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.

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

Farmacokinetiek van gemalen elvitegravir in combinatie met sondevoeding

András Vermes

Rubriek: Referaat
Identificatie: 2017;2:e1639
Datum: 9 mei 2017

Effect van medicatieverificatie door de apotheker op onbedoelde medicatiediscrepanties bij opname op en ontslag van de intensive care

E. Meuwese a, B.E. Bosma b*, N.G.M. Hunfeld ac, R.A.M. Quax ad, K.C.F. Hemesath ae, C. van Wijngaarden af, Z. Aref ae, R. Hassan ae en P.M.L.A. van den Bemt a

Lees abstract

Effect of medication reconciliation by a pharmacist on unintended medication discrepancies at admission to and discharge from the intensive care unit

BACKGROUND

The transfer of patients to and from the intensive care unit (ICU) is prone to medication errors.

OBJECTIVE

To study the effect of medication reconciliation by a pharmacist on the frequency and type of unintended medication discrepancies at admission to and discharge from the ICU.

DESIGN AND METHODS

A prospective intervention study with a pre- and post-design was carried out on the ICU of the Erasmus MC. The proportion of patients with one or more unintended medication discrepancies at admission to and discharge from the ICU was compared before and after the implementation of medication reconciliation by a pharmacist.

RESULTS

159 patients were included during the pre-intervention phase and 129 patients during the post-intervention phase. The proportion of patients with at least one unintended medication discrepancy 24 hours after admission to the ICU was reduced from 48.4 to 13.4% (OR 0.16; CI95 0.09-0.30). At discharge from the ICU this proportion was reduced from 71.9 to 37.6% (OR 0.24; CI95 0.14-0.41). The most frequently occurring type of medication discrepancy was an omission, explaining 80.9% of the discrepancies at admission and 76.5% at discharge. The type of discrepancies at admission was not significantly different between the pre- and post-intervention phase. At discharge the frequency of dosing errors was significantly reduced from 10.9% to 1.4%.

CONCLUSION

Medication reconciliation by a pharmacist significantly reduces the proportion of unintended medication discrepancies at admission to and discharge from the ICU.

Rubriek: Korte bijdrage
Identificatie: 2017;2:a1646
Datum: 4 mei 2017

Biomarkers voor de voorspelling van nierfunctieafname bij patiënten met diabetes mellitus

Bob Wilffert

Rubriek: Referaat
Identificatie: 2017;2:e1638
Datum: 10 april 2017

Genotypering VKORC1 en CYP2C9 bij dosering van acenocoumarol en fenprocoumon

Bob Wilffert

Rubriek: Referaat
Identificatie: 2017;2:e1637
Datum: 3 april 2017

Productzorg in de opleiding

Yvonne Bouwman

Rubriek: Referaat
Identificatie: 2017;2:e1636
Datum: 3 april 2017

Risico’s en klinische relevantie van medicatiediscrepanties op poliklinieken voor angst- en stemmingsstoornissen (verkorte vertaling)

Mirjam Simoons abc, Hans Mulder ad*, Arne J. Risselada a, Frederik W. Wilmink e, Robert A. Schoevers c, Henricus G. Ruhé cf† en Eric N. van Roon bg

Lees abstract

Risks and clinical relevance of medication discrepancies at outpatient departments for mood and anxiety disorders

OBJECTIVE

To identify discrepancies between actual drug use by outpatients with mood and anxiety disorders and medication overviews from health care providers as well as to investigate the clinical relevance of those discrepancies.

DESIGN

Cross-sectional cohort study.

METHODS

We included adults visiting one of four participating outpatient departments for mood and anxiety disorders between March and November 2014. Primary outcome was the number of discrepancies between the actual medication use as determined by medication reconciliation with the patient and the medication overview from the outpatient department, general practitioner and community pharmacy. Our secondary outcome was the clinical relevance of discrepancies, as assessed by an expert panel that reviewed all discrepancies for their potential to cause patient harm.

RESULTS

Of 367 patients included, 94.8% had at least one discrepancy in the medication overview from the outpatient department. On average 3.9 discrepancies existed per patient. Of all discrepancies at the outpatient departments, 22.7% had the potential to cause moderate to severe discomfort or clinical deterioration, affecting 49.3% of the patients. Both total number and number of clinically relevant discrepancies were lower in medication overviews from general practitioners and pharmacies.

