DOCSLIB.ORG

BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 29, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from Potentially inappropriate prescriptions and omissions in pediatrics: detection by POPI (Pediatrics: Omission of Prescription and Inappropriate prescription) in the emergency unit and in the ambulatory setting. ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2017-019186 Article Type: Research Date Submitted by the Author: 16-Aug-2017 Complete List of Authors: Berthe-Aucejo, Aurore; Hopital Universitaire Robert Debre, Pharmacy department Nguyen, Phuong Khanh Hoang; Hopital Universitaire Robert Debre, Department of Pharmacy Angoulvant, François; Hopital universitaire Necker-Enfants malades, Emergency unit; INSERM, U1123 Bellettre, Xavier; Hopital Universitaire Robert Debre, Emergency unit Albaret, Patrick; Albaret Pharmacy Weil, Thomas; Hopital Universitaire Robert Debre, Department of Pharmacy Boulkedid, Rym; Hopital Universitaire Robert Debre, Clinical Epidemiology unit; INSERM, U1123 Bourdon, Olivier; Hopital Universitaire Robert Debre, Department of http://bmjopen.bmj.com/ pharmacy; Universite Paris Descartes, Clinical Pharmacy Prot-Labarthe, Sonia; Hopital Universitaire Robert Debre, Department of Pharmacy; INSERM, U1123 <b>Primary Subject Paediatrics Heading</b>: Secondary Subject Heading: General practice / Family practice Keywords: inappropriate prescription, omission, tool, detection on September 29, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 27 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from 1 2 3 Potentially inappropriate prescriptions and omissions in pediatrics: detection by POPI 4 (Pediatrics: Omission of Prescription and Inappropriate prescription) in the emergency 5 unit and in the ambulatory setting. 6 7 8 A. Berthe-Aucejo1, H.P.K Nguyen1, F. Angoulvant2,3, X. Bellettre4, P. Albaret5,6, T. Weil1, R. 9 10 3,7 1,6,8,9 1,3,9 11 Boulkedid , O. Bourdon , S.Prot-Labarthe 12 13 14 15 1 16 Department of ForPharmacy, peer Robert-Debré review Hospital, Paris, France only 17 18 2 19 Emergency unit, Necker Hospital, Paris, France 20 21 3 U1123, INSERM ECEVE, Paris, France 22 23 4 24 Emergency unit AP-HP, Robert-Debré Hospital, Paris, France 25 26 5 Albaret Pharmacy, Cesson, France 27 28 29 6 Clinical Pharmacy, Paris Descartes University, Paris, France 30 31 7 32 Clinical Epidemiology Unit, Robert-Debré Hospital, Paris, France http://bmjopen.bmj.com/ 33 34 8 Laboratoire Educations et Pratiques de Santé, Paris XIII University, Bobigny, France 35 36 37 9 Groupe Pédiatrie de la Société Française de Pharmacie Clinique, Paris, France 38 39 40 on September 29, 2021 by guest. Protected copyright. 41 Word count : 2628 42 43 44 Corresponding author 45 46 47 Dr Aurore Berthe-Aucejo, Service Pharmacie, AP-HP Hôpital Robert-Debré, 48 Boulevard 48 49 Sérurier, 75019 Paris, Fax: 01-40-03-24-81, Tel: 0140-03-57-41, Email: 50 [email protected] 51 52 53 Keywords 54 55 56 Inappropriate prescription, omission, tool, detection 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 27 BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from 1 2 3 ABSTRACT 4 5 6 Background and Objective: POPI (Pediatrics: Omission of Prescription and Inappropriate 7 prescription) is the first tool of detection for potentially inappropriate medicines (PIM) and 8 9 potentially prescribing omissions (PPO) in pediatrics. The aim of this study was to evaluate 10 11 the prevalence of PIM and PPO detected by POPI regarding issuing of prescription in hospital 12 and outpatient car. The second objective is to determine the risk factors related to PIM. 13 14 Design: A retrospective and descriptive study was conducted in the emergency department 15 16 (ED) and communityFor pharmacy peer (CP) from review 1 October 2014 only and 31 March 2015. POPI was 17 18 used to identify inappropriate prescriptions and omissions. 