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Abdel Shaheed C, Hayes C, Maher CG, Ballantyne JC, Underwood M, McLachlan AJ, Martin JH, Narayan SW, Sidhom MA. Opioid analgesics for nociceptive cancer pain: A comprehensive review. CA Cancer J Clin 2023. [PMID: 38108561 DOI: 10.3322/caac.21823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite stable and adequately controlled background pain). They found a paucity of placebo-controlled trials for background cancer pain, although tapentadol or codeine may be more efficacious than placebo (moderate-certainty to low-certainty evidence). Nonsteroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac, ketorolac, and the antidepressant medicine imipramine, may be at least as efficacious as opioids for moderate-to-severe background cancer pain. For breakthrough cancer pain, oral transmucosal, buccal, sublingual, or intranasal fentanyl preparations were identified as more efficacious than placebo but were more commonly associated with toxicities, including constipation and nausea. Despite being recommended worldwide for the treatment of cancer pain, morphine was generally not superior to other opioids, nor did it have a more favorable toxicity profile. The interpretation of study results, however, was complicated by the heterogeneity in the study populations evaluated. Given the limited quality and quantity of research, there is a need to reappraise the clinical utility of opioids in people with cancer pain, particularly those who are not at the end of life, and to further explore the effects of opioids on immune system function and quality of life in these individuals.
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Affiliation(s)
- Christina Abdel Shaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Christopher Hayes
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher G Maher
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jane C Ballantyne
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- University Hospitals of Coventry and Warwickshire, Coventry, United Kingdom
| | - Andrew J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer H Martin
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sujita W Narayan
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
| | - Mark A Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Narayan SW, Gad F, Chong J, Chen VM, Patanwala AE. Preventability of Venous Thromboembolism in Hospitalised Patients. Intern Med J 2021; 53:577-583. [PMID: 34719859 DOI: 10.1111/imj.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hospital-acquired venous thromboembolism (VTE) is a major cause of morbidity and mortality. AIM Our study aimed to determine the proportion of patients with hospital-acquired VTE that are preventable. METHODS This was a retrospective study of patients in two tertiary care hospitals in Sydney, Australia. Data were collected for patients with hospital-acquired VTE based on ICD-10-AM coding from January 2018 to May 2020. Patients were classified as low, moderate or high risk of developing a VTE during hospitalization based on demographic and clinical factors. A hospital-acquired VTE was considered to be potentially preventable if there was suboptimal prophylaxis in the absence of contraindications. Suboptimal therapy included at least one of the following related to VTE prophylaxis: low dose, missed dose (prior to developing a VTE), suboptimal drug, and delayed start (>24 hours from admission). RESULTS There were 229 patients identified with VTE based on ICD-10-AM coding. A subset of 135 were determined to have actual hospital-acquired VTEs. Of these, there were no patients at low risk, 64% (87/135) at moderate risk, and 44% (48/135) at high risk of developing a VTE. Most patients (65%, n=88/135) had one or more contraindications to receive recommended prophylaxis. Overall, the proportion of patients who received suboptimal prophylaxis was 11% (15/135). CONCLUSION Approximately, 1 in 10 hospital-acquired VTE are preventable. Hospitals should focus on measuring and reporting VTE that are preventable to provide a more accurate measure of the burden of VTEs that can be reduced by improving care. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Fady Gad
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Julianne Chong
- Concord Repatriation General Hospital, Sydney, Australia
| | - Vivien M Chen
- Concord Repatriation General Hospital, Sydney, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
