Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all‐cause emergency department revisits

What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug‐related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post‐discharge hospital revisits or death. Methods: This prospective, controlled study included all patients hospitalized in three internal medicine wards in a university hospital, between 1 January 2006 and 31 May 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n = 1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n = 2758) attended the wards before implementation of the intervention. Results and Discussion: No impact of medication reconciliation and reviews on ED revisits [hazard ratio (HR), 0·95; 95% confidence interval (CI), 0·86–1·04]or event‐free survival (HR, 0·96; 95% CI, 0·88–1·04) was demonstrated. In the intervention group, 594 patients (48·8%) visited the ED, compared with 1416 (51·3%) control patients. In total, 716 intervention (58·9%) and 1688 (61·2%) control patients experienced any event (ED visit, hospitalization or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (P < 0·05), we re‐examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (P = 0·608). What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, re‐hospitalizations or mortality over 6‐month follow‐up.     

Morbidity of childhood onset narcolepsy: a controlled national study

Narcolepsy is associated with significant morbidities. We evaluated the morbidities and mortality in a national group of child and adolescent patients after a first diagnosis of narcolepsy.MethodsIdentified from the Danish National Patient Registry (NPR), 243 patients (128 boys) aged 0–19 years diagnosed with narcolepsy between 1998 and 2012 with follow-up until 2014 were compared with 970 controls who were randomly chosen from the Danish Civil Registration System Statistics and matched by age, gender and geography. Comorbidities were calculated three years before and after diagnoses.ResultsIn addition to the more frequent health contacts due to neurological diseases, patients showed elevated odds ratios before and after diagnosis of endocrine and metabolic conditions (4.4 (95% CI, 1.9–10.4); 3.8 (1.7–8.4)), nervous disorders (16.6 (8.0–34.4); 198 (49.0–804)), psychiatric illnesses (4.5 (2.3–9.1)/5.8 (2.8–12.1)), pulmonary diseases, and other diseases (3.1 (2.0–4.9); 3.1 (2.0–4.9)). Congenital abnormalities (2.5 (1.1–5.5)), respiratory (2.9 (1.5-5-5)) and eye (5.7 (2.2–15.0)) diseases were more common before diagnosis. Injuries were also more common after diagnosis (1.5 (1.0–2.1)). Narcoleptic children presented significantly more diagnoses of multiple comorbidities than controls before and after diagnosis.ConclusionBefore and after a diagnosis of narcolepsy in children, morbidity is more frequent in several domains, including metabolic, psychiatric, neurological and other diseases.     

Efficacy of repetitive transcranial magnetic stimulation in depression: A review of the evidence

Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment in psychiatry. We reviewed all published evidence on the efficacy of this treatment option in depressive disorders. An extensive electronic and manual search for eligible research reports identified only 12 studies that met the predetermined criteria for inclusion. rTMS was administered differently in most studies, and patient characteristics varied widely. A formal meta-analysis of the studies was thus not possible. Instead, we conducted a qualitative evaluation of the included studies. The antidepressive efficacy was not consistent, and where efficacy was demonstrated, it was modest in most studies. Some patients had good but transient responses to rTMS. Treatment gains were not maintained beyond the treatment period. Comparisons with electroconvulsive therapy (ECT) indicated the superiority of ECT. More, larger and more carefully designed studies are needed to demonstrate convincingly a clinically relevant effect of rTMS. We conclude that there is insufficient evidence for rTMS as a valid treatment for depression at present.     

Déterminants de l’hypertension artérielle contrôlée chez les sujets traités par antihypertenseurs en France : enquête FLAHS 2015