19 20 Setting: Robert-Debré Hospital (AP-HP, France) and Albaret community pharmacy (Seine 21 and Marne 22 23 Participants: Inclusion criteria included patients who were under 18 years old and who had 24 25 one medicine prescription between 1st October 2014 and 31st March 2015. Exclusion criteria 26 27 consisted of inaccessible medical records for patients consulted in ED and prescription 28 without drugs for outpatients. 29 30 Primary and secondary outcome measures: PIM and PPO rate, PIM risk factors 31 32 Results: A total of 18.562 prescriptions for 15.973 patients at the ED and 4.780 prescriptions http://bmjopen.bmj.com/ 33 34 for 2.225 patients at the CP were analyzed. The PIM rate and PPO rate were respectively 35 36 3.3% and 2.6% at the ED and 26.4% and 13.2% at the CP. Respiratory and digestive diseases 37 had the highest rate of PIM in hospital and community pharmacy. Multivariate analysis 38 39 showed that children aged between 2 and 6 years (OR=2.4; IC 1.9-2.9; p<0,001) and 40 on September 29, 2021 by guest. Protected copyright. 41 prescriptions issued from outpatient care (OR=5.2, 95% confidence interval (CI) 5.0-6.5, 42 p<0.001) correlated with a higher risk of PIM. 43 44 Conclusion: This study is the first to observe the prevalence of PIM and PPO detecting by 45 46 POPI in a pediatric population. A prospective and multicenter study should be conducted to 47 evaluate its impact and benefit in clinical practice. 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 27 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from 1 2 3 Strengths and limitations of this study 4 5 6 - This study is the first to observe the prevalence of PIM and PPO in a pediatric population. 7 8 The inappropriate prescription rate and omission rate were respectively 3.3% and 2.6% at the 9 10 emergency unit and 26.4% and 13.2% at the community pharmacy. 11 12 13 - It is a retrospective and monocentric study. Our result in the hospital could be 14 15 underestimated. 16 For peer review only 17 18 19 - Ambulatory prescription and the group age between two and six years were associated with 20 21 a higher risk of inappropriate prescribing. 22 23 24 - Our study showed that there are many criteria which could be detected without access to 25 26 27 clinical information and that they are easy to identify. 28 29 30 31 32 http://bmjopen.bmj.com/ 33 34 35 36 37 38 39 40 on September 29, 2021 by guest. Protected copyright. 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 27 BMJ Open: first published as 10.1136/bmjopen-2017-019186 on 20 March 2019. Downloaded from 1 2 3 INTRODUCTION 4 5 6 Inappropriate prescribing is a known preventable cause of adverse drug events (ADE) and has 7 8 an important impact on public health and cost of care.[1,2] Incidence of hospitalization due to 9 10 ADE was 42.8% according to a French survey in 2009.[3] The World Health Organization 11 12 estimated that 50% of medications are prescribed and utilized inappropriately.[4] The most 13 14 recent definition of inappropriate prescription (IP) encompasses potentially inappropriate 15 16 For peer review only 17 medicines (PIM) and prescribing omissions (PPO).[5] In a report from the French National 18 19 Authority for Health, PIMs are defined as “drugs being used in a situation in which the risks 20 21 involved in treatment potentially outweigh the benefits, lack of indication demonstrated, high 22 23 risk of ADE, and an unfavorable cost-effect or risk-benefit ratio exists”. PPO or underuse of 24 25 appropriate medication is defined as the absence of initiation of an effective treatment in 26 27 subjects with a condition for which one or several drug classes have demonstrated their 28 29 30 efficacy [6]. In an elderly population, which presents with age-related physiological changes 31 32 and high prevalence of polypharmacy, various measures have been developed to detect PIM http://bmjopen.bmj.com/ 33 34 such as: Beers’ criteria, the Inappropriate Prescribing in the Elderly Tool, The Medication 35 36 Appropriate Index, and STOPP/START (Screening Tool of Older Person’s 37 38 prescriptions/Screening Tool to Alert doctor to Right Treatment).[7–11] Only the 39 40 STOPP/START enables us to detect under-prescribing.[5] Using these tools, many studies on September 29, 2021 by guest.