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Tay HP, Wang X, Narayan SW, Penm J, Patanwala AE. Persistent postoperative opioid use after total hip or knee arthroplasty: A systematic review and meta-analysis. Am J Health Syst Pharm 2021; 79:147-164. [PMID: 34537828 PMCID: PMC8513405 DOI: 10.1093/ajhp/zxab367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To identify the proportion of patients with continued opioid use after total hip or knee arthroplasty. Methods This systematic review and meta-analysis searched Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts for articles published from January 1, 2009, to May 26, 2021. The search terms (opioid, postoperative, hospital discharge, total hip or knee arthroplasty, and treatment duration) were based on 5 key concepts. We included studies of adults who underwent total hip or knee arthroplasty, with at least 3 months postoperative follow-up. Results There were 30 studies included. Of these, 17 reported on outcomes of total hip arthroplasty and 19 reported on outcomes of total knee arthroplasty, with some reporting on outcomes of both procedures. In patients having total hip arthroplasty, rates of postoperative opioid use at various time points were as follows: at 3 months, 20% (95% CI, 13%-26%); at 6 months, 17% (95% CI, 12%-21%); at 9 months, 19% (95% CI, 13%-24%); and at 12 months, 16% (95% CI, 15%-16%). In patients who underwent total knee arthroplasty, rates of postoperative opioid use were as follows: at 3 months, 26% (95% CI, 19%-33%); at 6 months, 20% (95% CI, 17%-24%); at 9 months, 23% (95% CI, 17%-28%); and at 12 months, 21% (95% CI, 12%-29%). Opioid naïve patients were less likely to have continued postoperative opioid use than those who were opioid tolerant preoperatively. Conclusion Over 1 in 5 patients continued opioid use for longer than 3 months after total hip or knee arthroplasty. Clinicians should be aware of this trajectory of opioid consumption after surgery.
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Affiliation(s)
- Hui Ping Tay
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Xinyi Wang
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Sujita W Narayan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.,Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Abu Sardaneh A, Goradia S, Narayan SW, Penm J, McLachlan AJ, Patanwala AE. Dose equivalence between metaraminol and norepinephrine in critical care. Br J Clin Pharmacol 2021; 88:303-310. [PMID: 34197654 DOI: 10.1111/bcp.14969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was to determine the conversion dose ratio between continuous infusion metaraminol and norepinephrine in critically ill patients with shock. METHODS A retrospective cohort study was conducted in adult patients with shock admitted to an intensive care unit from 29 October 2018 to 30 October 2019 and who transitioned from metaraminol monotherapy to norepinephrine monotherapy. Mean arterial pressure (MAP) and infusion doses for both drugs were collected at hourly intervals; 2 hours before to 5 hours after switching from metaraminol monotherapy to norepinephrine monotherapy. The conversion dose ratio was defined as the ratio of metaraminol (μg.kg-1 .min-1) : norepinephrine (μg.kg-1 .min-1 ) required to achieve a similar MAP. RESULTS A total of 43 out of 144 eligible patients were included. The median age was 68 years (IQR 56-76) and 22 (51%) were male. There was no significant difference between the baseline MAP during metaraminol monotherapy (median 71 mm Hg, IQR 66-76) and the post-transition MAP during norepinephrine monotherapy (median 70 mm Hg, IQR 66-73) (P = .09). The median conversion dose ratio between metaraminol and norepinephrine was 13 (IQR 7-24). In the sensitivity analyses, the median conversion dose ratio using the maximum and the mean norepinephrine infusion dose was 8 (IQR 5-16) and 12 (IQR 8-23), respectively. CONCLUSION A conversion dose ratio of 10:1 (metaraminol μg.kg-1 .min-1 :norepinephrine μg.kg-1 .min-1 ) may be used in critically ill patients with shock to account for ease of calculations and variability of the conversion ratio in the primary and sensitivity analyses.
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Affiliation(s)
- Arwa Abu Sardaneh
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Shruti Goradia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew J McLachlan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Patanwala AE, Narayan SW, Haas CE, Abraham I, Sanders A, Erstad BL. Proposed guidance on cost-avoidance studies in pharmacy practice. Am J Health Syst Pharm 2021; 78:1559-1567. [PMID: 34007979 DOI: 10.1093/ajhp/zxab211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. SUMMARY Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists' action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. CONCLUSIONS Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.
