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  • 1
    ISSN: 1432-1041
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1041
    Keywords: Key words Osteoporosis ; Treatment ; Bisphosphonates
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To investigate whether the alkylbisphosphonate etidronate is associated with an increased risk of gastrointestinal symptoms. Methods: We conducted an observational follow-up study on a possible relationship between etidronate use and the risk of gastrointestinal symptoms in a cohort of 2754 women over 50 years of age. The study was performed with data on drug prescriptions obtained from the PHARMO database in the Netherlands. Women were included when they used either cyclical etidronate (n=1050) or estrogen (n=1704) for at least 14 days. They were followed-up for incident use of antiulcer drugs while on exposure medication. Results: The mean ages were 72 years and 59 years in the etidronate and estrogen groups, respectively. In total, there were 95 women with incident prescriptions for gastrointestinal events after a median duration of follow-up of 2.7 months (range 0.1–19.4 months). The crude relative risk of a gastrointestinal event for etidronate compared with estrogen use was 1.2 [95% confidence interval (95% CI) 0.8–1.8]. Adjusted for baseline age, use of corticosteroids, salicylates and nonsteroidal anti-inflammatory drugs, the relative risk reversed to 0.6 (95% CI 0.4–1.2). Conclusion: The use of cyclical etidronate is not associated with an elevated risk of symptoms of peptic ulcer disease.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1041
    Keywords: Drug–drug interaction Pharmacovigilance Spontaneous reporting system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract. Objective: Drug–drug interactions are relatively rarely reported to spontaneous reporting systems (SRSs) for adverse drug reactions. For this reason, the traditional approach for analysing SRS has major limitations for the detection of drug–drug interactions. We developed a method that may enable signalling of these possible interactions, which are often not explicitly reported, utilising reports of adverse drug reactions in data sets of SRS. As an example, the influence of concomitant use of diuretics and non-steroidal anti-inflammatory drugs (NSAIDs) on symptoms indicating a decreased efficacy of diuretics was examined using reports received by the Netherlands Pharmacovigilance Foundation Lareb. Methods: Reports received between 1 January 1990 and 1 January 1999 of patients older than 50 years were included in the study. Cases were defined as reports with symptoms indicating a decreased efficacy of diuretics, non-cases as all other reports. Exposure categories were the use of NSAIDs or diuretics versus the use of neither of these drugs. The influence of the combined use of both drugs was examined using logistic regression analysis. Results: The odds ratio of the statistical interaction term of the combined use of both drugs was increased [adjusted odds ratio 2.0, 95% confidence interval (CI) 1.1–3.7], which may indicate an enhanced effect of concomitant drug use. Conclusion: The findings illustrate that spontaneous reporting systems have a potential for signal detection and the analysis of possible drug–drug interactions. The method described may enable a more active approach in the detection of drug–drug interactions after marketing.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Notes: Pharmacogenomics is the study of the myriad interactions between genes and pharmacotherapy. Developments in pharmacogenomics have changed and will affect pharmaceutical research, drug development and the practice of medicine in a significant way. In this article, we make an inventory of the ethical implications that might arise as a result of possible developments in pharmacogenomics and investigate whether the present ethical framework will be able to adequately answer arising questions.We think that many of the questions related to the consequences of pharmacogenomics are answerable along the lines of present ethical thinking. We also believe, however, that many ‘changes of degree’ may result in a ‘change of kind.’ We therefore think that pharmacogenomics may potentially have such a profound influence on scientific research and the pharmaceutical industry, the practice of medicine and society at large, that this will generate its own unique dynamic, which will require new ethical research. We suggest that the notion of ‘responsibility’ will be a major focus of such research.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1573-739X
    Keywords: Adverse drug events ; Hospitalized patients ; Risk factors ; Pharmacoepidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Adverse drug events in hospitalized patients lead to increased morbidity, mortality and costs. Early detection of adverse drug events could aid in the prevention of these adverse outcomes. A cost‐effective system for the early detection of adverse drug events should focus on high risk patients. A study was set up with the primary aim to identify characteristics that are associated with the development of adverse drug events (ADEs) in hospitalized patients.ADE reports were gathered from physicians and nurses (spontaneous reports) and from patients after intensive ward interviews by hospital pharmacists. All patients admitted to the internal medicine wards of two Dutch hospitals, during a two month period, were included.The following characteristics were analyzed for their potential relationship to the occurence of ADEs: age (categorized), gender, number of drugs prescribed during hospital stay, types of drugs used and changes in drug use on admission.Age was found to be inversely associated with the development of ADEs (OR 0.36, CI 0.21‐0.61 for age category 〉 80 years; OR 0.56; CI 0.31‐1.02 for age