Thierry Christiaens

2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension

Correspondence to: Professor Giuseppe Mancia, Centro di Fisiologia Clinica e, Ipertensione, Via F. Sforza, 35, 20122, Milano, Italy. Tel: 39 039 233 3357; Fax: 39 039 322 274; E-mail: giuseppe.mancia@unimib.it, Professor Robert Fagard, Hypertension & Cardiovascular Rehab. Unit, KU Leuven, University, Herestraat 49, 3000 Leuven, Belgium. Tel: 32 16 348 707; Fax: 32 16, 343 766; E-mail: robert.fagard@uzleuven.be

2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension.

1. INTRODUCTION1.1 PrinciplesThe 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines continue to adhere to some fundamental principles that inspired the 2003 and 2007 guidelines, namely to base recommendations on properly conducted studies identified from an ext

Home Medication Cabinets and Self-Medication: A Source of Potential Health Threats?

BACKGROUND: Data regarding the contents of home medication cabinets (HMCs), the management of leftover medications, and the inclination of patients toward self-initiated treatment using nonprescription drugs are scarce. OBJECTIVE: To evaluate the nature and safety of medication storage and intended self-medication in a general population. METHODS: A cross-sectional study was conducted in 72 Belgian community pharmacies. Pharmacy customers (N = 288, aged 18–80 y) were visited in their homes by pharmacy students. The HMCs were inventoried and the participants were interviewed. RESULTS: A mean of 31 ± 17 (range 6–136) drug packages were identified per household; in one-third of the cases, the packages were not stored safely. Prescription drugs accounted for 34% of the total. The most frequently encountered categories of registered medicines were nonopioid analgesics (7.2%), nonsteroidal antiinflammatory drugs (NSAIDs) (6.9%), nasal decongestants (3.5%) and antinausea agents (3.2%). Despite their high prevalence, NSAIDs and non-opioid analgesics did not predominate among the most frequently used drugs, whereas food supplements were used daily in 23.3% of households. Twenty-one percent of the drugs were expired, 9% were not stored in the original container, and the package insert was missing for 18%. Self-initiated treatment was considered for 56% of all drugs (over-the-counter drugs, 74%; prescription drugs, 21%). Indication, dosage, or treatment duration was misjudged by only 5.2% of the participants, but consulting the package insert was allowed. The tendency toward self-treatment decreased with age and with increasing number of medications taken daily (p = 0.002). CONCLUSIONS: We found large amounts of drugs per household, with a high prevalence of analgesics and NSAIDs. Self-medication, although generally acceptable in terms of indication and dosage, was commonly practiced, also with prescription drugs. Taking into account that younger people showed a significantly higher intention of self-medication, a sustained awareness of the risks of self-medication is warranted for the future.

The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives.

Objective. Chronic benzodiazepine (BZD) use is widespread and linked with adverse effects. There is consensus concerning the importance of initiating BZD as a crucial moment. Nevertheless specific research in this field is lacking. This paper addresses the views of GPs on why they start prescribing BZDs to first-time users. Design. Qualitative study with five focus groups analysed using a systematic content analysis. Setting. Regions of Ghent and Brussels in Belgium. Subjects. A total of 35 general practitioners. Main outcome measure. The GPs’ perspective on their initiating of BZD prescribing. Results. GPs reported that they are cautious in initiating BZD usage. At the same time, GPs feel overwhelmed by the psychosocial problems of their patients. They show empathy by prescribing. They feel in certain situations there are no other solutions and they experience BZDs as the lesser evil. They admit to resorting to BZDs because of time restraint and lack of alternatives. GPs do not perceive the addictive nature of BZD consumption as a problem with first-time users. GPs do not specifically mention patients’ demand as an element for starting. Conclusion. The main concern of GPs is to help the patient. GPs should be aware of the addictive nature of BZD even in low doses and a non-pharmacological approach should be seen as the best first approach. If GPs decide to prescribe a BZD they should make plain to the patient that the medication is only a “temporary” solution with clear agreements with regard to medication withdrawal.

Guidelines, evidence, and cultural factors Comparison of four European guidelines on uncomplicated cystitis

Objective – To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. Design – Descriptive study with a qualitative analysis of authors’ reasons for recommendations. Material – Guidelines for general practitioners published 1999–2000 from Germany, The Netherlands, Norway, and Belgium on diagnosis and treatment of uncomplicated cystitis. Opinions of the guideline authors on the influence of local factors on the recommendations were collected before and after feedback on the differences between the guidelines. Results – Few cited references were shared between the guidelines, and recommendations differed substantially, especially on diagnostic strategies and referral criteria. The authors attributed parts of the differences to local factors. German and Belgian authors stressed the need for safety in their diagnostic and therapeutic approach, while Dutch authors felt confident in their gatekeeper role and the Norwegian authors mainly relied on “the evidence”. Dutch and Belgian authors perceived patients to hold power, German authors referred to the power of the sub-specialists, while the Norwegians aimed to share power with the patient through a patient-centred approach. Conclusion – There are substantial differences even between high-standard guidelines on the same well-defined clinical entity. The selection of literature data, and diagnostic and therapeutic recommendations, seemed to be influenced by such cultural aspects as habits, the patients expectations, and the structure of the healthcare system.

