The Development of Practice Recommendations for Drug-Disease Interactions by Literature Review and Expert Opinion

Background: Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence. As a consequence the translation of SmPC to clinical practice may lead to non-specific recommendations. For the translation of this information to the real world, it is necessary to evaluate the available knowledge about drug-disease interactions, and to formulate specific recommendations for prescribers and pharmacists. The aim of this paper is to describe a standardized method how to develop practice recommendations for drug-disease interactions by literature review and expert opinion. Methods: The development of recommendations for drug-disease interactions will follow a six-step plan involving a multidisciplinary expert panel (1). The scope of the drug-disease interaction will be specified by defining the disease and by describing relevant effects of this drug-disease interaction. Drugs possibly involved in this drug-disease interaction are selected by checking the official product information, literature, and expert opinion (2). Evidence will be collected from the official product information, guidelines, handbooks, and primary literature (3). Study characteristics and outcomes will be evaluated and presented in standardized reports, including preliminary conclusions on the clinical relevance and practice recommendations (4). The multidisciplinary expert panel will discuss the reports and will either adopt or adjust the conclusions (5). Practice recommendations will be integrated in clinical decision support systems and published (6). The results of the evaluated drug-disease interactions will remain up-to-date by screening new risk information, periodic literature review, and (re)assessments initiated by health care providers. Actionable Recommendations: The practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published and implemented in all Clinical Decision Support Systems in the Netherlands. Discussion: The recommendations result in professional guidance in the context of individual patient care. The professional will be supported in the decision making in concerning pharmacotherapy for the treatment of a medical problem, and the clinical risks of the proposed medication in combination with specific diseases

Medicine, a threat to health: limitations of drug, non drug treatments and protocolized medicine

Een behoorlijk aantal ziekenhuisopnamen is niet het gevolg van een acute aandoening, maar van ernstige bijwerkingen van medicijnen. Roya Atiqi onderzocht onder meer opnamen op de afdelingen Inwendige Geneeskunde, Cardiologie en Longziekten van het Albert Schweitzer Ziekenhuis in Dordrecht. Bijna twintig procent van de opnamen was het gevolg van neveneffecten van medicijnen en bij nog eens dertig procent waren deze een mogelijke oorzaak. Een aanzienlijk deel, maar niet alle gevallen van bijwerkingen, werd door de artsen herkend. Ook onderzocht Atiqi verschillen tussen het voorschrijven van medicijnen voor artsen op het platteland en in de stad. Op het platteland geven artsen vaker aanbevelingen bij de behandeling van hoge bloeddruk, zoals stoppen met roken, afvallen en meer sporten

KONVERGENSI NUMERIK FLUKS RUSANOV DAN HLLE PADA METODE BEDA VOLUM UNTUK MENGHAMPIRI PERSAMAAN AIR DANGKAL

This one-dimensional simulation is performed to find the convergence of different fluxes on the water wave using shallow water equation. There are two cases where the topography is flat and not flat. The water level and grid of each simulation are made differently for each case, so that the water waves that occur can be analyzed. Many methods can be used to approximate the shallow water equation, one of the most used is the finite volume method. The finite volume method offers several numerical solutions for approximate shallow water equation, including Rusanov and HLLE. The derivation result of the numerical solution is used to approximate the shallow water equation. Differences in numerical and topographic solutions produce different waves. On flat topography, the rusanov flux has an average error of 0.06403 and HLLE flux with an average error of 0.06163. While the topography is not flat, the rusanov flux has a 1.63250 error and the HLLE flux has an error of 1.56960

Prevalence of iatrogenic admissions to the Departments of Medicine/Cardiology/ Pulmonology in a 1,250 bed general hospital

