Nederlands Platform voor Farmaceutisch Onderzoek

Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen, zoals medicatieveiligheid, patiëntenzorg, formulering, (bio)analyse, (klinische) farmacologie en casuïstiek.

TDM bij fluoroquinolonen om verworven resistentie bij tuberculose tegen te gaan

Ithamar Brinkman

Rubriek: Referaat
Identificatie: 2017;2:e1646
Datum: 12 september 2017

Streefspiegels behalen met continue dosering piperacilline/tazobactam op de IC

Ithamar Brinkman

Rubriek: Referaat
Identificatie: 2017;2:e1645
Datum: 12 september 2017

Telefonische startbegeleiding door apothekers verbetert de therapietrouw; een cluster-gerandomiseerd onderzoek

Marcel J. Kooij a*, Eibert R. Heerdink a, Liset van Dijk b, Erica C.G. van Geffen c, Svetlana V. Belitser a en Marcel L. Bouvy a

Lees abstract

Effects of telephone counselling intervention by pharmacists (TelCIP) on medication adherence; results of a cluster randomized trial

OBJECTIVE

To assess the effect of a pharmacist telephone counselling intervention on patients’ medication adherence.

DESIGN AND METHODS

A pragmatic cluster randomized controlled trial was performed in 53 community pharmacies in The Netherlands. Participants included were patients ≥ 18 years initiating treatment with antidepressants, bisphosphonates, renin-angiotensin system (RAS) inhibitors or statins (lipid lowering drugs). Pharmacies in arm A provided the intervention for antidepressants and bisphosphonates and usual care for RAS inhibitors and statins. Pharmacies in arm B provided the intervention for RAS inhibitors and statins and usual care for antidepressants and bisphosphonates. Intervention consisted of a telephone counselling intervention 7-21 days after the start of therapy. Counselling included assessment of practical and perceptual barriers and provision of information and motivation. Primary outcome was refill adherence measured over 1 year expressed as continuous and dichotomous outcomes (refill rate ≥ 80%). Secondary outcome was discontinuation within one year.

RESULTS

In the control arms 3627 patients were eligible and in the intervention arms 3094 patients. Of the latter, 1054 patients (34%) received the intervention. Intention to treat analysis showed no difference in adherence rates between the intervention and the usual care arm (74.7%; standard deviation 37.5 respectively 74.5% and 37.9). More patients starting with RAS inhibitors had a refill ratio ≥ 80% in the intervention arm compared to usual care (81.4% versus 74.9% with odds ratio 1.43; 95% confidence interval 1.11-1.99). Comparing patients with counselling to patients with usual care (per protocol analysis), adherence was statistically significant higher for patients starting with RAS inhibitors, statins and bisphosphonates. Patients initiating antidepressants did not benefit from the intervention.

CONCLUSION

Telephone counselling at start of therapy improved adherence in patients initiating RAS inhibitors. The per protocol analysis indicated an improvement for lipid lowering drugs and bisphosphonates. No effect on adherence in patients initiating antidepressants was found.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1655
Datum: 11 september 2017

Veel voorschriften voor orale corticosteroïden bij jonge kinderen

Martina Teichert

Rubriek: Referaat
Identificatie: 2017;2:e1648
Datum: 8 september 2017

Heruitgifte van ongebruikte medicijnen

Martina Teichert

Rubriek: Referaat
Identificatie: 2017;2:e1647
Datum: 8 september 2017

Prisma Symposium, 16 mei 2017

Rubriek: Congresabstracts
Identificatie: 2017;2:a1649
Datum: 11 augustus 2017

Prescriptie antibiotica aan kinderen in eerste lijn kan beter

Sander Borgsteede

Rubriek: Referaat
Identificatie: 2017;2:e1642
Datum: 1 augustus 2017

Beschermend gastro-intestinaal effect van PPI’s en COX-2-remmers bevestigd

Sander Borgsteede

Rubriek: Referaat
Identificatie: 2017;2:e1641
Datum: 1 augustus 2017

Effectiviteit van een gestandaardiseerd oraal vitamine D-doseringsregime bij somatische en psychogeriatrische verpleeghuisbewoners

M.L. Toren-Wielema a*, R.B. Veenhuizen b, J.W. Kappelle c, N.J.G.M. Veeger d en E.N. van Roon ef

Lees abstract

Effectiveness of a standardised oral vitamin D dosing regimen for somatic and psychogeriatric nursing home residents

BACKGROUND

The prevalence of vitamin D deficiency in nursing home residents (NHR) ranges from 79 to 98%.

OBJECTIVE

To determine the efficacy of a standardised oral vitamin D dosing regimen (VDDR) consisting of a loading dose (LD) of 200,000 IU followed by a maintenance dose (MD) of 100,000 IU every 13 weeks in obtaining and maintaining an adequate and safe serum vitamin D trough level (VDTL) in somatic and psychogeriatric NHR.

DESIGN

Cross-sectional observational study.

