Hospital Pharmacist

Valenciennes, France

Hospital Pharmacist

Valenciennes, France

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Van Haelst I.M.M.,Hospital Pharmacist | Van Klei W.A.,Intensive Care and Emergency Medicine | Warnier M.J.,University Utrecht | De Bruin M.L.,University Utrecht | And 2 more authors.
Journal of Clinical Psychiatry | Year: 2014

Objective: To investigate the association between the use of a selective serotonin reuptake inhibitor (SSRI) and the occurrence of QT interval prolongation in an elderly surgical population. Method: A cross-sectional study was conducted among patients (> 60 years) scheduled for outpatient preanesthesia evaluation in the period 2007 until 2012. The index group included elderly users of an SSRI. The reference group of nonusers of antidepressants was matched to the index group on sex and year of scheduled surgery (ratio, 1:1). The primary outcome was the occurrence of QT interval prolongation shown on electrocardiogram. The QT interval was corrected for heart rate (QTc interval). The secondary outcome was the duration of the QTc interval. The outcomes were adjusted for confounding by using regression techniques. Results: The index and reference groups included 397 users of an SSRI and 397 nonusers, respectively. QTc interval prolongation occurred in 25 (6%) and 19 (5%) index and reference patients, respectively. After adjustment for confounding, users of an SSRI did not have a higher risk for QTc interval prolongation compared to nonusers: OR = 1.1 (95% CI, 0.5 to 2.0). The adjusted mean QTc interval length in users of an SSRI and nonusers was comparable (difference of 1.5 milliseconds [95% CI, -1.8 to 4.8]). Use of the most frequently used SSRIs citalopram and paroxetine was not associated with a higher risk of QTc interval prolongation nor with lengthening of the QTc interval duration. Conclusions: The use of an SSRI by elderly surgical patients was not associated with the occurrence of QT interval prolongation. © Copyright 2013 Physicians Postgraduate Press, Inc.


Van Haelst I.M.M.,Hospital Pharmacist | Van Haelst I.M.M.,University Utrecht | Egberts T.C.G.,University Medical Center | Egberts T.C.G.,University Utrecht | And 3 more authors.
Anesthesiology | Year: 2010

Background: Selective serotonin reuptake inhibitors have been associated with an increased bleeding tendency. Information on the impact of a possible impaired hemostasis associated with the perioperative use of selective serotonin reuptake inhibitors is limited. This study aimed to determine the association between the perioperative use of selective serotonin reuptake inhibitors and the amount of blood loss during surgery and perioperative transfusion requirements. Methods: The authors conducted a retrospective cohort study among patients who underwent elective primary total hip arthroplasty in two hospitals from the period of July 1, 2004 until July 1, 2008. The index group included all users of both serotonergic and nonserotonergic antidepressants. The reference group included a random sample (ratio 1:3) of nonusers. The primary outcome was the amount of intraoperative blood loss. The requirement for blood transfusion was a secondary outcome. The outcomes were adjusted for confounding factors (comorbidity and comedication) using regression techniques. Results: The index group included 66 users of serotonergic and 29 users of nonserotonergic antidepressants, and the reference group included 285 patients. After adjustment for confounding factors, mean blood loss during surgery was significantly higher in the users of selective serotonin reuptake inhibitors when compared with the reference group: 95 ml (95% CI 9-181). Mean blood loss in the users of nonserotonergic antidepressants did not differ from the reference group. Users of antidepressants did not have a higher risk for transfusion. Conclusions: Patients undergoing total hip arthroplasty who continue the use of serotonergic antidepressants show a significantly higher, but clinically unimportant, intraoperative blood loss, without an increase in perioperative transfusion requirements. Copyright © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.


Ullah I.,University of Swabi | Ullah I.,University of Peshawar | Subhan F.,University of Peshawar | Ayaz M.,University of Malakand | And 5 more authors.
BMC Complementary and Alternative Medicine | Year: 2015