category 75‐80 years and OR 0.69; CI 0.42‐1.11 for age category 60‐74 years). Furthermore, statistically significant associations were found for the number of drugs prescribed per hospitalized patient (for the class of 4‐6 drugs per patient OR 2.61, CI 1.32‐5.18), for newly prescribed drugs (OR 6.65, CI 2.63‐16.81) and for the cessation of drugs on hospital admission (OR 1.50, CI 1.02‐2.20). The use of gastrointestinal drugs (OR 2.13, CI 1.32‐3.45), central nervous system drugs (OR 1.66, CI 1.07‐2.57) and antibiotics (OR 2.44, CI 1.65‐3.60) were associated with the development of ADEs, when compared to all other drugs taken by the patients.In this study, the most important risk factors are the number of drugs used per patient and the starting of a new drug during hospitalization. As most hospitalized patients start new drug therapies while in hospital, this seems an inappropriate focus. However, careful monitoring of patients using more than 7 drugs at a time may be possible in a cost‐effective system for the early detection of ADEs.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-739X
    Keywords: Benzodiazepines ; Health Status ; RAND‐36 ; PCS ; MCS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The relationship between characteristics of benzodiazepine exposure and health‐status was examined in order to investigate risk profiles of benzodiazepine users.In the only pharmacy of a Dutch community of 13,500 inhabitants, all current benzodiazepine users that presented with a benzodiazepine prescription in November 1994 were invited to participate. On the basis of the RAND‐36 questionnaire, summary scores for both physical and mental health were calculated, the Physical Component Summary (PCS) and the Mental Component Summary (MCS). After dichotomization with a cut‐off point indicating seriously impaired health and after the combination of the PCS and MCS, four different categories of health status could be identified. We used logistic regression to study the relation between these four different groups with respect to benzodiazepine exposure.In total a group of 360 current benzodiazepine users was studied. Results showed that almost one‐third of the participants had no significant impaired health; this group was further classified as reference group. We classified three other groups: one with physical problems (31%), one with mental problems (18%), and one with a combination of the two (22%). Multivariate analysis showed differences in risk factors for an impaired health status. The group with impaired physical health was associated with self‐reported indication for muscle relaxation, hypnotic use, and a high CDS (Chronic Disease Score). The group with impaired mental health was associated with more frequent consulting of a mental health care specialist and with a low sense of self‐efficacy. The group with both impaired physical as well as mental health was associated with a higher incidence of widowhood, a lower sense of self‐efficacy, a high CDS, using benzodiazepines more than prescribed, and reporting depression as reason for their benzodiazepine use.In particular, two groups need critical examination: a group of apparently healthy users with long‐term benzodiazepine use; and a frail group with impaired physical and mental health and using a higher dose than prescribed. Patient counseling and management of these four groups can be tailored to the specific needs of each group.
    Type of Medium: Electronic Resource
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  • 7
    Publication Date: 2018-05-27
    Description: Objectives and setting Conflicting results from studies using electronic health records to evaluate the associations between type 2 diabetes and cancer fuel concerns regarding potential biases. This study aimed to describe completeness of cancer recording in UK primary care data linked to hospital admissions records. Design Patients aged 40+ years with insulin or oral antidiabetic prescriptions in Clinical Practice Research Datalink (CPRD) primary care without type 1 diabetes were matched by age, sex and general practitioner practice to non-diabetics. Those eligible for linkage to Hospital Episode Statistics Admitted Patient Care (HES APC), and with follow-up during April 1997–December 2006 were included. Primary and secondary outcome measures Cancer recording and date of first record of cancer were compared. Characteristics of patients with cancer most likely to have the diagnosis recorded only in a single data source were assessed. Relative rates of cancer estimated from the two datasets were compared. Participants 53 585 patients with type 2 diabetes matched to 47 435 patients without diabetes were included. Results Of all cancers (excluding non-melanoma skin cancer) recorded in CPRD, 83% were recorded in HES APC. 94% of cases in HES APC were recorded in CPRD. Concordance was lower when restricted to same-site cancer records, and was negatively associated with increasing age. Relative rates for cancer were similar in both datasets. Conclusions Good concordance in cancer recording was found between CPRD and HES APC among type 2 diabetics and matched controls. Linked data may reduce misclassification and increase case ascertainment when analysis focuses on site-specific cancers.
    Keywords: Open access, Epidemiology
    Electronic ISSN: 2044-6055
    Topics: Medicine
    Published by BMJ Publishing
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  • 8
    Publication Date: 2018-06-29
    Description: Response to proposal for a novel cancer drug pricing model Response to proposal for a novel cancer drug pricing model, Published online: 28 June 2018; doi:10.1038/s41571-018-0062-7 Response to proposal for a novel cancer drug pricing model
    Print ISSN: 1759-4774
    Electronic ISSN: 1759-4782
    Topics: Medicine
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