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Thesis . 2009
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Drug-related problems with special emphasis on drug : drug interactions

Authors: Mannheimer, Buster;

Drug-related problems with special emphasis on drug : drug interactions

Abstract

The aim of this thesis was to address some aspects of drug related problems with special regard to drug-drug interactions. In paper I we aimed to describe the scenario and frequency of drug-related problems (DRPs) in in-patients and to determine whether a pharmacotherapeutic advisory intervention aiming at reducing DRPs could affect rates of re-hospitalisation and / or death within 6 months. A total of 299 DRPs among 71% (106/150) of the patients were found, who had not previously been identified in the usual care. Thirty-five per cent (106/299) of DRPs in 39% (58/150) of the patients were judged to be of such importance that advice was given to the physician in charge. The proportion of re-hospitalisation and death in the intervention group was 49% (73/150) compared to 46% (69/150) in the control group (Risk ratio: 1.06, 95% confidence interval: 0.84 to 1.32, P=0.64). In conclusion, drug-related problems were common. The impact of drug-related problems on hard endpoints such as re-hospitalisation and death may however be overestimated. It is of importance to clarify if and in what way drug-related problems are preventable. The purpose in paper II was to evaluate the clinical relevance of the Janus Web application in screening for potential drug-drug interactions. One hundred and fifty DDIs, regarding 58 different interaction pairs, were classified as significant. 126 interactions that were significant by definition did not result in advice. A look at the alerts which featured most frequently in such combinations illustrates the nature of this discrepancy. With the aim to develope a drug-drug interaction software with the goal of achieving and maintaining a general use on a routine basis, it is of great importance that the alerts are clinically relevant. Equally important may be to present the warnings in an adequate way to give the prescribing physician a balanced picture of the problem and thereby avoid "alert fatigue". In paper III we evaluated if steady-state plasma levels of risperidone or the corresponding ...

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Sweden
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Thesis, 615, 617

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average