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Affiliation(s)
- Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
| | - Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
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Narayan SW, Abraham I, Erstad BL, Haas CE, Sanders A, Patanwala AE. Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review. Am J Health Syst Pharm 2021; 78:1576-1590. [PMID: 34003209 DOI: 10.1093/ajhp/zxab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists' interventions in acute care settings. METHODS An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. RESULTS The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. CONCLUSION Cost-avoidance studies of pharmacists' interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.
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Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
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Wang X, Narayan SW, Penm J, Johnstone C, Patanwala AE. Gastrointestinal Adverse Events in Hospitalized Patients Following Orthopedic Surgery: Tapentadol Immediate Release Versus Oxycodone Immediate Release. Pain Physician 2021; 24:E309-E315. [PMID: 33988952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Tapentadol has relatively less effect on mu-opioid receptors compared with other opioids. This has the potential to reduce the occurrence of gastrointestinal (GI) adverse drug events (ADEs). OBJECTIVES To compare the GI ADEs during hospitalization between tapentadol immediate release (IR) and oxycodone IR following orthopedic surgeries. STUDY DESIGN Retrospective cohort study. SETTING A major metropolitan tertiary referral hospital in Australia. METHODS Data for adult orthopedic surgery patients receiving postoperative tapentadol IR or oxycodone IR during hospitalization between January 1, 2018 and June 30, 2019, were collected from electronic medical records. The primary outcome was the occurrence of postoperative GI ADEs occurring during hospitalization. This was defined as a composite of nausea, vomiting, or constipation. RESULTS The study cohort included 199 patients. Of these, 99 patients received tapentadol IR and 100 patients received oxycodone IR for postoperative pain during hospitalization. The mean age was 66 ± 12 years, and 111 patients (56%) were women. There was no significant difference between groups on the occurrence of GI ADEs (53% in oxycodone group and 51% in tapentadol group, difference 2%, 95% confidence interval [CI], -11% to 16%; P = 0.777). After adjusting for potential confounders, the use of tapentadol IR was not associated with a significant reduction of GI ADEs (odds ratio, 0.62; 95% CI, 0.32-1.20; P = 0.154). LIMITATIONS This was a single-center study and should be extrapolated with caution. As this was a retrospective study, the accuracy and availability of data were dependent on documentation in electronic medical records. CONCLUSIONS Tapentadol IR is associated with similar GI ADE occurrence compared with oxycodone IR in patients with orthopedic postoperative pain during hospitalization.
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Affiliation(s)
- Xinyi Wang
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Sujita W Narayan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Charlotte Johnstone
- Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Narayan SW, Thoma Y, Drennan PG, Yejin Kim H, Alffenaar JW, Van Hal S, Patanwala AE. Predictive Performance of Bayesian Vancomycin Monitoring in the Critically Ill. Crit Care Med 2021; 49:e952-e960. [PMID: 33938713 DOI: 10.1097/ccm.0000000000005062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES It is recommended that therapeutic monitoring of vancomycin should be guided by 24-hour area under the curve concentration. This can be done via Bayesian models in dose-optimization software. However, before these models can be incorporated into clinical practice in the critically ill, their predictive performance needs to be evaluated. This study assesses the predictive performance of Bayesian models for vancomycin in the critically ill. DESIGN Retrospective cohort study. SETTING Single-center ICU. PATIENTS Data were obtained for all patients in the ICU between 1 January, and 31 May 2020, who received IV vancomycin. The predictive performance of three Bayesian models were evaluated based on their availability in commercially available software. Predictive performance was assessed via bias and precision. Bias was measured as the mean difference between observed and predicted vancomycin concentrations. Precision was measured as the SD of bias, root mean square error, and 95% limits of agreement based on Bland-Altman plots. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 466 concentrations from 188 patients were used to evaluate the three models. All models showed low bias (-1.7 to 1.8 mg/L), which was lower with a posteriori estimate (-0.7 to 1.8 mg/L). However, all three models showed low precision in terms of SD (4.7-8.8 mg/L) and root mean square error (4.8-8.9 mg/L). The models underpredicted at higher observed vancomycin concentrations (bias 0.7-3.2 mg/L for < 20 mg/L; -5.1 to -2.3 for ≥ 20 mg/L) and the Bland-Altman plots showed a great deviation between observed and predicted concentrations. CONCLUSIONS Bayesian models of vancomycin show not only low bias, but also low precision in the critically ill. Thus, Bayesian-guided dosing of vancomycin in this population should be used cautiously.