A recent meta-analysis in this journal showed incidences between 3.4 and 33.9%. Studies performed by pharmacists and epidemiologists produced lower incidences than internists' studies. We reassessed the prevalence of iatrogenic admissions in a study of internists. Iatrogenic disease was defined as adverse drug reactions according to the World Health Organization Definition and complications induced by non-drug medical interventions. Subsequent admissions at the Departments of Medicine/Cardiology/Pulmonology in a 1,250 bed general hospital in the Netherlands from May 2007 to August 2007 were studied. 2,000 consecutive admissions were studied: 576 (29%, 26 - 32%) were classified as possibly iatrogenic; out of these 380 (19%, 17 - 22%) as definitely iatrogenic, out of whom 229 (12%, 10 - 14%) had already been classified as iatrogenic by the admitting physicians. Patients with cardiac disease, hypertension, gastrointestinal conditions, anticoagulant treatment and use of NSAIDs were, particularly, at risk of iatrogenic admission with percentages of 22 (16 - 24), 13 (11 - 18), 12 (9 - 15), and 7 (5 - 11) %. An independent predictor of iatrogenic admissions was age with an odds ratio of 1.27 per 10 years (p = 0.0001). 1. At least 19% of admissions to the Departments of Internal Medicine/Cardiology/Pulmonology, and, maybe, even percentages up to 29% were due to adverse drug effects. 2. A large difference between the numbers of iatrogenic admission according to the physicians in charge of admission and the investigators, 229 versus 380 patients, was observed. 3. Most often iatrogenic admissions were observed with cardiac disease, hypertension, gastrointestinal conditions, anticoagulant treatment, and use of NSAID

Meta-analysis of recent studies on patients admitted to hospital due to adverse drug effects

The use of drugs has expanded during the previous decade. However, earlier studies oil patients admitted for adverse drugs effects (ADEs) have been heterogeneous. The objectives of this Study were to assess the number of recent admissions to hospital Clue to ADEs and to assess the degree of heterogeneity in recent studies. Prospective Studies published in the past decade were therefore pooled and compared with the pooled results from earlier Studies. The pooled overall percentage in recent Studies (n = 20) was 5.4% (5.0 - 5.8) and this did not significantly differ from that in the earlier studies (n = 21, pooled percentage 4.7%, 3.1-6.2). The Studies were clinically very heterogeneous With percentages of ADEs between 3.4 and 33.2%. The nature of the patient group Could be held largely responsible for the clinical heterogeneity observe

Ferric carboxymaltose-induced hypophosphataemia after kidney transplantation

Background: Ferric carboxymaltose (FCM) can induce hypophosphataemia in the general population and patients with chronic kidney disease (CKD). Less is known about the effect of FCM in the kidney transplant population. It has been suggested that fibroblast growth factor 23 (FGF-23)-mediated renal phosphate wasting may be the most likely cause of this phenomenon. In the current study, the effects of FCM on phosphate metabolism were studied in a cohort of kidney transplant recipients. Methods: Two index patients receiving FCM are described. Additionally, data of 23 kidney transplant recipients who received a single dose of FCM intravenously between 1 January 2014 and 1 July 2015 were collected. Changes in the serum phosphate concentration were analysed in all subjects. Change in plasma FGF-23 concentrations was analysed in the index patients. Results: In the two index patients an increase in FGF-23 and a decrease in phosphate concentrations were observed after FCM administration. In the 23 kidney transplant patients, median estimated glomerular filtration rate was 42 ml/min/1.73 m2 (range 10-90 ml/ min/1.73 m2). Mean phosphate concentration before and after FCM administration was 1.05 ± 0.35 mmol/l and 0.78 ± 0.41 mmol/l, respectively (average decrease of 0.27 mmol/l; p = 0.003). In the total population, 13 (56.5%) patients showed a transient decline in phosphate concentration after FCM administration. Hypophosphataemia following FCM administration was severe (i.e. < 0.5 mmol/l) in 8 (34.8%) patients. Conclusion: Administration of a single dose of FCM may induce transient and mostly asymptomatic renal phosphate wasting and hypophosphataemia in kidney transplant recipients. This appears to be explained by an increase in FGF-23 concentration