Contextualized Drug–Drug Interaction Management Improves Clinical Utility Compared With Basic Drug–Drug Interaction Management in Hospitalized Patients

Drug–drug interactions (DDIs) frequently trigger adverse drug events or reduced efficacy. Most DDI alerts, however, are overridden because of irrelevance for the specific patient. Basic DDI clinical decision support (CDS) systems offer limited possibilities for decreasing the number of irrelevant DDI alerts without missing relevant ones. Computerized decision tree rules were designed to context-dependently suppress irrelevant DDI alerts. A crossover study was performed to compare the clinical utility of contextualized and basic DDI management in hospitalized patients. First, a basic DDI-CDS system was used in clinical practice while contextualized DDI alerts were collected in the background. Next, this process was reversed. All medication orders (MOs) from hospitalized patients with at least one DDI alert were included. The following outcome measures were used to assess clinical utility: positive predictive value (PPV), negative predictive value (NPV), number of pharmacy interventions (PIs)/1,000 MOs, and the median time spent on DDI management/1,000 MOs. During the basic DDI management phase 1,919 MOs/day were included, triggering 220 DDI alerts/1,000 MOs; showing 57 basic DDI alerts/1,000 MOs to pharmacy staff; PPV was 2.8% with 1.6 PIs/1,000 MOs costing 37.2 minutes/1,000 MOs. No DDIs were missed by the contextualized CDS system (NPV 100%). During the contextualized DDI management phase 1,853 MOs/day were included, triggering 244 basic DDI alerts/1,000 MOs, showing 9.6 contextualized DDIs/1,000 MOs to pharmacy staff; PPV was 41.4% (P &lt; 0.01), with 4.0 PIs/1,000 MOs (P &lt; 0.01) and 13.7 minutes/1,000 MOs. The clinical utility of contextualized DDI management exceeds that of basic DDI management.</p

Contextualized Drug–Drug Interaction Management Improves Clinical Utility Compared With Basic Drug–Drug Interaction Management in Hospitalized Patients

Drug–drug interactions (DDIs) frequently trigger adverse drug events or reduced efficacy. Most DDI alerts, however, are overridden because of irrelevance for the specific patient. Basic DDI clinical decision support (CDS) systems offer limited possibilities for decreasing the number of irrelevant DDI alerts without missing relevant ones. Computerized decision tree rules were designed to context-dependently suppress irrelevant DDI alerts. A crossover study was performed to compare the clinical utility of contextualized and basic DDI management in hospitalized patients. First, a basic DDI-CDS system was used in clinical practice while contextualized DDI alerts were collected in the background. Next, this process was reversed. All medication orders (MOs) from hospitalized patients with at least one DDI alert were included. The following outcome measures were used to assess clinical utility: positive predictive value (PPV), negative predictive value (NPV), number of pharmacy interventions (PIs)/1,000 MOs, and the median time spent on DDI management/1,000 MOs. During the basic DDI management phase 1,919 MOs/day were included, triggering 220 DDI alerts/1,000 MOs; showing 57 basic DDI alerts/1,000 MOs to pharmacy staff; PPV was 2.8% with 1.6 PIs/1,000 MOs costing 37.2 minutes/1,000 MOs. No DDIs were missed by the contextualized CDS system (NPV 100%). During the contextualized DDI management phase 1,853 MOs/day were included, triggering 244 basic DDI alerts/1,000 MOs, showing 9.6 contextualized DDIs/1,000 MOs to pharmacy staff; PPV was 41.4% (P &lt; 0.01), with 4.0 PIs/1,000 MOs (P &lt; 0.01) and 13.7 minutes/1,000 MOs. The clinical utility of contextualized DDI management exceeds that of basic DDI management.</p

The effect of genotyping on the number of pharmacotherapeutic gene-drug interventions in chronic kidney disease patients

Patients with chronic kidney disease (CKD) stage 3-5 are polypharmacy patients. Many of these drugs are metabolized by cytochrome P450 (CYP450) and CYP450. Genetic polymorphism is well known to result in altered drug metabolism capacity. This study determined the added value of pharmacogenetic testing to the routine medication evaluation in polypharmacy patients with CKD. In adult outpatient polypharmacy patients with CKD3-5 disease, a pharmacogenetic profile was determined. Then, automated medication surveillance for gene-drug interactions was performed based on the pharmacogenetic profile and the patients' current prescriptions. Of all identified gene-drug interactions, the hospital pharmacist and the treating nephrologist together assessed clinical relevance and necessity of a pharmacotherapeutic intervention. The primary endpoint of the study was the total number of applied pharmacotherapeutic interventions based on a relevant gene-drug interaction. A total of 61 patients were enrolled in the study. Medication surveillance resulted in a total of 66 gene-drug interactions, of which 26 (39%) were considered clinically relevant. This resulted in 26 applied pharmacotherapeutic interventions in 20 patients. Systematic pharmacogenetic testing enables pharmacotherapeutic interventions based on relevant gene-drug interactions. This study showed that pharmacogenetic testing adds to routine medication evaluation and could lead to optimized pharmacotherapy in CKD patients.Personalised Therapeutic

