Pharmacist‐led hypertension drug use review

Few studies have shown the impact of pharmacists on the control of hypertension in patients Many studies have shown that there is scope for improvement in the control of hypertension A review of patients receiving nifedipine or amlodipine at two GP practices was carried out in line with British Hypertension Society guidelines Patients were also assessed with a view to changing calcium channel blocker to felodipine since trials have demonstrated equal benefit in terms of blood pressure control and long term outcomes of morbidity and mortality This review demonstrated that a pharmacist can actively review and improve the control of hypertension in a primary care population whilst optimising prescribing costs     

Synthesis of 5,5,6,6‐D4‐L‐lysine‐aflatoxin Bl for use as a mass spectrometric internal standard

Human exposure to the hepatocarcinogenic mycotoxin aflatoxin B_l results in modification of serum albumin lysine ε‐amino residues to form lysine‐aflatoxin adducts. A perdeuterated reference standard is now required to quantitatively measure this adduct in epidemiologic studies of liver cancer using isotopic dilution mass spectrometry. A convenient method for the preparation of D4‐L ‐lysine‐AFB_l using commercially available 5,5,6,6‐D4‐l ‐lysine is demonstrated for the first time. The application of two standard α‐amino protection methods is also reported that simplifies the production of natural isotopic abundance lysine‐AFB_l over the currently used method employing N_α‐acetyl‐l ‐lysine. t‐Boc‐N_α‐lysine was used to prepare lysine‐AFB_l; however, a preferred method for directing reaction of AFB_l‐dialdehyde to the ε‐amino group of 5,5,6,6‐D4‐l ‐lysine utilized cupric ions that were spontaneously removed during the reverse phase HPLC purification of D4‐lysine‐AFB_l using 1% HOAc. This strategy eliminates the need to otherwise synthesize and purify t‐Boc‐N_α‐ or N_α‐acetyl‐5,5,6,6‐D4‐lysine and then TFA or enzymatically deprotect overnight to obtain the target compound. Copyright © 2004 John Wiley & Sons, Ltd.     

The use of serial point‐prevalence studies to investigate hospital anti‐infective prescribing

Objectives — To develop and test an efficient, reproducible method for the surveillance of hospital anti‐infective use; to use this method to investigate patterns of anti‐infective prescribing. Method — A series of three standardised point‐prevalence studies were carried out in which pharmacists recorded details of all inpatients prescribed systemic anti‐infectives. Time taken to collect, enter and analyse these data was documented. Parameters examined included: percentage of patients prescribed anti‐infectives, percentage of anti‐infectives that were for “reserved” use, percentage of these with appropriate approval, percentage of anti‐infectives administered intravenously, duration of therapy, and combinations of anti‐infectives used. Setting — All hospital inpatients in a large National Health Service (NHS) Trust comprising four sites. Key findings — For each study, an estimated 35 additional hours of pharmacists' time was required for data collection, cleaning and analysis, and 15 hours for data entry. The method developed was easily reproducible and results from the three studies were very similar. Overall, 33 per cent of 2,656 inpatients were prescribed at least one anti‐infective (mean 1.7 per patient); 48 per cent of anti‐infectives were given intravenously (IV), of which 34 per cent could have been given orally. Of the anti‐infectives used, 21 per cent were for “reserved” use. Of these, 65 per cent were used for an approved indication, and 11 per cent were not. The remaining 24 per cent had no indication documented in the medical notes. Conclusion — This is a practical method for studying hospital anti‐infective use in the absence of computerised prescribing. The database produced provides a wealth of information and various targets for intervention have been identified; these can now be evaluated against the baseline data collected. The methods developed could be used in other hospitals to provide benchmarking data.     

中美军人用药目录及相关政策比较研究

满足军人医疗用药需求的同时控制药品总费用是军队医疗卫生体制改革的重难点问题之一.本文对中美军人用药目录的组成与应用、制订流程及药品使用相关政策进行了对比分析,并对我军用药目录及政策可借鉴之处开展了分析与讨论.     

Meta‐analysis: proton pump inhibitor use and the risk of community‐acquired pneumonia

Aliment Pharmacol Ther 31 , 1165–1177

Summary

Background Observational studies examining the association between proton pump inhibitor (PPI) use and risk of community‐acquired pneumonia are conflicting. Aim To assess systematically the association between risk of community‐acquired pneumonia and PPI use in adults. Methods We searched MEDLINE, EMBASE and CINAHL databases between 1988 and January 2010. Two reviewers independently selected studies based on eligibility criteria and extracted data. Included studies evaluated adults (≥18 years) who took PPIs as an out‐patient. The primary outcome was community‐acquired pneumonia. Only observational studies with a comparison arm were included. Results Over 2600 citations were reviewed. Six studies were included. All were nested case‐control studies. Meta‐analysis found an increased risk of community‐acquired pneumonia associated with PPI use [OR 1.36 (95% CI 1.12–1.65)]; significant heterogeneity remained (I² 92%, P < 0.001). In exploratory subgroup analysis, short duration of use was associated with an increased odds of community‐acquired pneumonia [OR 1.92 (95% CI 1.40–2.63), I² 75%, P = 0.003], whereas chronic use was not [OR 1.11 (95% CI 0.90–1.38), I² 91%, P < 0.001], a significant interaction (P < 0.005). Conclusions Heterogeneity precluded interpretation of the summary statistic. Exploratory analysis revealed that duration of PPI use may impact the risk of community‐acquired pneumonia, a finding that should be explored in future studies.