Load more

Recommended publications
  • Anaphylactic Microshock of the Guinea-Pig by H
    Brit. J. Pharmacol. (1963), 21, 414-418. THE EFFECT OF SOME NEW ANTIHISTAMINES ON THE ANAPHYLACTIC MICROSHOCK OF THE GUINEA-PIG BY H. HERXHEIMER AND E. STRESEMANN From the Asthmapoliklinik, Free University, West Berlin, Germany (Received May 14, 1963) The dose/response curves for the protective effects of the new antihistamine compounds trimeprazine, 10-(3-diethylamino-2-methylpropyl)phenothiazine 1,1-dioxide hydrochloride (oxomemazine hydrochloride), cyproheptadine, homochlorcyclizine and methotrimeprazine against the anaphylactic microshock of the guinea-pig were similar to that of promethazine. The first three compounds, however, protected at lower doses than promethazine (5 to 10 ug/kg). The protective effect of cyproheptadine lasted longer than 24 hr. The antianaphylactic effects of promethazine, mepyramine, chlorcyclizine, tri- pelennamine and diphenhydramine have been investigated by Armitage, Herxheimer & Rosa (1952). In this paper we describe investigations of a few of the newer antihistamines. METHODS The microshock method (Herxheimer, 1952) was used and the protection against anaphylactic shock was calculated according to Armitage et al. (1952) with the formula p=100(1-c/t), in which p is the percentage of full protection, c the control preconvulsion time and t the preconvulsion time of the animal under the influence of the drug. The compounds investigated were trimeprazine, methotrimeprazine, cyproheptadine, homo- chlorcyclizine and 10(-3-diethylamino-2-methylpropyl)phenothiazine 1,1-dioxide hydrochloride (oxomemazine hydrochloride, 6847 R.P.). They were injected intramuscularly in aqueous solution; the exposure to the antigen (an aerosol of 5% albumen solution) was done 1 hr later. For cyproheptadine, the exposure was delayed by between 1 and 48 hr in order to investigate the duration of the effect.
    [Show full text]
  • Guidelines for the Forensic Analysis of Drugs Facilitating Sexual Assault and Other Criminal Acts
    Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel.: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org Guidelines for the Forensic analysis of drugs facilitating sexual assault and other criminal acts United Nations publication Printed in Austria ST/NAR/45 *1186331*V.11-86331—December 2011 —300 Photo credits: UNODC Photo Library, iStock.com/Abel Mitja Varela Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts UNITED NATIONS New York, 2011 ST/NAR/45 © United Nations, December 2011. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. List of abbreviations . v Acknowledgements .......................................... vii 1. Introduction............................................. 1 1.1. Background ........................................ 1 1.2. Purpose and scope of the manual ...................... 2 2. Investigative and analytical challenges ....................... 5 3 Evidence collection ...................................... 9 3.1. Evidence collection kits .............................. 9 3.2. Sample transfer and storage........................... 10 3.3. Biological samples and sampling ...................... 11 3.4. Other samples ...................................... 12 4. Analytical considerations .................................. 13 4.1. Substances encountered in DFSA and other DFC cases .... 13 4.2. Procedures and analytical strategy...................... 14 4.3. Analytical methodology .............................. 15 4.4.
    [Show full text]
  • ESPGHAN/European Society for Pediatric Infectious Diseases
    CLINICAL GUIDELINES European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Update 2014 ÃAlfredo Guarino (Coordinator), yShai Ashkenazi, zDominique Gendrel, ÃAndrea Lo Vecchio, yRaanan Shamir, and §Hania Szajewska ABSTRACT Results: Gastroenteritis severity is linked to etiology, and rotavirus is the most Objectives: These guidelines update and extend evidence-based indications severe infectious agent and is frequently associated with dehydration. for the management of children with acute gastroenteritis in Europe. Dehydration reflects severity and should be monitored by established score Methods: The guideline development group formulated questions, systems. Investigations are generally not needed. Oral rehydration with identified data, and formulated recommendations. The latter were graded hypoosmolar solution is the major treatment and should start as soon as with the Muir Gray system and, in parallel, with the Grading of possible. Breast-feeding should not be interrupted. Regular feeding should Recommendations, Assessment, Development and Evaluations system. continue with no dietary changes including milk. Data suggest that in the hospital setting, in non–breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy Received March 17, 2014; accepted March 19, 2014. may reduce the duration and severity of diarrhea. Effective interventions From the ÃDepartment of Translational Medical Science, Section of include administration of specific probiotics such as Lactobacillus GG or Pediatrics, University of Naples Federico II, Naples, Italy, the Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs ySchneider Children’s Medical Center, Tel-Aviv University, Tel-Aviv, should be given in exceptional cases.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 De Juan Et Al
    US 200601 10428A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 de Juan et al. (43) Pub. Date: May 25, 2006 (54) METHODS AND DEVICES FOR THE Publication Classification TREATMENT OF OCULAR CONDITIONS (51) Int. Cl. (76) Inventors: Eugene de Juan, LaCanada, CA (US); A6F 2/00 (2006.01) Signe E. Varner, Los Angeles, CA (52) U.S. Cl. .............................................................. 424/427 (US); Laurie R. Lawin, New Brighton, MN (US) (57) ABSTRACT Correspondence Address: Featured is a method for instilling one or more bioactive SCOTT PRIBNOW agents into ocular tissue within an eye of a patient for the Kagan Binder, PLLC treatment of an ocular condition, the method comprising Suite 200 concurrently using at least two of the following bioactive 221 Main Street North agent delivery methods (A)-(C): Stillwater, MN 55082 (US) (A) implanting a Sustained release delivery device com (21) Appl. No.: 11/175,850 prising one or more bioactive agents in a posterior region of the eye so that it delivers the one or more (22) Filed: Jul. 5, 2005 bioactive agents into the vitreous humor of the eye; (B) instilling (e.g., injecting or implanting) one or more Related U.S. Application Data bioactive agents Subretinally; and (60) Provisional application No. 60/585,236, filed on Jul. (C) instilling (e.g., injecting or delivering by ocular ion 2, 2004. Provisional application No. 60/669,701, filed tophoresis) one or more bioactive agents into the Vit on Apr. 8, 2005. reous humor of the eye. Patent Application Publication May 25, 2006 Sheet 1 of 22 US 2006/0110428A1 R 2 2 C.6 Fig.