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Affiliation(s)
- Sujita W Narayan
- 1 The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia. 2 Reconfigurable and Embedded Digital Systems Institute, School of Business and Engineering Vaud, University of Applied Sciences Western Switzerland, Yverdon-les-Bains, Switzerland. 3 Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. 4 Westmead Hospital, Westmead, NSW, Australia. 5 Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia. 6 New South Wales Health Pathology, Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 7 Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Goradia S, Sardaneh AA, Narayan SW, Penm J, Patanwala AE. Vasopressor dose equivalence: A scoping review and suggested formula. J Crit Care 2021; 61:233-240. [DOI: 10.1016/j.jcrc.2020.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
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Abstract
PURPOSE Calculating equipotent doses between vasopressor agents is necessary in clinical practice and research pertaining to the management of shock. This scoping review summarizes conversion ratios between vasopressors and provides a formula to incorporate into study designs. MATERIALS AND METHODS Medline, Embase and Web of Science databases were searched from inception to 21st October 2020. Additional papers were obtained through bibliography searches of retrieved articles. Two investigators assessed articles for eligibility. Clinical trials comparing the potency of at least two intravenous vasopressors (norepinephrine, epinephrine, dopamine, phenylephrine, vasopressin, metaraminol or angiotensin II), with regard to an outcome of blood pressure, were selected. RESULTS Of 16,315 articles, 21 were included for synthesis. The range of conversion ratios equivalent to one unit of norepinephrine were: epinephrine (0.7-1.4), dopamine (75.2-144.4), metaraminol (8.3), phenylephrine (1.1-16.3), vasopressin (0.3-0.4) and angiotensin II (0.07-0.13). The following formula may be considered for the calculation of norepinephrine equivalents (NE) (all in mcg/kg/min, except vasopressin in units/min): NE = norepinephrine + epinephrine + phenylephrine/10 + dopamine/100 + metaraminol/8 + vasopressin*2.5 + angiotensin II*10. CONCLUSION A summary of equipotent ratios for common vasopressors used in clinical practice has been provided. Our formula may be considered to calculate NE for studies in the intensive care unit.
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Affiliation(s)
- Shruti Goradia
- The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia.
| | - Arwa Abu Sardaneh
- The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia.
| | - Sujita W Narayan
- The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia.
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia.
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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Narayan SW, Castelino R, Hammond N, Patanwala AE. Effect of mannitol plus hypertonic saline combination versus hypertonic saline monotherapy on acute kidney injury after traumatic brain injury. J Crit Care 2020; 57:220-224. [PMID: 32220771 DOI: 10.1016/j.jcrc.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the effect of mannitol plus hypertonic saline combination (MHS) versus hypertonic saline monotherapy (HS) on renal function in patients with traumatic brain injury (TBI). MATERIALS AND METHODS This was a secondary analysis of data from the Resuscitation Outcomes Consortium Hypertonic Saline Trial Shock Study and Traumatic Brain Injury Study. The study cohort included a propensity matched subset of patients with TBI who received MHS or HS. The primary outcome measure was the maximum serum creatinine value during critical illness. RESULTS The cohort consisted of 163 patients in the MHS group and 163 patients in the HS group (n = 326). The maximum serum creatinine value during hospitalization was 82 ± 47 μmol/L (0.86 ± 0.26 mg/dL) in the MHS group and 76 ± 23 μmol/L (0.92 ± 0.53 mg/dL) in the HS group (difference -6 μmol/L, 95% CI -14 to 2 μmol/L, p = .151). The lowest eGFR during hospitalization was 108 ± 25 mL/min in the MHS group and 112 ± 24 mL/min in the HS group (difference -4 mL/min, 95% CI -1 to 9 mLmin, p = .150). CONCLUSIONS The addition of mannitol to HS did not increase the risk of renal dysfunction compared to HS alone in patients with TBI.
