You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Archive for March, 2013

More needs to be done to tackle TB

27 Mar, 13 | by kuppell

European healthcare system managers and policy makers need to take proactive measures to meet the growing problem of multidrug-resistant tuberculosis (MDR-TB) and the emergence of extensively drug-resistant TB (XDR-TB) warns Dr Roberto Frontini, President of the European Association of Hospital Pharmacists (EAHP). Following on from World TB Day (March 24th) Dr Frontini said it was a time to pause and reconsider the policy options and highlighted five hospital pharmacy related measures currently available to policy-makers:

  1. Ensure hospital pharmacists are involved in medicines counselling for tuberculosis patients starting new courses of treatment in order to improve adherence
  2. Expand the role of hospital pharmacists in Therapeutic Drug Monitoring for patients with drug-resistant TB on long term courses of treatment
  3. Concentrate efforts on improving the systems for communication between hospital and community based healthcare professionals to deliver integrated and joined up care for TB patients
  4. Give hospital pharmacists a leading role in antimicrobial stewardship to help prevent further resistance to existing antibiotic treatments
  5. Redouble attention on the provision of fresh incentives for the development of new antibiotic treatments for the treatment of TB

‘The evidence is stark. There are over 380,000 reported new cases of TB in Europe each year, and the growing problem of multi-drug resistant TB is exacerbated by people not continuing their treatment for the full six months. By ensuring all professions are able to maximise the contribution of their expertise, we can reverse some of the concerning trends in the area of tuberculosis’, said Dr Frontini.

In support of the fight against TB, the BMJ Group has made its latest tuberculosis related content and products free until the end of April (www.rebelmouse.com/Thorax). 

 

Impact of benzodiazepines on pneumonia

13 Mar, 13 | by kuppell

Benzodiazepines are associated with an increased risk of, and mortality from, community-acquired pneumonia (CAP) suggesting further research is required into the immune safety profile of benzodiazepines, according to a study published in Thorax. Using data from The Health Improvement Network (THIN) database, British researchers identified 29,697 controls and 4964 cases of CAP. They used conditional logistic regression to investigate the association between benzodiazepines and pneumonia occurrence, and Cox regression to determine the impact of benzodiazepines on mortality in the 4964 cases of CAP.

The researchers report that: ‘Exposure to benzodiazepines was associated with an increased risk of pneumonia (OR 1.54, 95% CI 1.42 to 1.67). Individually diazepam, lorazepam and temazepam, but not chlordiazepoxide, were associated with an increased incidence of CAP’. They also found that, as a class, benzodiazepines were associated with increased 30-day (HR 1.22 [95% CI 1.06 to 1.39]) and long-term mortality (HR 1.32 [95% CI 1.19 to 1.47]) in patients with a prior diagnosis of CAP. Individually diazepam, chlordiazepoxide, lorazepam and temazepam affected long-term mortality in these patients. ‘Given the widespread use of benzodiazepine drugs, further studies are required to evaluate their safety in the context of infection’, add the researchers. Thorax 2013;68:163-170.

Statin therapy and reduction in recurrent pulmonary embolism

13 Mar, 13 | by kuppell

A study carried out in the Netherlands suggests that statin treatment could decrease the risk of recurrent pulmonary embolism (PE) and might be an alternative to anticoagulant treatment in the long-term treatment of PE. Researchers identified patients hospitalized with an acute episode of PE between 1998 and 2008 by using data from a Dutch population-based registry of pharmacy records linked with hospital discharge records. Prescription-based use of statins and vitamin K antagonist (VKA) were identified starting at hospital discharge and during follow-up.  The researchers used Cox regression analysis to assess the incidence of recurrences, cardiovascular events and death.

The median duration of VKA treatment after acute PE was 199 (45–3793) days. Twenty-four per cent of the patients (n = 737) had at least one prescription of statins during the follow-up period and the median duration of statin therapy was 1557 (5–4055) days.

Reporting their findings in the European Heart Journal the researchers say that during a median follow-up of 1529 (1–4155) days, 285 (9.2%) patients experienced a recurrence. Treatment with statins was associated with a reduced risk of recurrent PE (adjusted hazard ratio [HR] 0.50, 95% CI: 0.36–0.70), both during and after stopping VKA treatment. A dose–response relationship was shown for potency, with the largest reduction in those with the most potent statins. ’Statin treatment also reduced the risk for cardiovascular events and all-cause mortality’, add the researchers. Eur Heart J (2013)doi: 10.1093/eurheartj/eht046.

Long-term aspirin use linked to age-related macular degeneration

12 Mar, 13 | by kuppell

Regular aspirin use is associated with an increased risk for developing neovascular age-related macular degeneration (AMD), according to a study published in JAMA Internal Medicine.  Researchers analysed data from an Australian population-based cohort. Four examinations were carried out over a 15-year period with participants completing a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Retinal photographs were taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification.

Of 2389 participants at baseline, 257 (10.8%) were regular aspirin users and 63 of the 2389 developed neovascular AMD. ‘Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers’, report the researchers. They add that the association was independent of potential confounders such as cardiovascular disease, age, sex, smoking, systolic blood pressure, and body mass index. A link was not, however, found between aspirin use and geographic atrophy. The researchers conclude that: ‘Regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking’. JAMA Intern Med. 2013;173(4):258-264.

Medicines shortages – 99% of hospital pharmacists experience difficulties

12 Mar, 13 | by kuppell

A survey focusing on the prevalence of medicines shortages found that 99% of responding hospital pharmacists had experienced difficulties with medicines shortages in the past year. The survey was carried out by the European Association of Hospital Pharmacists (EAHP) and 346 hospital pharmacists from 25 countries took part. Sixty-three per cent of hospital pharmacists reported medicines shortages to be a weekly, sometimes daily, occurrence. Areas commonly experiencing shortages were identified as oncology (71% of respondents), emergency medicine (44%) and cardiovascular medicine (35%).

Announcing the results at an event in the European Parliament on access to medicines EAHP President Roberto Frontini said: ‘These headline results confirm what I have increasingly heard from our members across Europe: that the shortages problem is widespread, doesn’t respect national borders, and urgently requires attention if patient care and health services are not to suffer’. EAHP will present the full results of its survey at the EAHP Congress in Paris (March 13-15th, 2013).

Latest from European Journal of Hospital Pharmacy

Latest from European Journal of Hospital Pharmacy