Interakcije lijekova i medikacijske pogreške u terapiji kroničnih onkoloških bolesnika

Cilj istraživanja: Utvrditi učestalost, vrstu i značajnost potencijalnih medikacijskih pogrešaka i potencijalnih interakcija lijekova u farmakoterapiji kroničnih onkoloških bolesnika, u praksi javnog ljekarništva. Ispitanici i metode: U razdoblju od rujna 2017. do ožujka 2018. godine prikupljeni su podatci o farmakoterapiji kroničnih onkoloških bolesnika u javnoj ljekarni u Hrvatskoj. U obzir su uzeti podatci o farmakoterapiji pacijenata koji su minimalno 6 mjeseci liječeni od onkološke bolesti. Probir potencijalnih potencijalnih interakcija lijekova radio se korištenjem Wolters Kluwer Clincal Drug Information Lexicomp® programa, te pregledom baza podataka o lijekovima. Rezultati: Podatci o farmakoterapiji 109 bolesnika uključeno je u istraživanje. Identificirane su 123 potencijalne medikacijske pogreške, razvrstane u 11 kategorija. Najučestalija potencijalna medikacijska pogreška je izostanak propisivanja terapije pacijentima s povećanim rizikom osteoporoze i fraktura. Većina potencijalnih interakcija bila je farmakodinamskog mehanizma nastanka. Uočeno je ukupno 343 potencijalnih interakcija lijekova, od kojih 61% kliničkog stupnja značajnosti C, 36% D i 3% stupnja X. Zaključak: Ljekarnička skrb o onkološkom pacijentu ne uključuje samo uočavanje i ispravljanje potencijalnih interakcija lijekova i potencijalnih medikacijskih pogrešaka, već i suportivnu terapiju u prepoznavanju specifičnih stanja onkoloških bolesnika. Rezultati ovog istraživanja upućuju na potrebu za sustavnom edukacijom ljekarnika o posebnostima onkološkog liječenja, važnosti uključivanja javnog ljekarnika u aktivnu skrb o onkološkom bolesniku te ispravljanje potencijalnih medikacijskih pogrešaka i sprječavanje nastanka potencijalnih interakcija lijekova. Važno je naglasiti potrebu za stvaranjem prikladnih načina komunikacije javnog ljekarnika s liječnicima svih specijalnosti uključenih u liječenje onkološkog pacijenta.Objectives: To determine the frequency, type, number, and significance of potential medication errors and potential interactions in pharmacotherapy of chronic oncology patients, from the aspect of a community pharmacist. Patients and Methods: Data on pharmacotherapy of chronic oncology patients was collected for the period from September 2017 until March 2018, within a community pharmacy in Croatia. Exclusion point for collecting data were patients with an oncology diagnosis for less than six months, regardless having been prescribed another pharmacotherapy. Collected data were processed for potential drug interactions, using Wolters Kluwer Clincal Drug Information Lexicomp® and medical professional data bases. Results: 109 patients’ pharmacotherapy data was included in the research. 123 potential medication errors were found and classified in 11 categories. The most common potential medication error was underprescribing (failure to prescribe medication when needed) for patients with a risk of osteoporosis and fractures. Irrespective of their clinical significance, most of the interactions were those of pharmacodynamic mechanism. We have noticed 343 interactions, of which 61% were classified having clinical significance C, 36% D, and 3% significance X. Conclusion: Pharmaceutical care of oncology patients involves not only recognising and correcting medication errors and interactions, but also supportive care and therapy for oncology specific issues. Results of this research show a need for continuous education of pharmacist, and the importance of including pharmacist in the care of oncology patients. It is vital to form and establish a channel of communication between pharmacist and other oncology specialists

Correction to: Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment (Scientific Reports, (2024), 14, 1, (6235), 10.1038/s41598-024-56780-1)

Correction to: Scientific Reportshttps://doi.org/10.1038/s41598-024-56780-1, published online 14 March 2024 The original version of this Article contained an error in the Funding section. “All the research work was funded by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by the Grants: InoMed, Reg. No CZ.02.1.01/0.0/0.0/18_069/0010046, the European Horizon 2020 I-CARE4OLD Grant No 965341, START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551 Grant and Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Therapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.” now reads: “Publication of this work was supported by the I-CARE4OLD project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 96534. Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them. More information on the I-CARE4OLD project can be found at http://www.icare4old.eu and https://cordis.europa.eu/project/id/965341. Except secondary analyses and works on the publication, data collection and teamwork were funded also by the EuroAgeism H2020 project (ESR7 project), supported by the European Union research and innovation program under the Grant Agreement of the Marie Skłodowska-Curie Foundation Number MSCF-ITN-764632. Research works of Assoc. Prof. Daniela Fialová, PharmD, Ph.D. and members of her research team were supported by grants: START/MED/093 EN.02.2.69/0.0/0.0/19_073/0016935, SVV 260 551, Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit: “Ageing, Polypharmacotherapy and Changes in Terapeutic Value of Drugs in the Aged’’, KSKF-I.), and NETPHARM project CZ.02.01.01/00/22_008/0004607.” The original Article has been corrected.Link to the corrected article:[ https://farfar.pharmacy.bg.ac.rs/handle/123456789/5571