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Affiliation(s)
- Sujita W Narayan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.
| | - Ronald Castelino
- The University of Sydney, Faculty of Medicine and Health, School of Nursing, Sydney, New South Wales, Australia; Pharmacy Department, Blacktown Hospital, New South Wales, Australia.
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonard's, New South Wales, Australia.
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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de Oliveira Costa J, Schaffer AL, Medland NA, Litchfield M, Narayan SW, Guy R, McManus H, Pearson SA. Adherence to Antiretroviral Regimens in Australia: A Nationwide Cohort Study. AIDS Patient Care STDS 2020; 34:81-91. [PMID: 32049558 DOI: 10.1089/apc.2019.0278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The lifetime use of combination antiretroviral therapy (cART) highlights the need to understand patterns of and factors associated with adherence to cART. In this cohort study using a 10% random sample of dispensing claims data for eligible Australians, we identified 2042 people dispensed cART between January 2016 and December 2017 (mean age 48.0 ± 12.0 years old, 88.6% male, and 85.9% treatment experienced). We considered people to be adherent if the proportion of treatment coverage days was ≥80% in the 360 days after their first observed cART dispensing. We also used group-based trajectory modeling (GBTM) to examine different patterns of adherence for 360 days from first observed cART dispensing. Most commonly, people receiving cART were treated with two nucleoside/nucleotide reverse transcriptase inhibitors with an integrase strand transfer inhibitors (INSTI-46.6%). Overall, 1708 people [83.6% (95% confidential interval 82.0-85.3%)] remained adherent over 360 days. GBTM identified three distinct adherence patterns: nearly always adherent [67.8% (63.7-71.9%) of the cohort], moderate adherence [26.6% (23.0-30.1%)], and low adherence [5.6% (4.1-7.2%)]. People were more likely to belong to the "nearly always adherent" trajectory if they were older (per additional year of age), treated with an INSTI regimen, and on treatment for more than 6 months. Our study demonstrates that the 360-day adherence to cART is generally high, but approximately one-third maintain a moderate or low adherence pattern. The use of INSTI regimens and additional support of treatment adherence, especially among younger people and those initiating therapy, may further improve adherence.
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Affiliation(s)
- Juliana de Oliveira Costa
- Faculty of Medicine, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
- Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andrea L. Schaffer
- Faculty of Medicine, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Melisa Litchfield
- Faculty of Medicine, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Sujita W. Narayan
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Sallie-Anne Pearson
- Faculty of Medicine, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
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Narayan SW, Yu Ho K, Penm J, Mintzes B, Mirzaei A, Schneider C, Patanwala AE. Missing data reporting in clinical pharmacy research. Am J Health Syst Pharm 2019; 76:2048-2052. [DOI: 10.1093/ajhp/zxz245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
This study aimed to document the ways by which missing data were handled in clinical pharmacy research to provide an insight into the amount of attention paid to the importance of missing data in this field of research.
Methods
Our cross-sectional descriptive report evaluated 10 journals affiliated with pharmacy organizations in the United States, Canada, the United Kingdom, and Australia. Randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in 2018 were included. The primary outcome measure was the proportion of studies that reported the handling of missing data in their methods or results.