METHODS

Blood samples of NHR who had received the LD followed by at least one MD were analysed for VDTL, calcium, parathyroid hormone and creatinine. Data on age, sex, race, body weight, length, co-morbidity, co-medication, number of MDs, calcium supplementation, smoking and use of alcohol were obtained from patient charts. The primary outcome for the efficacy of the VDDR was defined as the percentage of NHR with a VDTL 75-220 nmol/L. A percentage of 75.31% was considered to be non-inferior to the aimed percentage of 85% (α 0.05; β 0.0881). Secondary outcomes were analysed as dichotomous variables using binary logistic regression.

RESULTS

In 91 of 156 included NHR (58%) a VDTL of 75-220 nmol/L was measured (average 81, standard deviation 28, range 13-150). Data were abstracted from the charts of 138 NHR (88%). The only variable found to be a significant predictor for obtaining a VDTL ≥ 75 nmol/L was a larger number of MDs (≥ 4 versus < 4; odds ratio 2.69; 95% confidence interval 1.36-5.33).

CONCLUSION

The VDDR was not efficacious in obtaining and maintaining an adequate VDTL in NHR.

Rubriek: Korte bijdrage
Identificatie: 2017;2:a1648
Datum: 11 juli 2017

IJzerintoxicatie: hoe zit dat eigenlijk? Intraveneuze en orale intoxicatie hetzelfde behandelen?

Walter J. Brummelhuis a*, Rik H. Olde Engberink b, Jan H.M. Schellens a en Dees P.M. Brandjes b

Lees abstract

What to do in case of iron intoxication? Treat intravenous and oral intoxication the same?

INTRODUCTION

Iron overdose can be fatal. After ingesting large amounts of iron tablets, the ensuing intoxication can be treated with chelation therapy (deferoxamine) according to guidelines. However, it is not known whether a patient should be treated after administering too much iron intravenously.

DESCRIPTION

A 79 year old female suffering from iron-deficiency anaemia erroneously received a double dose of ferric carboxymaltose (2x1000 mg Ferinject). 6.5 hours later her non-haemolytic serum iron level was 147 µmol/L (a serum level of > 90 µmol/L after iron tablet ingestion is considered to be a severe intoxication). In the absence of guidelines and despite lack of evidence, she was treated with 4500 mg of deferoxamine during 29 hours. 61.5 hours after treatment started, the serum iron level was 55 µmol/L. No acute complications were observed and there were no signs of long-term organ damage after two months follow-up.

DISCUSSION

The harmful effects of oral iron intoxication are believed to be the result of gastro-intestinal toxicity with ensuing inflammatory response and free radical formation facilitated by iron. Theoretically, only the latter process plays a role in intravenous iron intoxication. It is unknown what the consequences are of an untreated intravenous intoxication.

CONCLUSION

This case report suggests that deferoxamine can be used to eliminate iron and prevent end-organ damage after intravenous iron intoxication. It is our belief that treatment with deferoxamine should be considered in intravenous iron intoxication. However, it should be taken into account that available guidelines are based on oral iron intoxication and that clinical evidence is scarce.

Rubriek: Casuïstische mededeling
Identificatie: 2017;2:a1647
Datum: 6 juni 2017

Hoeveel CO is goed voor een patiënt of zorgverlener? De klinische bruikbaarheid van contra-indicatieregistratie

E.M. de Vogel abc*, E.F. van Bommel d en M.M. Beex-Oosterhuis a

Lees abstract

How much input can healthcare professionals and patients handle? The clinical implications of drug-disease safety alerts

BACKGROUND

Computerized physician order entry systems with integrated decision support components can reduce medication errors and improve patient safety. Insignificant alerts, however, might cause alert fatigue which may cause clinicians to override both significant and insignificant alerts.

OBJECTIVE

To provide insight into the relevance of the currently applied drug-disease safety alerts in the Dutch database G-Standard.

DESIGN AND METHODS

In this database study the frequency of handling of clinical drug-disease safety alerts by both physicians and hospital pharmacists was monitored in a Dutch teaching hospital between January and December 2014. In addition, the nature of the most common alerts was studied. After consensus meetings with doctors of different medical departments, drug-disease alerts were modified. From July to December 2015 frequency of handling of drug-disease alerts by both the physician and hospital pharmacist was monitored again.

RESULTS

Nearly 90% of all drug-disease safety alerts for inpatients were generated by eight diseases: hypertension (20%), asthma/COPD (15%), angina pectoris (13%), heart failure (5%), diabetes mellitus (11%), Parkinson’s disease (15%), renal failure (6%) and thyroid dysfunction (4%). Only 1% of the drug-disease alerts was administratively handled (mainly as ‘no action required’) by the physician and another 1% by the hospital pharmacist (contact with the physician either written or by telephone). After suppression of insignificant drug-disease alerts, 50% fewer alerts were generated. Handling of the contra-indication alerts by physicians and hospital pharmacist increased to 35%.

CONCLUSION

Suppression of insignificant drug-disease alerts increases the awareness for drug-disease safety alerts and possibly decreases alert fatigue.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1645
Datum: 22 mei 2017

Luchtwegstent met microsferen voor langdurige en lokale afgifte gefitinib

András Vermes

Rubriek: Referaat
Identificatie: 2017;2:e1640
Datum: 9 mei 2017

Contact

Redacteur / secretaris
Arjan Polderman

(070) 373 73 14 npfo@npfo.nl