infarction and subsequent acute coronary syndrome events

Background: Antiplatelet drugs are important for secondary prevention of cardiovascular events after myocardial infarction (MI). Objectives: The objectives of this study were to assess the patterns of antiplatelet drug use in patients who had a MI and to evaluate the impact of subsequent acute coronary syndrome (ACS) events on antiplatelet drug use in the Netherlands. Methods: A descriptive retrospective cohort study was conducted on 4719 patients in Utrecht Cardiovascular Pharmacogenetics studies, who had their first MI during 1986-2009. Medication use was assessed through the Dutch PHARMO Record Linkage System (dispensing database linked to the hospital admission registry). Antiplatelet users were classified as continuous users (gap between consecutive prescriptions ≤90 days), discontinued users (gap of >90days or no refills), and restarters (with a new antiplatelet drug episode after earlier discontinuation) and were followed for a maximum of 10years. Antiplatelet drug use in 90days before and after recurrent consecutive ACS events (MI and unstable angina) following the first MI was also compared. Results: At 1 year of follow-up, 83.7% patients continued using antiplatelets, 76.9% were still on aspirin, and only 36.4% patients were continuing clopidogrel. Most of the discontinuers restarted antiplatelet drugs later, leading to 74.7% antiplatelet users, 62.1% aspirin users and 35.2% clopidogrel users in 10 years after the index MI. For a subgroup of MI patients who started dual antiplatelet therapy with aspirin and clopidogrel (DAPT) after hospital discharge in 2002-2009, a total of 28.9% remained continuous users in 1 year, whereas 24% of the subjects switched to aspirin or clopidogrel monotherapy. When a recurrent ACS event occurred, antiplatelet use increased by 3.6% (

Оптимизация лапароскопической методики лечения тератомы яичника у женщин репродуктивного возраста

В эксперименте и клиническими исследованиями показано влияние лучевой аргоновой коагуляции, биполярной коагуляции и эндоскопического ушивания яичников кетгутом при лапароскопическом лечении дермоидных кист яичников у пациенток с бесплодием на дальнейшую их репродуктивную функцию и развитие спаечного процесса в послеоперационном периоде.The influence of argon coagulation, bipolar coagulation and endoscopic suture of ovaries with catgut at laparoscopic treatment for dermoid ovarian cysts in infertile patients on the further reproductive function and development of adhesions after the surgery were investigated experimentally and clinically