Results
A total of 178 studies were included in the analysis. Of these, 19.7% (n = 35) mentioned missing data either in their methods (3.4%, n = 6), results (15.2%, n = 27), or in both sections (1.1%, n = 2). Only 4.5% (n = 8) of the studies mentioned how they handled missing data, the most common method being multiple imputation (n = 3), followed by indicator (n = 2), complete case analysis (n = 2), and simple imputation (n = 1). One study using multiple imputation and both studies using an indicator method also combined other strategies to account for missing data. One study only used complete case analysis for subgroup analysis, and the other study only used this method if a specific baseline variable was missing.
Conclusions
Very few studies in clinical pharmacy literature report any handling of missing data. This has the potential to lead to biased results. We advocate that researchers should report how missing data were handled to increase the transparency of findings and minimize bias.
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Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kar Yu Ho
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ardalan Mirzaei
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carl Schneider
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Capra S, Narayan SW, Parratt K, Patanwala AE. Cannabinoids for drug-resistant seizures in a critically ill patient-Case report and literature review. J Clin Pharm Ther 2019; 45:570-572. [PMID: 31770462 DOI: 10.1111/jcpt.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-resistant seizures are life-threatening and contribute to sustained hospitalization. We present the case of a critically ill 28-year-old male with Lennox-Gastaut syndrome who had approximately 30 seizures/day in the intensive care unit. CASE DESCRIPTION Patient required mechanical ventilation and pharmacologically induced thiopentone coma. He was commenced on cannabidiol and subsequently extubated. He remained seizure-free thereafter on a combination of cannabidiol and anti-epileptic medication that predated his critical illness. WHAT IS NEW AND CONCLUSION Our case report provides a unique perspective on the role of cannabidiol in achieving remission from drug-resistant seizures in critically ill patients.
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Affiliation(s)
- Stefania Capra
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sujita W Narayan
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Kaitlyn Parratt
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Asad E Patanwala
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Narayan SW, Pearson SA, Litchfield M, Le Couteur DG, Buckley N, McLachlan AJ, Zoega H. Anticholinergic medicines use among older adults before and after initiating dementia medicines. Br J Clin Pharmacol 2019; 85:1957-1963. [PMID: 31046175 PMCID: PMC6710547 DOI: 10.1111/bcp.13976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS We investigated anticholinergic medicines use among older adults initiating dementia medicines. METHODS We used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days (n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines. RESULTS One-third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3-3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6-12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3-9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines. CONCLUSION Use of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.
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Affiliation(s)
- Sujita W Narayan
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Melisa Litchfield
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nicholas Buckley
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Sydney Pharmacy School, The University of Sydney, Sydney, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
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Zheng D, Narayan SW, Zoega H, Litchfield M, Buckley NA, Pearson SA, Schaffer AL. Anticipating the effects of restricting high-dose preparations of strong opioids in Australia: A population-based analysis to inform the current policy debate. Pharmacoepidemiol Drug Saf 2019; 28:521-527. [PMID: 30790376 DOI: 10.1002/pds.4755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/04/2018] [Accepted: 01/27/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE Countries worldwide are developing a variety of strategies to combat the opioid epidemic, such as restricting access to high-strength opioid formulations. We aimed to examine the dispensing patterns of strong opioids by dose units (DUs), age, and sex. METHODS We used Australian population-level dispensing data from January 2003 to December 2015 and categorised strong opioids by DU: very low, low, moderate, and high, corresponding to total daily doses of less than or equal to 25, 26 to 50, 51 to 100, and greater than 100 morphine milligramme equivalents, respectively. We measured trends in strong opioid use as dispensings/1000 population/year and stratified dispensing in 2015 by patient age and sex. RESULTS From 2003 to 2015, strong opioid dispensing of very low, low, moderate, and high DU increased 6.7-, 6.2-, 2.2-, and 1.8-fold, respectively. The increase in very low and low DU dispensing was driven primarily by oxycodone (5, 10, and 15 mg tablets and capsules) and buprenorphine transdermal patches. In 2015, the number of dispensings/1000 population for very low, low, moderate, and high DU were 180.3, 77.0, 52.7, and 34.8, respectively. Females aged greater than or equal to 85 years had the highest opioid use, ranging from 157.1 dispensings/1000 population for high DU to 2104.5 dispensings/1000 population for very low DU. In contrast, the high DU dispensings in males aged 25 to 64 years exceeded their female counterparts by approximately 1.3-fold. CONCLUSION Relative to moderate and high DU strong opioids, dispensing of very low and low DU strong opioids increased dramatically during the study period in Australia. Future studies investigating opioids use and harms in elderly females and males between 25 to 64 years are warranted.