Evolution of bacterial susceptibility pattern of Escherichia coli in uncomplicated urinary tract infections in a country with high antibiotic consumption: a comparison of two surveys with a 10 year interval

OBJECTIVES For the empirical treatment of cystitis, clinicians are often guided by susceptibility data taken from urinary samples that sent to regional microbiological laboratories, which are not representatives for uncomplicated urinary tract infections (UTIs). To offer adequate recommendations, the distribution and susceptibility pattern of uropathogens in uncomplicated UTIs in women were compared with those obtained 10 years ago in our uropathogen surveillance in a primary healthcare setting. METHODS Sixty-six general practitioners in the region of the city of Ghent were asked to inoculate a dipslide with midstream urine from every adult female patient with complaints suggestive for cystitis, during a period of 1 year. The dipslides were further processed in a central microbiological laboratory, where counting, identification and susceptibility testing were performed. RESULTS Three hundred specimens were collected, of which 187 (62.3%) yielded a positive culture of 10(5) cfu/mL. In the age group of 18-54 years, Escherichia coli was the most frequently isolated uropathogen (77.5%), followed by Staphylococcus saprophyticus (13.5%) and Proteus spp. (2.7%). There were no statistically significant differences when compared with the data from 1996. In 2006, susceptibility of E. coli to nitrofurantoin was 100%, to quinolones 100%, to ampicillin 62.8% and to co-trimoxazole 86%, compared with 99.3%, 99.3%, 73.2% and 83.3%, respectively, in 1996 (no statistically significant differences). CONCLUSIONS Over a period of 10 years, a systematic surveillance of uropathogens in female patients with uncomplicated UTI in general practice could not demonstrate a significant change in species distribution or antimicrobial susceptibility.

General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis

BackgroundBenzodiazepines are often prescribed long-term inappropriately. We aimed to systematically review and meta-synthesise qualitative studies exploring clinicians’ experiences and perceptions of benzodiazepine prescribing to build an explanatory model of processes underlying current prescribing practices.MethodsWe searched seven electronic databases for qualitative studies in Western primary care settings published in a European language between January 1990 and August 2011 analysing GP or practice nurse experiences of benzodiazepine prescribing. We assessed study quality using the Critical Appraisal Skills Programme Checklist. We analysed findings using thematic synthesis.ResultsWe included eight studies from seven countries published between 1993 and 2010. Benzodiazepine prescribing decisions are complex, uncomfortable, and demanding, taken within the constraints of daily general practice. Different GPs varied in the extent to which they were willing to prescribe benzodiazepines, and individual GPs’ approaches also varied. GPs were ambivalent in their attitude towards prescribing benzodiazepines and inconsistently applied management strategies for their use. This was due to the changing context of prescribing, differing perceptions of the role and responsibility of the GP, variation in GPs’ attitudes to benzodiazepines, perceived lack of alternative treatment options, GPs’ perception of patient expectations and the doctor-patient relationship. GPs faced different challenges in managing initiation, continuation and withdrawal of benzodiazepines.ConclusionWe have developed a model which could be used to inform future interventions to improve adherence to benzodiazepine prescribing guidance and improve prescribing through education and training of professionals on benzodiazepine use and withdrawal, greater provision of alternatives to drugs, reflective practice, and better communication with patients.

Self-medication of regular headache: a community pharmacy-based survey.

Background:  This observational community pharmacy‐based study aimed to investigate headache characteristics and medication use of persons with regular headache presenting for self‐medication.

Effectiveness of PHARMAceutical care for patients with COPD (PHARMACOP): a randomized controlled trial

AIMS Few well-designed randomized controlled trials have been conducted regarding the impact of community pharmacist interventions on pharmacotherapeutic monitoring of patients with chronic obstructive pulmonary disease (COPD). We assessed the effectiveness of a pharmaceutical care programme for patients with COPD. METHODS The pharmaceutical care for patients with COPD (PHARMACOP) trial is a single-blind 3 month randomized controlled trial, conducted in 170 community pharmacies in Belgium, enrolling patients prescribed daily COPD medication, aged ≥ 50 years and with a smoking history of ≥ 10 pack-years. A computer-generated randomization sequence allocated patients to an intervention group (n = 371), receiving protocol-defined pharmacist care, or a control group (n = 363), receiving usual pharmacist care (1:1 ratio, stratified by centre). Interventions focusing on inhalation technique and adherence to maintenance therapy were carried out at start of the trial and at 1 month follow-up. Primary outcomes were inhalation technique and medication adherence. Secondary outcomes were exacerbation rate, dyspnoea, COPD-specific and generic health status and smoking behaviour. RESULTS From December 2010 to April 2011, 734 patients were enrolled. Forty-two patients (5.7%) were lost to follow-up. At the end of the trial, inhalation score [mean estimated difference (Δ),13.5%; 95% confidence interval (CI), 10.8-16.1; P < 0.0001] and medication adherence (Δ, 8.51%; 95% CI, 4.63-12.4; P < 0.0001) were significantly higher in the intervention group compared with the control group. In the intervention group, a significantly lower hospitalization rate was observed (9 vs. 35; rate ratio, 0.28; 95% CI, 0.12-0.64; P = 0.003). No other significant between-group differences were observed. CONCLUSIONS Pragmatic pharmacist care programmes improve the pharmacotherapeutic regimen in patients with COPD and could reduce hospitalization rates.