ObjectiveThe FLASH 2015 survey sought the determinants of hypertension control in subjects treated with antihypertensive drugs in France.MethodSending self-administered questionnaire by mail to a representative sample of the population living in metropolitan France (MetaScope basis, TNS Sofres, France). Patients who declare taking antihypertensive drugs are considered treated hypertensives. A home blood pressure monitoring during 3 days was asked in subjects owing a blood pressure monitor and the average of 18 measurements was calculated.ResultsA total of 6379 subjects aged 55 and older were included with 2814 (44.1%) treated with antihypertensive drugs. Home blood pressure was obtained from 1455 subjects including 882 (60.6%) treated. SBP/DBP are 129.3 ± 13.5/75.5 ± 9.0 mmHg and are higher in treated subjects in each age category. BP < 135/85 was observed in 55.4% and BP < 140/90 in 71.7%. Determinants of BP control (< 135/85) are the number of measurement for averaging (18 measures over 3 days vs 3 measurements on a morning; 55.4%/44.3%), age (55–64 years vs 80 years old; 57.6%/49.1%), gender (women vs men; 60.3%/50.1%), BMI (< 25 vs > 30; 63.1%/46.1%). In the 80 and older, a SBP < 145 was observed in 74.7% of subjects. The control was 61% when considering an SBP/DBP < 135/85 in 55–79 years and SBP < 145 among 80 and older.ConclusionThe control of hypertension evaluated by home blood pressure on a representative population living in metropolitan France is estimated at between 44.3% and 74.7% and several determinants influence the control of blood pressure like age, gender and BMI.     

Polymeric nanofibers: targeted gastro-retentive drug delivery systems

Background: Conventional oral dosage forms exhibit poor/low bioavailability due to incomplete release of drug and short residence time at the absorption site. Gastro-retentive drug delivery system (GRDDS) is particularly used to improve bioavailability of the drugs, which have narrow absorption window down in the levels of gastrointestinal tract and also to treat local disorders.

Purpose: The purpose of this review is to describe the utility of the nanofibers as gastro-retentive dosage form. From last few decades, formulation scientists have put extensive efforts to develop suitable gastro-retentive drug delivery system, which is appropriate for commercialization. Current approaches used for preparation of gastro-retentive drug delivery system offers limited functional features to control the floating behavior. Recently, an extensive research has been developed to improve the gastric residence time by using nanofibers, which ultimately leads to the increased bioavailability of the drug. Multiple functional features and unique properties of nanofibers improve its gastro retention.

Conclusion: Nanofiber system provides stomach-specific drug release for longer duration; moreover, increased local action of the drug due to prolonged contact time with the gastric mucosa. Thus, the nanofiber system promises to be the potential approach for gastric retention drug delivery system.     

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.

Graphical Abstract

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多胺在恶性肿瘤诊断及疗效观察中的应用

近年来研究表明,多胺在癌症患者体内合成与积累增多,可作为一种肿瘤标志物,但其临床应用价值还有待商榷。本文分析目前已发表的临床对照试验,包括乳腺癌、宫颈癌、白血病患者与健康受试者或良性疾病患者体液中的多胺成分或比例变化的情况,对多胺的临床应用进展做一综述。     

云南昭通燃煤中砷的释放规律及其环境效应研究

目的探讨燃煤型氟中毒病区燃煤中砷的实际燃烧释放规律及其环境效应。方法于2005—2010年,在云南昭通系统采集了24户农户的煤、拌煤粘土、煤泥、煤渣以及新鲜玉米和烘烤玉米样品进行砷含量的检测,并计算煤泥中砷元素的燃烧释放量及释放率,分析了煤泥中砷释放量与烘烤玉米中砷增加量的关系。结果煤中砷含量为0.72~14.35 mg/kg,中位数为3.92 mg/kg;拌煤粘土中砷含量为1.66~66.59 mg/kg,中位数为17.22 mg/kg;煤泥中砷含量为1.81~29.52 mg/kg,中位数为7.79 mg/kg;煤泥中砷的释放量为0.09~22.47 mg/kg,中位数为2.00 mg/kg;煤泥中砷的释放率为0.92%~76.10%,中位数为31.76%;新鲜玉米中的砷含量为未检出~0.03 mg/kg,中位数为0.02 mg/kg,远低于GB 2762—2005《食品中污染物限量》中砷限量(0.2 mg/kg);烘烤玉米中的砷含量为未检出~0.34 mg/kg,中位数为0.09 mg/kg,与新鲜玉米相比有了大幅增加,超标率仅为23.8%。粘土与煤泥中砷释放量呈正相关(P=0.001),而砷释放量与烘烤玉米砷增加量间无统计学相关性(P=0.604)。结论拌煤粘土是燃煤中砷污染物释放的重要来源。烘烤玉米中砷污染程度不仅与煤泥中砷释放量有关,而且受到烤房条件、敞炉结构、烘烤时间等多种因素的影响。