Background: Zingiber officinale (ZO, family Zingiberaceae) has been reported for its antiemetic activity against cancer chemotherapy induced emesis in animal models and in clinics. Current study was designed to investigate ZO for potential usefulness against cisplatin induced vomiting in pigeon and its effects on central and peripheral neurotransmitters involved in the act of vomiting. Methods: Zingiber officinale acetone fraction (ZO-ActFr) was investigated for attenuation of emesis induced by cisplatin in healthy pigeons. Neurotransmitters DA, 5HT and their metabolites DOPAC, HVA and 5HIAA were analyzed using High Performance Liquid Chromatography system coupled with electrochemical detector in area postrema, brain stem and intestine. Antiemetic effect of ZO-ActFr was correlated with central and intestinal neurotransmitters levels in pigeon. Results: Cisplatin (7mg/kg i.v.) induced emesis without lethality upto the observation period. ZO-ActFr (25, 50 & 100mg/kg) attenuated cisplatin induced emesis~44.18%, 58.13% (P<0.05) and 27.9%, respectively; the reference drug, metoclopramide (MCP; 30mg/kg), produced~48.83% reduction (P<0.05). ZO-ActFr reduced (P<0.05 - 0.001) 5-hydroxytryptamine (5HT) concentration in the area postrema, brain stem and intestine at 3rd hour of cisplatin administration, while at the 18th hour ZO treatments attenuated the dopamine upsurge (P<0.001) caused by cisplatin in the area postrema and 5HT concentration (P<0.01 - 0.001) in the brain stem and intestine. ZO treatments alone did not altered the basal neurotransmitters and their metabolites in the brain areas and intestine. Conclusion: The behavioral study verify the antiemetic profile of ZO against cisplatin induced emesis in the pigeon, where central and peripheral neural evidences advocate the involvement of serotonergic mechanism at initial time point (3rd hr), while the later time point (18th hr) is associated with serotonergic and dopaminergic component in the mediation of its antiemetic effect. © Ullah et al.; licensee BioMed Central.


Karapinar-Carkit F.,Sint Lucas Andreas Hospital | Karapinar-Carkit F.,University Utrecht | Borgsteede S.D.,Community Pharmacy | Zoer J.,Hospital Pharmacist | And 3 more authors.
Annals of Pharmacotherapy | Year: 2012

BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included. RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved?1 €63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and?9 €79 at 6 months. Optimizing pharmacotherapy saved?20 euro;13/patient in medication costs at 1 month and? €86.86 at 6 months. The associated labor costs for performing medication reconciliation were? €41.04/patient. Medication cost savings from correcting hospital formularyinduced changes and optimizing of pharmacotherapy?(€96.65/patient) outweighed the labor costs at 6 months extrapolation by? €55.62/patient (sensitivity analysis?€ 37.25-71.10). CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.


Santoleri F.,Hospital Pharmacist | Sorice P.,Hospital Pharmacist | Lasala R.,Hospital Pharmacist | Rizzo R.C.,Hospital Pharmacist | Costantini A.,Hospital Pharmacist
PLoS ONE | Year: 2013

Introduction: The aim of this study is to evaluate adherence and persistence of patients treated with Imatinib, Nilotinib or Dasatinib, also giving economic evaluations on therapy costs for Received Daily Dose (RDD). Materials and Methods: In this retrospective study, we took into account 3 years from 1st Jan. 2009 to 31st March.2012. Treatment adherence was quantified utilizing ratio between RDD and PDD (Prescribed Daily Dose). Persistence is reckoned taking into account the actual therapy days, comparing posology with supplied dose, drawing the graph using Kaplan-Meir method. Results: Adherence results in values between 0.8 and 1.0 for Nilotinib (Adh = 0.93), Imatinib (Adh = 0.83) and Dasatinib (0.85). Imatinib has better persistence, 90% of patients in treatment exceed one year of treatment versus 83.3% for Nilotinib and 80% for Dasatinib. The cost per single day of treatment (cost per RDD) was € 39.41 for Imatinib, € 113.60 for Nilotinib and € 94.84 for Dasatinib. Conclusion: Patients with CML have a loose of adherence both in first line with Imatinib and in second line of therapy with Dasatinib and Nilotinib. Loss of adherence remains a big problem and could be minimized by a patient-oriented project invlolving physicians, nurses, pharmacists and caregiver. © 2013 santoleri et al.


Simons-Sanders K.,Hospital Pharmacist | Crul M.,Hospital Pharmacist
European Journal of Oncology Pharmacy | Year: 2013

A national clinical rule for proper handling of methotrexate was developed and implemented in The Netherlands in 2010 following a number of fatal incidents. The aim was to increase patient safety by preventing dispensing errors. Interventions implemented and results obtained in two hospitals are discussed. © 2013 Pharma Publishing and Media Europe. All rights reserved.