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Affiliation(s)
- Danni Zheng
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sujita W Narayan
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Helga Zoega
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Melisa Litchfield
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Nicholas A Buckley
- Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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Narayan SW, Nishtala PS. Population-based study examining the utilization of preventive medicines by older people in the last year of life. Geriatr Gerontol Int 2018; 18:892-898. [DOI: 10.1111/ggi.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/02/2017] [Accepted: 12/21/2017] [Indexed: 01/28/2023]
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18
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Bala SS, Narayan SW, Nishtala PS. Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. Eur J Clin Pharmacol 2018; 74:645-653. [PMID: 29330585 DOI: 10.1007/s00228-018-2412-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The prescription of potentially inappropriate medications (PIMs) is associated with an increase in adverse events, prescribing cascades, high health-care costs, morbidity, and mortality in the elderly. The overarching objective of this study is to examine the prevalence of PIMs in the elderly, applying the 2012 American Geriatrics Society Beers criteria for the study period 2012-2014, and the updated 2015 Beers criteria for 2015. METHODS The study population (N = 70,479) included a continuously recruited national cohort of community-dwelling older (aged ≥ 65 years) New Zealanders who had undertaken the International Resident Assessment Instrument-Home Care (interRAI-HC) assessments between September 2012 and October 2015. Exposure of PIMs 90 days before and after assessment, and 90-180 days after assessment are reported. RESULTS Exposure to PIMs was highest in individuals aged over 95 years and in males. The average number of PIMs prescribed 90 days before assessment during the period 2015 was marginally higher compared to 2012-2014 (0.19 versus 0.04), and a greater number of individuals were exposed to one or more PIMs in 2015 compared to 2012-2014 (7.13 versus 2.17%). The prevalence of PIMs 90 days before and after assessment was 2.17 and 6.92% for 2012-2014, and 7.13 and 24.7% for 2015, respectively. The percent change in PIMs in 2012-2014 and 2015 after 90 days of assessment were 4.70% (confidence interval (CI) 4.50%, 5.00%, p < 0.001) and 17.60% (95% CI 16.80%, 18.30%, p < 0.001), respectively. The majority of PIMs prescribed belonged to the therapeutic class of medications acting on the central nervous system and the gastrointestinal system. CONCLUSION Geriatric risk assessments may provide a vital opportunity to review medication lists by multidisciplinary teams with a view to reducing PIMs and unnecessary polypharmacy in older adults. Comprehensive geriatric risk assessment has the potential to reduce adverse medication outcomes and costs associated with inappropriate prescribing in a vulnerable population of older adults.
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Affiliation(s)
- Sharmin S Bala
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand.
| | - Sujita W Narayan
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Prasad S Nishtala
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
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Narayan SW, Hilmer SN, Nishtala PS. A population-level study examining discontinuation of statins in older people with dementia. Eur J Clin Pharmacol 2017; 74:379-381. [PMID: 29192380 DOI: 10.1007/s00228-017-2390-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, University of Otago, P O Box 56, Dunedin, 9054, New Zealand.
