British journal of clinical pharmacology
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Br J Clin Pharmacol · Apr 2008
Determinants of chronic benzodiazepine use in the elderly: a longitudinal study.
* The risk of adverse events due to chronic benzodiazepine use is high in the elderly. * Cross-sectional studies have shown that increasing age, female gender and poor physical and mental health are associated with benzodiazepine use. * When users were re-examined some years later, chronic somatic disease, pain and stress seemed to contribute to the continuation of benzodiazepine use. ⋯ The elderly with poor mental and physical health are at an increased risk of chronic benzodiazepine use. Living alone was found to decrease the risk of chronic use, which suggests that social factors may determine drug usage patterns. Very few characteristics predicted chronic benzodiazepine use once patients had received their first prescription. For clinicians, identification of patients at high risk is therefore not straightforward.
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Br J Clin Pharmacol · Mar 2008
Comparative StudyRelative lung deposition of salbutamol following inhalation from a spacer and a Sidestream jet nebulizer following an acute exacerbation.
What is already known about this subject. Studies have shown that a large volume spacer attached to a metered dose inhaler provides similar bronchodilator effects to nebulized dosing during the management of patients following an acute exacerbation. Due to the high doses used, these effects could be measured at the top of the dose-response relationship and the response limited due to the patient's exacerbation. Although clinical end-points are the gold standard to show comparability, some indication of similar lung deposition is useful to consolidate any claims. What this study adds. The urinary pharmacokinetic method we have used postinhalation provides an index of lung deposition for inhalation methods that can be incorporated into the routine management of patients with an acute exacerbation. This is the first study to identify and compare lung deposition and systemic delivery for inhalation methods within the setting of the routine management of asthma and chronic obstructive pulmonary disease patients following hospitalization due to an acute exacerbation. The study highlights the comparability of the doses for the two inhalation methods evaluated with respect to lung deposition, systemic delivery and bronchodilator response. ⋯ The relative lung deposition after inhaling 500 mug salbutamol from MDI + SP is similar to 5 mg from a Sidestream nebulizer following an acute exacerbation.
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Br J Clin Pharmacol · Mar 2008
Comparative StudyLimited frequency of the CYP2C19*17 allele and its minor role in a Japanese population.
A novel CYP2C19 gene variant, CYP2C19*17, is associated with increased metabolic activity. Ethnic differences in the frequency of the variant allele have been reported. However, the frequency of the CYP2C19*17 allele has not been studied in the Japanese population. ⋯ The low frequency of CYP2C19*17 and the absence of *17/*17 indicates that CYP2C19*17 plays a minor role in the Japanese population.
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Br J Clin Pharmacol · Feb 2008
Comparative StudyThe effects of electronic prescribing on the quality of prescribing.
Electronic prescribing has been shown to reduce prescribing errors in US hospitals. However we know little about its effect on prescribing quality, or its effectiveness in UK hospitals where systems for medication prescribing and supply are very different. Hospital pharmacists already review prescriptions to both detect errors and improve prescription quality. ⋯ EP improved the quality of prescribing by reducing both prescribing errors and pharmacists' clinical interventions. Prescribers and pharmacists need to be aware of new types of error with EP, so that they can best target their activities to reduce clinical risk. Pharmacists may need to change the way they work to complement, rather than duplicate, the benefits of EP.