Fifteen per cent of patients had a change in their treatment before falling. The average number of drugs per patient was nine per day. In these patients, the rate of prescription of drugs at risk of falling was high (87% for hypotensive treatments and 91% for inducing drowsiness treatments). A very high consumption of diuretics (40%) and benzodiazepines (60%) was observed. The combination of benzodiazepines was found in 16% of patients. Respectively, 24% and 65% of patients had a modification in their hypotensive and inducing drowsiness treatments. Conclusion The use of drugs that increased the risk of falling was common in our hospital. The recent change in inducing drowsiness treatments seemed to increase the risk of falling.Pharmaceutical interventions with prescribers on good prescribing practices in the elderly should be strengthened to minimise the use of drugs at risk of falling.
been treated previously with anti-TNF biologics and only 24.56% were naïve for BT. EULAR response after 12 months of ABA treatment was satisfactory in 48.94% (69/141) of patients. Clinical remission (DAS 28 <2.6) at 12 months was 28.37%. Bivariate analysis revealed a higher EULAR response in patients with a lower HAQ score (OR=0.22; 95% CI 0.06 to 0.66; p=0.012), EVA (OR=0.94; 95% CI 0.89 to 0.98; p=0.014) and lower DAS 28 score (OR=0.45; 95% CI 0.20 to 0.84; p=0.025) at the beginning. The incidence of adverse events was 12.87% and 7.8% after 6 and 12 months, respectively. 26.90% stopped ABA before 6 months due to ineffectiveness and 71.63% continued the therapy after 12 months. Conclusion and relevance In conclusion, ABA exhibited good effectiveness and safety in RA patients, some of whom had failed to respond to previous TNFi treatment.
Background and importance Pain is highly prevalent in old, frail adults with paracetamol as the mainstay treatment. Pain management is regularly suboptimal and using different paracetamol formulations might improve pain control.
poor in relation to steady state and peak/trough concentrations (Clozapine (n=196) 41% samples were not troughs, and LMWH (n=193) 57% samples were not at peak levels).A literature review has shown that there is small and sporadic research within this area. The research has shown some benefits of a pharmacist-led TDM service. Unfortunately, the studies within the literature are often limited by a small sample size and factors such as a specific population (i.e. oncology patients) or specific pharmacists (i.e. the infectious diseases pharmacist). Purpose To review the TDM process within an outer metropolitan hospital. Material and methods A retrospective audit was conducted on TDM undertaken between 1 January and 31 December 2016. Patients were identified using the electronic pathology database. Patients were excluded if under the age of 18, in an outpatient setting or the emergency department. Progress notes, medication charts and other relevant pathology were reviewed via the electronic pathology program and via the Electronic Clinical Record Management System. They were assessed for appropriateness of the timing of collection, compliance to recommended TDM guidelines, the appropriateness of action of the resulting pathology and the documented involvement of the pharmacist. Results Atotal of 3095 tests were included in the study, covering 11 medications. Of these, 32.6% were collected at an inappropriate time, making interpretation difficult and at a pathology cost of $23,084.86. On average, 50% of the doses administered to patients after TDM were appropriate based on results and the clinical scenario. There was documented pharmacist advice on the TDM result in only 8.6% of the time. Conclusion TDM has a large impact on the therapy and outcome of patients. This audit showed that TDM is currently performed sub-optimally and with an unknown or ad hoc role of the pharmacist. These preliminary results show a review of the current TDM process is required and, with their drug and pharmacokinetic knowledge, a greater impact and role of the pharmacist is required.
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