Contextualized Drug–Drug Interaction Management Improves Clinical Utility Compared With Basic Drug–Drug Interaction Management in Hospitalized Patients

Drug–drug interactions (DDIs) frequently trigger adverse drug events or reduced efficacy. Most DDI alerts, however, are overridden because of irrelevance for the specific patient. Basic DDI clinical decision support (CDS) systems offer limited possibilities for decreasing the number of irrelevant DDI alerts without missing relevant ones. Computerized decision tree rules were designed to context-dependently suppress irrelevant DDI alerts. A crossover study was performed to compare the clinical utility of contextualized and basic DDI management in hospitalized patients. First, a basic DDI-CDS system was used in clinical practice while contextualized DDI alerts were collected in the background. Next, this process was reversed. All medication orders (MOs) from hospitalized patients with at least one DDI alert were included. The following outcome measures were used to assess clinical utility: positive predictive value (PPV), negative predictive value (NPV), number of pharmacy interventions (PIs)/1,000 MOs, and the median time spent on DDI management/1,000 MOs. During the basic DDI management phase 1,919 MOs/day were included, triggering 220 DDI alerts/1,000 MOs; showing 57 basic DDI alerts/1,000 MOs to pharmacy staff; PPV was 2.8% with 1.6 PIs/1,000 MOs costing 37.2 minutes/1,000 MOs. No DDIs were missed by the contextualized CDS system (NPV 100%). During the contextualized DDI management phase 1,853 MOs/day were included, triggering 244 basic DDI alerts/1,000 MOs, showing 9.6 contextualized DDIs/1,000 MOs to pharmacy staff; PPV was 41.4% (P < 0.01), with 4.0 PIs/1,000 MOs (P < 0.01) and 13.7 minutes/1,000 MOs. The clinical utility of contextualized DDI management exceeds that of basic DDI management

Trifolio-Geranietea-Gesellschaften im nördlichen Steigerwald

Die wärmebedürftigen und trockenheitsertragenden Saumgesellschaften der Klasse Trifolio-Geranietea im nördlichen Steigerwald (Nord-Bayern) werden beschrieben. Das Gebiet ist aus Tonen und Sandsteinen des Keupers aufgebaut und erreicht Höhen zwischen 270 und 450 m üNN. Wir können zwei Verbände (Geranion sanguinei und Trifolion medii) unterscheiden, deren typische Verbreitungsmuster von den verschiedenen klimatischen und edaphischen Bedingungen abhängen. Das Geranion (mit den Assoziationen Geranio-Peucedanetum und Geranio-Trifolietum) ist vor allem im klimatisch wärmeren Westen des Gebietes auf kalkreichen Böden konzentriert. Das stärker mesophile Trifolion ist nur schwach charakterisiert. Besonders im Osten finden wir weitverbreitet das Trifolio-Agrimonietum und seltener das Agrimonio-Vicietum cassubicae. Alle diese Säume stehen in Kontakt mit wärmeliebenden Gebüschgesellschaften (Berberidion). Die Verbreitung der unterschiedenen Saumgesellschaften wird auf zwei Karten, ihre floristische Zusammensetzung in einer synthetischen Übersichtstabelle gezeigt.The warmth requiring, drought resistant fringe communities of woodland edges of the class Trifolio-Geranietea in the northern Steigerwald (Northern Bavaria) are described. This region is formed by strata of clay and sandstone (Keuper) of altitudes between 270 and 450 m. We can distinguish two alliances, Geranion sanguinei and Trifolion medii, whose characteristic distribution patterns depend on different climatic and edaphic conditions. The Geranion (with the associations Geranio-Peucedanetum and Geranio-Trifolietum) is concentrated in the western, warmer part of the area, on lime — rich soils. The more mesophilous alliance, Trifolion, is weakly characterised. The Trifolio-Agrimonietum commonly occurs especially in the eastern part of the area, while the Agrimonio-Vicietum cassubicae is found less. All these fringe communities are in contact with thermophilic shrub communities (Berberidion). The distribution of the fringe communities is shown on two maps, and the floristic composition is demonstrated in a synthetic phytosociological table