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Adverse drug events as a cause of hospital admission in the elderly

Background: Previous studies of adverse drug events (ADE) as a cause of hospital admission in the elderly have often been limited in their ability to assess fully the impact and potential for prevention because they either did not include all categories of ADE and/or did not assess severity and preventability.

Hyperbaric oxygen therapy increases free radical levels in the blood of humans.

It has been postulated that exposure to high concentrations of oxygen results in increased oxygen radical production which may account for the toxic effects of excessive exposure to oxygen. Examination of blood from persons undergoing hyperbaric oxygen (HBO) exposure, by low temperature electron spin resonance (ESR) spectroscopy, demonstrated a marked increase in the magnitude of a signal with properties consistent with a free radical (g = 2.006). The signal diminished to baseline levels within 10 minutes of cessation of HBO exposure. Further in vitro studies of blood revealed an ESR signal generated in red blood cells by oxygen, and dependent on oxyhaemoglobin, which had characteristics indistinguishable from those of the ESR signal of ascorbate radical and the signal in blood from persons undergoing HBO exposure. It is postulated that HBO exposure increases ascorbate radical levels in blood, which is likely to reflect increased ascorbate turnover in human red blood cells.

Doctors’ beliefs on the use of antithrombotic therapy in atrial fibrillation: identifying barriers to stroke prevention

Abstract

Outcomes in the management of atrial fibrillation: clinical trial results can apply in practice.

Background: The benefits of antithrombotic therapy in chronic atrial fibrillation (AF) have been established in clinical trials, but there is a paucity of data on outcomes in practice.

Improving the outcomes of anticoagulation: An evaluation of home follow-up of warfarin initiation

Objectives.  A number of studies have reported that the risk of bleeding associated with warfarin is highest early in the course of therapy. This study examined the effect of a programme focused on the transition of newly anticoagulated patients from hospital to the community.

A Community-Based Educational Intervention to Improve Antithrombotic Drug Use in Atrial Fibrillation

BACKGROUND Despite evidence that antithrombotics are effective in reducing the risk of stroke in atrial fibrillation (AF), they remain underused. OBJECTIVE To perform a controlled trial of a comprehensive educational program promoting the rational prescribing of antithrombotics for stroke prevention in AF. METHODS The intervention was conducted in Southern Tasmania, Australia, using Northern Tasmania as a control area. General practitioners were sent locally produced guidelines on stroke risk stratification and antithrombotic drug use in AF, which were followed by academic detailing visits. Outcomes were measured using evaluation feedback from the general practitioners, and drug utilization data were provided by a series of patients presenting to the hospital with an admission diagnosis of AF and dispensing of antithrombotic therapy under the Australian Pharmaceutical Benefits Scheme. RESULTS During the educational intervention, 272 guidelines were mailed and, subsequently, 162 general practitioners were visited and the guidelines discussed. Hospital admission data before and after the intervention revealed a significant increase in the use of warfarin in patients at high risk of stroke (33% vs 46% of eligible patients; p < 0.05). Analysis of prescription data for warfarin also indicated that the increase in use of warfarin within the intervention region was significantly greater than for the control region (p < 0.001). CONCLUSIONS The educational program described here led to a significant increase in the prescribing of warfarin for stroke prevention in patients with AF.

Improving the outcomes of anticoagulation in rural Australia: an evaluation of pharmacist-assisted monitoring of warfarin therapy

Objective:  The aim of this project was to assess whether rural pharmacist involvement in the management of patients receiving warfarin has the potential to lead to safer and more effective anticoagulation, and is valued and welcomed by patients and their general practitioners (GPs).

Undertreatment of congestive heart failure in an Australian setting

Aim:  Guidelines for the management of patients with chronic heart failure have undergone change in recent years, with β‐blockers and spironolactone shown to reduce mortality when added to angiotensin converting enzyme (ACE) inhibitors, diuretics and digoxin. The aim of this study was to examine the therapeutic management of heart failure in patients admitted to Tasmanias three major public hospitals, with an assessment of the appropriateness of the therapy according to contemporary published guidelines.

Review of management of type 2 diabetes mellitus

Background: Commonly used drugs for type 2 diabetes are not ideal. The sulphonylureas, especially potent and long‐acting agents such as glibenclamide, can induce hypoglycaemia, while metformin carries the risk of lactic acidosis. Aim: To review the management of type 2 diabetes at the major teaching hospital in Tasmania, Australia, principally to determine the extent of use of glibenclamide and metformin in the elderly and patients where published contraindications are present. Methods: A retrospective review of the medical records for 150 consecutive patients with type 2 diabetes admitted to the hospital in mid‐1997, was performed. An extensive range of demographic and clinical variables was recorded for each patient. These included the duration of type 2 diabetes, the presence of other medical conditions, medication history, presence of any contraindications to the use of metformin or sulphonylureas, biochemical measures of diabetic control, and the presence of any diabetic complications. Results: The mean (±SD) age of the 150 patients included in the study was 70·1±11·8 years. The mean body mass index was 28·7±6·2 kg/m2 and the mean recent HbA1c level was 8·6±2·1%; only 24·7% of patients had a HbA1c level of 7% or lower. Of the 45 patients using glibenclamide, 40 (88·9%) had one or more risk factors for hypoglycaemia: over 65 years of age, renal impairment, or cognitive impairment and living alone. The study also found an extensive use of metformin in patients with contraindications and at highest risk of developing lactic acidosis. Sixty‐six out of 70 patients (94%) using metformin had at least one contraindication according to the manufacturers prescribing information, 57% of patients had two or three contraindications and 14% of patients had more than three contraindications. More than 20% of the patients had a renal function below published exclusion criteria. Conclusions: There was evidence of over‐utilization of metformin and glibenclamide in type 2 diabetes patients most at risk of adverse reactions. Insulin therapy could be a safer and more effective management strategy in many of these patients.

DELAYED RECOVERY FROM NG-NITRO-L-ARGININE IN THE CONSCIOUS SHEEP

1. In the chronic, awake, instrumented sheep model NG‐nitro‐L‐arginine (NOLA) an inhibitor of nitric oxide synthesis, injected at a dose of 40 mg/kg, produced a significant increase in systolic blood pressure (from 110±6 to 145±8 mmHg after 5 min) which persisted for at least 1 h but returned to baseline after 24 h.