Lopez Tricas J.M.,Hospital Pharmacist
Atencion Farmaceutica | Year: 2014

Evaluation of carfilzomib, an inhibitor of the proteasomic cellular system, the main system of degradation of proteins in the cells. The deciphering of the protea-some structure and mechanism of action signified a scientific breakthrough worthy of the Nobel Prize award in chemistry for its discoverers, Aaron Ciechanover, Avram Hershiko, and Irwin Rose, in 2004. Carfilzomib represents an improvement in relation to bortezomib in several aspects: specificity of action, irreversible inhibition of the proteasome system (according to initial studies) reduced incidence of peripheral neuropathy; and mainly clinical efficacy in patients who are either refractory, or have relapsed after treatment with bortezomib. Carfilzomib is indicated in mono-therapy regimen, or included in more complex treatment protocols. Carfilzomib seems to be a breakthrough for the treatment of the most complex multiple myeloma stages.


Fadda V.,Hospital Pharmacist | Maratea D.,Hospital Pharmacist
Recenti Progressi in Medicina | Year: 2015

Background. When analyzing the use of luteinising hormone-releasing hormone (LHRH) analogues for different clinical indications, current available evidence does not support a presumed drug class effect among the various LHRH in the treatment of prostate cancer. Methods. The following search key words were entered in the PubMed database and the NICE and FDA websites: "LHRH agonist AND prostatic cancer", "androgen deprivation therapy", "androgen suppression", "buserelin", "leuprorelin", "goserelin", "triptorelin", "degarelix". The direct costs included the following items: follow-up visits, diagnostic exams (e.g. prostate-specific antigen PSA) and drug costs. The indirect costs included working days lost by the patient. Results. With intermittent therapy as a reference, leuprorelin injectable solution of 22,25 mg was associated with the lowest cost and degarelix with the highest cost. However, given the mandatory presence of a nurse for drug injection, the buserelin depot formulation was associated with the lowest cost. If the costs for hospital visits were added to drug costs, differences between the various therapeutic strategies were less remarkable. Conclusions. Our study showed how various factors (e.g. route of administration, frequency of administration, presence of a nurse for drug reconstitution and injection) should be taken into account by decision makers in addition to the price of drugs.


PubMed | Hospital Pharmacist
Type: Journal Article | Journal: The Journal of clinical psychiatry | Year: 2014

To investigate the association between the use of a selective serotonin reuptake inhibitor (SSRI) and the occurrence of QT interval prolongation in an elderly surgical population.A cross-sectional study was conducted among patients (> 60 years) scheduled for outpatient preanesthesia evaluation in the period 2007 until 2012. The index group included elderly users of an SSRI. The reference group of nonusers of antidepressants was matched to the index group on sex and year of scheduled surgery (ratio, 1:1). The primary outcome was the occurrence of QT interval prolongation shown on electrocardiogram. The QT interval was corrected for heart rate (QTc interval). The secondary outcome was the duration of the QTc interval. The outcomes were adjusted for confounding by using regression techniques.The index and reference groups included 397 users of an SSRI and 397 nonusers, respectively. QTc interval prolongation occurred in 25 (6%) and 19 (5%) index and reference patients, respectively. After adjustment for confounding, users of an SSRI did not have a higher risk for QTc interval prolongation compared to nonusers: OR = 1.1 (95% CI, 0.5 to 2.0). The adjusted mean QTc interval length in users of an SSRI and nonusers was comparable (difference of 1.5 milliseconds [95% CI, -1.8 to 4.8]). Use of the most frequently used SSRIs citalopram and paroxetine was not associated with a higher risk of QTc interval prolongation nor with lengthening of the QTc interval duration.The use of an SSRI by elderly surgical patients was not associated with the occurrence of QT interval prolongation.


PubMed | Hospital Pharmacist
Type: Journal Article | Journal: PloS one | Year: 2013

The aim of this study is to evaluate adherence and persistence of patients treated with Imatinib, Nilotinib or Dasatinib, also giving economic evaluations on therapy costs for Received Daily Dose (RDD).In this retrospective study, we took into account 3 years from 1st Jan. 2009 to 31st March.2012. Treatment adherence was quantified utilizing ratio between RDD and PDD (Prescribed Daily Dose). Persistence is reckoned taking into account the actual therapy days, comparing posology with supplied dose, drawing the graph using Kaplan-Meir method.Adherence results in values between 0.8 and 1.0 for Nilotinib (Adh =0.93), Imatinib (Adh =0.83) and Dasatinib (0.85). Imatinib has better persistence, 90% of patients in treatment exceed one year of treatment versus 83.3% for Nilotinib and 80% for Dasatinib. The cost per single day of treatment (cost per RDD) was 39.41 for Imatinib, 113.60 for Nilotinib and 94.84 for Dasatinib.Patients with CML have a loose of adherence both in first line with Imatinib and in second line of therapy with Dasatinib and Nilotinib. Loss of adherence remains a big problem and could be minimized by a patient-oriented project invlolving physicians, nurses, pharmacists and caregiver.

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