Deprescribing potential of commonly used medications among community-dwelling older adults: insights from a pharmacist’s geriatric assessment

Pharmacist’s geriatric assessment can provide valuable insights into potential deprescribing targets, while including important information on various health-related domains. Data collected from a geriatric assessment questionnaire, for 388 patients, from the Croatian cohort of the EuroAgeism H2020 ESR 7 international project, along with guideline-based deprescribing criteria, were used to analyse potentially inappropriate prescribing of four medication groups (benzodiazepines (BZN), proton pump inhibitors (PPI), opioids, and non-steroidal anti-inflammatory drugs (NSAID)), and to assess the deprescribing potential. Binary logistic regression was used to explore the effects of age, gender, number of medicines and diagnoses, self-reported health, frailty score, and healthcare utilization on the likelihood of needing deprescribing. More than half of participants (n = 216, 55.2%) are candidates for deprescribing, with 31.1% of PPI, 74.8% of NSAID, 75% of opioid, and 96.1% of BZN users meeting at least one criterion. Most common criteria for deprescribing were inappropriately long use and safety concerns. Women (aOR = 2.58; p < 0.001), those reporting poor self-reported health (aOR = 5.14; p < 0.001), and those exposed to polypharmacy (aOR = 1.29; p < 0.001) had higher odds of needing to have medicines deprescribed. The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy. Pharmacist’s geriatric assessment and deprescribing-focused medication review could be used to lead a personalised approach.https://farfar.pharmacy.bg.ac.rs/handle/123456789/562

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift&nbsp; includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift&nbsp; includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora

Interakcije lijekova i medikacijske pogreške u terapiji kroničnih onkoloških bolesnika

Cilj istraživanja: Utvrditi učestalost, vrstu i značajnost potencijalnih medikacijskih pogrešaka i potencijalnih interakcija lijekova u farmakoterapiji kroničnih onkoloških bolesnika, u praksi javnog ljekarništva. Ispitanici i metode: U razdoblju od rujna 2017. do ožujka 2018. godine prikupljeni su podatci o farmakoterapiji kroničnih onkoloških bolesnika u javnoj ljekarni u Hrvatskoj. U obzir su uzeti podatci o farmakoterapiji pacijenata koji su minimalno 6 mjeseci liječeni od onkološke bolesti. Probir potencijalnih potencijalnih interakcija lijekova radio se korištenjem Wolters Kluwer Clincal Drug Information Lexicomp® programa, te pregledom baza podataka o lijekovima. Rezultati: Podatci o farmakoterapiji 109 bolesnika uključeno je u istraživanje. Identificirane su 123 potencijalne medikacijske pogreške, razvrstane u 11 kategorija. Najučestalija potencijalna medikacijska pogreška je izostanak propisivanja terapije pacijentima s povećanim rizikom osteoporoze i fraktura. Većina potencijalnih interakcija bila je farmakodinamskog mehanizma nastanka. Uočeno je ukupno 343 potencijalnih interakcija lijekova, od kojih 61% kliničkog stupnja značajnosti C, 36% D i 3% stupnja X. Zaključak: Ljekarnička skrb o onkološkom pacijentu ne uključuje samo uočavanje i ispravljanje potencijalnih interakcija lijekova i potencijalnih medikacijskih pogrešaka, već i suportivnu terapiju u prepoznavanju specifičnih stanja onkoloških bolesnika. Rezultati ovog istraživanja upućuju na potrebu za sustavnom edukacijom ljekarnika o posebnostima onkološkog liječenja, važnosti uključivanja javnog ljekarnika u aktivnu skrb o onkološkom bolesniku te ispravljanje potencijalnih medikacijskih pogrešaka i sprječavanje nastanka potencijalnih interakcija lijekova. Važno je naglasiti potrebu za stvaranjem prikladnih načina komunikacije javnog ljekarnika s liječnicima svih specijalnosti uključenih u liječenje onkološkog pacijenta.Objectives: To determine the frequency, type, number, and significance of potential medication errors and potential interactions in pharmacotherapy of chronic oncology patients, from the aspect of a community pharmacist. Patients and Methods: Data on pharmacotherapy of chronic oncology patients was collected for the period from September 2017 until March 2018, within a community pharmacy in Croatia. Exclusion point for collecting data were patients with an oncology diagnosis for less than six months, regardless having been prescribed another pharmacotherapy. Collected data were processed for potential drug interactions, using Wolters Kluwer Clincal Drug Information Lexicomp® and medical professional data bases. Results: 109 patients’ pharmacotherapy data was included in the research. 123 potential medication errors were found and classified in 11 categories. The most common potential medication error was underprescribing (failure to prescribe medication when needed) for patients with a risk of osteoporosis and fractures. Irrespective of their clinical significance, most of the interactions were those of pharmacodynamic mechanism. We have noticed 343 interactions, of which 61% were classified having clinical significance C, 36% D, and 3% significance X. Conclusion: Pharmaceutical care of oncology patients involves not only recognising and correcting medication errors and interactions, but also supportive care and therapy for oncology specific issues. Results of this research show a need for continuous education of pharmacist, and the importance of including pharmacist in the care of oncology patients. It is vital to form and establish a channel of communication between pharmacist and other oncology specialists