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Royal North Shore Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Prasad S Nishtala
- School of Pharmacy, University of Otago, P O Box 56, Dunedin, 9054, New Zealand
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Abstract
AIM To evaluate the National Minimum Data Set (NMDS) against the International Resident Assessment Instrument-Home Care (interRAI-HC) in diagnosing dementia or Parkinson disease (PD). METHOD The NMDS data were matched with interRAI-HC for all older individuals in New Zealand. Dementia or PD was compared within 90 and 180 days and 1 to 4 years preceding and subsequent to the date of diagnosis in interRAI-HC. Consistency was measured through sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), weighted kappa (κ), and McNemar test. RESULTS For a diagnosis within 90 days, dementia showed 60.77% sensitivity, 95.33% specificity, 68.46% PPV, and 93.58% NPV. The PD showed 65.74% sensitivity, 99.52% specificity, 80.43% PPV, and 98.98% NPV. κ for dementia (κ = 0.59), PD (κ = 0.720), and McNemar test was significant ( P < .001) for all lengths of follow-up. CONCLUSION Substantial agreement between multiple sources of health data can be a valuable resource for decision-making in older people with neurological conditions.
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Affiliation(s)
| | - Hamish A Jamieson
- 2 Department of Medicine, University of Otago, Christchurch, New Zealand
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Narayan SW, Nishtala PS. Development and validation of a Medicines Comorbidity Index for older people. Eur J Clin Pharmacol 2017; 73:1665-1672. [DOI: 10.1007/s00228-017-2333-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/04/2017] [Indexed: 01/10/2023]
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Narayan SW, Nishtala PS. Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review. Drugs Aging 2017; 34:767-776. [DOI: 10.1007/s40266-017-0487-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Narayan SW, Nishtala PS. Antihypertensive medicines utilization: A decade-long nationwide study of octogenarians, nonagenarians and centenarians. Geriatr Gerontol Int 2017; 17:1109-1117. [DOI: 10.1111/ggi.12838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/23/2016] [Accepted: 04/27/2016] [Indexed: 11/30/2022]
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Narayan SW, Tordoff JM, Nishtala PS. Temporal trends in the utilisation of preventive medicines by older people: A 9-year population-based study. Arch Gerontol Geriatr 2016; 62:103-11. [DOI: 10.1016/j.archger.2015.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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Narayan SW, Nishtala PS. Prevalence of potentially inappropriate medicine use in older New Zealanders: a population-level study using the updated 2012 Beers criteria. J Eval Clin Pract 2015; 21:633-41. [PMID: 25940302 DOI: 10.1111/jep.12355] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 12/16/2022]
Abstract
RATIONAL, AIMS AND OBJECTIVES To examine the prevalence of potentially inappropriate medicines (PIMs) in older New Zealanders at a population level. METHODS De-identified prescription data for all individuals ≥65 years were obtained from the Pharmaceutical Claims Data Mart for 2011. International Classification of Diseases-10-AM (version 6) codes were used to extract diagnostic information from the National Minimum Datasets and PIMs were identified using the updated Beers 2012 criteria. RESULTS 40.9% of older people were prescribed PIMs with approximately half dispensed ≥2 PIMs in 2011. Exposure was highest in individuals aged 65-74 years (68.9 ± 2.9). The most prevalent PIMs dispensed were diclofenac (6.0%), amitriptyline (4.9%), ibuprofen (4.6%), zopiclone (3.2%) and naproxen (3.0%). 66.3% of individuals were dispensed ≥1 and 80.8% were dispensed ≥2 medicines with a potential for drug-disease/syndrome interaction. CONCLUSIONS The updated Beers 2012 criteria identified that the use of PIMs at a population level is common in older New Zealanders.
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Nishtala PS, Narayan SW, Wang T, Hilmer SN. Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf 2014; 23:753-8. [DOI: 10.1002/pds.3624] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/02/2014] [Accepted: 03/11/2014] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Ting Wang
- Department of Mathematics and Statistics; University of Otago; Dunedin New Zealand
| | - Sarah N. Hilmer
- Royal North Shore Hospital, Kolling Institute of Medical Research and Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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