CONCLUSION

Patients from outpatient departments for mood and anxiety disorders may be at substantial risk of medication discrepancies which are often clinically relevant. Medication reconciliation at mental health care outpatient departments is in need of improvement.

Rubriek: Korte bijdrage
Identificatie: 2017;2:a1644
Datum: 28 maart 2017

De prevalentie van incorrecte anti-Xa-bloedspiegels bij patiënten met een verminderde nierfunctie die laag-moleculairgewicht-heparines gebruiken

Y. Latify a*, H.J. Derijks bc, D. Hollander d, N. Péquériaux e en R.J. van Marumfg

Lees abstract

The prevalence of incorrect anti-Xa activity in patients with renal insufficiency who use low-molecular-weight heparins

OBJECTIVE

To determine the prevalence of incorrect anti-Xa activity in patients with renal insufficiency after three days of therapeutic use of nadroparin, as advised in the guideline of the Dutch federation of Nephrology.

DESIGN

Prospective, observational study.

METHODS

The source population consisted of patients aged ≥18 years old with renal insufficiency (eGFR [MDRD] < 60 mL/min/1.73 m2) from the Jeroen Bosch hospital who were treated therapeutically with nadroparin. All patients were followed from the start of nadroparin use (index date) for three days. At day three (t=3) the anti-Xa activity was monitored. Weight, eGFR (MDRD) and nadroparin use during the three days were obtained from the electronic patient file. We also checked if the patients received a dose of nadroparin according to the guideline during the three days of use.

RESULTS

In total 15 patients were included. Nadroparin dose was not adjusted according to the guideline in 13 patients. 4 of these patients (31%) still had a correct anti-Xa activity at t=3 and 9 had an incorrect anti-Xa activity. Only 2 patients received a nadroparin dose according to the guideline but had an incorrect anti-Xa activity at t=3.

CONCLUSION

The results of this study suggest that therapeutic use of nadroparin with and without dose adjustment often leads to incorrect anti-Xa activity in patients with renal insufficiency. Therefore we advise to individualise nadroparin dose according to the first anti-Xa activity which is measured at day three of nadroparin use. To confirm this conclusion, additional research with more patients is needed.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1643
Datum: 28 maart 2017

Is er een plaats voor voedingsmiddelen verrijkt met fytosterolen bij cardiovasculair risicomanagement? Kritische analyse van de bewijskracht voor cholesterolverlaging

E.K. (Kim) Alting a, L.M. (Laura) Riphagen b, C.C.M. (Nynke) Schuiling-Veninga a, J.R.B.J. (Koos) Brouwers a en H.J. (Herman) Woerdenbag b*

Lees abstract

Is there a place for phytosterol-enriched food products in cardiovascular risk management? Critical analysis of the evidence for cholesterol reduction

OBJECTIVE

To analyse the literature of the past decade regarding the cholesterol-lowering effect of phytosterol-enriched food products.

DESIGN

A literature study over a 10-year period, 2006-2016.

METHODS

PubMed was searched, using MeSH terms and free search terms, for studies on the effect of phytosterol-enriched food products on serum cholesterol levels and on the additive effect of such products on the lipid-lowering effect of statins. Only randomized placebo-controlled clinical studies, published between January 2006 and May 2016 were included. Total cholesterol (TC) and LDL cholesterol were considered as outcome measures.

RESULTS

In total, 32 studies fulfilled the inclusion criteria. Most studies showed a significant reduction of TC and LDL cholesterol blood levels after a daily intake of phytosterol-enriched functional foods. Most studies were short, covering a period of about four weeks, and performed in relatively healthy populations. The optimal daily dose was 2-2.5 g of phytosterols. A daily dose of > 3 g did not result in an extra cholesterol-lowering effect. Combined with statins, phytosterol-containing functional foods may have an additional effect.

CONCLUSION

Despite the positive effect of phytosterol-enriched food products in hypercholesteraemic patients as reported in various studies, inclusion of these food products in the guidelines for cardiovascular risk management is not yet justified. From the studies performed so far, no evidence was obtained on long-term effects or on the effect on cardiovascular morbidity and mortality. These issues are still to be addressed.

Rubriek: Overzichtsartikel
Identificatie: 2017;2:a1641
Datum: 28 maart 2017

Contact

Redacteur / secretaris
Arjan Polderman

(070) 373 73 14 npfo@knmp.nl