Development and Validation of Comprehensive Healthcare Providers’ Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire)

Successful implementation of deprescribing requires exploring healthcare professionals’ opinions, preferences, and attitudes towards deprescribing. The aim of this study was to develop and validate the questionnaire exploring healthcare providers’ opinions preferences and attitudes towards deprescribing (CHOPPED questionnaire). This was a cross-sectional on-line survey. A comprehensive 58-item questionnaire, in two versions (for pharmacists and physicians), was developed through an extensive literature review and interviews with experts. The questionnaire was validated, and its reliability was assessed through data collected from 356 pharmacists and 109 physicians. Exploratory factor analysis was performed, and 37- and 35-item questionnaires were developed. Ten factors were identified: knowledge, awareness, patient barriers and facilitators, competencies barriers and facilitators, collaboration barriers and facilitators, and healthcare system barriers and facilitators. The CHOPPED tool has satisfactory face, content (CVR > 0.62) (content validity ratio), construct, and criterion validity. The reliability statistics of all factors in both versions was acceptable with Cronbach’s alpha > 0.6. Test–retest reliability analysis showed that gamma rank correlations of total factor scores were strong and very strong (between 0.519 and 0.938). The CHOPPED tool can be used as a valid and reliable tool to explore healthcare providers’ opinions and attitudes toward discontinuing medications in the primary care setting in Croatia

Klinički značajne interakcije imunosupresiva

lmmunosuppressants are a relatively new group of medications with various chemical entities and indications for use ranging from prevention of transplanted organs to autoimmune and rheumatoid diseases. lt is beyond dispute that their use and indication spectrum will grow with time. Immunosuppressants currently registered in Croatia have 290 clinically significant drug interactions, 34.8 % of ali interactions are of the level of clinical significance D, 32.8 % level X and 32.4 % level C. Cyclosporine is the immunosuppressant with the largest number of drug interactions, while inhibitors of TNF-a, inhibitors of interleukin and antithymocyte globulin have the fewest interactions. lt is understandable that cyclosporine has most interactions since it has been in use and in the world market for the longest time and has the widest indications. Even though they have the fewest interactions, most interactions of TNF-a inhibitors are of level X compared to level C and D interactions. Regarding the ATC classification system, immunosuppressants mostly interact with drugs of groups J and L. These data are very important in clinical practice, especially during combined drug therapy. Almost 20 % of ali interactions are among immunosuppressants themselves. Based on their metabolism mechanism via CYP3A4 and P-glycoprotein, one would conclude that the mechanism of immunosuppressant interaction would mostly be of pharmacokinetic nature, but results show that more than 50% of interactions are of a still unknown mechanism. This can be attributed to the fact that immunosuppressants are quite new in the global drug market and their use with other medications is still insufficiently investigated

Clinical decision-making in benzodiazepine deprescribing by healthcare providers vs. AI-assisted approach

Aims: The aim of this study was to compare the clinical decision-making for benzodiazepine deprescribing between a healthcare provider (HCP) and an artificial intelligence (AI) chatbot GPT4 (ChatGPT-4). Methods: We analysed real-world data from a Croatian cohort of community-dwelling benzodiazepine patients (n = 154) within the EuroAgeism H2020 ESR 7 project. HCPs evaluated the data using pre-established deprescribing criteria to assess benzodiazepine discontinuation potential. The research team devised and tested AI prompts to ensure consistency with HCP judgements. An independent researcher employed ChatGPT-4 with predetermined prompts to simulate clinical decisions for each patient case. Data derived from human-HCP and ChatGPT-4 decisions were compared for agreement rates and Cohen's kappa. Results : Both HPC and ChatGPT identified patients for benzodiazepine deprescribing (96.1% and 89.6%, respectively), showing an agreement rate of 95% (κ=.200,P=.012). Agreement on four deprescribing criteria ranged from 74.7% to 91.3%(lack of indicationκ=.352,P< .001; prolonged useκ=.088,P=.280; safety concernsκ=.123,P=.006; incorrect dosageκ=.264,P=.001). Important limitationsof GPT-4 responses were identified, including 22.1% ambiguous outputs, genericanswers and inaccuracies, posing inappropriate decision-making risks.Conclusions : While AI-HCP agreement is substantial, sole AI reliance poses a risk forunsuitable clinical decision-making. This study's findings reveal both strengths andareas for enhancement of ChatGPT-4 in the deprescribing recommendations within areal-world sample. Our study underscores the need for additional research on chatbot functionality in patient therapy decision-making, further fostering the advance-ment of AI for optimal performance