    [Show full text]
  • The In¯Uence of Medication on Erectile Function
    International Journal of Impotence Research (1997) 9, 17±26 ß 1997 Stockton Press All rights reserved 0955-9930/97 $12.00 The in¯uence of medication on erectile function W Meinhardt1, RF Kropman2, P Vermeij3, AAB Lycklama aÁ Nijeholt4 and J Zwartendijk4 1Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; 2Department of Urology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands; 3Pharmacy; and 4Department of Urology, Leiden University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands Keywords: impotence; side-effect; antipsychotic; antihypertensive; physiology; erectile function Introduction stopped their antihypertensive treatment over a ®ve year period, because of side-effects on sexual function.5 In the drug registration procedures sexual Several physiological mechanisms are involved in function is not a major issue. This means that erectile function. A negative in¯uence of prescrip- knowledge of the problem is mainly dependent on tion-drugs on these mechanisms will not always case reports and the lists from side effect registries.6±8 come to the attention of the clinician, whereas a Another way of looking at the problem is drug causing priapism will rarely escape the atten- combining available data on mechanisms of action tion. of drugs with the knowledge of the physiological When erectile function is in¯uenced in a negative mechanisms involved in erectile function. The way compensation may occur. For example, age- advantage of this approach is that remedies may related penile sensory disorders may be compen- evolve from it. sated for by extra stimulation.1 Diminished in¯ux of In this paper we will discuss the subject in the blood will lead to a slower onset of the erection, but following order: may be accepted.
    [Show full text]
  • Interactions Medicamenteuses Index Des Classes Pharmaco
    INTERACTIONS MEDICAMENTEUSES INDEX DES CLASSES PHARMACO-THERAPEUTIQUES Mise à jour avril 2006 acides biliaires (acide chenodesoxycholique, acide ursodesoxycholique) acidifiants urinaires adrénaline (voie bucco-dentaire ou sous-cutanée) (adrenaline alcalinisants urinaires (acetazolamide, sodium (bicarbonate de), trometamol) alcaloïdes de l'ergot de seigle dopaminergiques (bromocriptine, cabergoline, lisuride, pergolide) alcaloïdes de l'ergot de seigle vasoconstricteurs (dihydroergotamine, ergotamine, methylergometrine) alginates (acide alginique, sodium et de trolamine (alginate de)) alphabloquants à visée urologique (alfuzosine, doxazosine, prazosine, tamsulosine, terazosine) amidons et gélatines (gelatine, hydroxyethylamidon, polygeline) aminosides (amikacine, dibekacine, gentamicine, isepamicine, kanamycine, netilmicine, streptomycine, tobramycine) amprénavir (et, par extrapolation, fosamprénavir) (amprenavir, fosamprenavir) analgésiques morphiniques agonistes (alfentanil, codeine, dextromoramide, dextropropoxyphene, dihydrocodeine, fentanyl, hydromorphone, morphine, oxycodone, pethidine, phenoperidine, remifentanil, sufentanil, tramadol) analgésiques morphiniques de palier II (codeine, dextropropoxyphene, dihydrocodeine, tramadol) analgésiques morphiniques de palier III (alfentanil, dextromoramide, fentanyl, hydromorphone, morphine, oxycodone, pethidine, phenoperidine, remifentanil, sufentanil) analogues de la somatostatine (lanreotide, octreotide) androgènes (danazol, norethandrolone, testosterone) anesthésiques volatils halogénés
    [Show full text]
  • List of Union Reference Dates A
    Active substance name (INN) EU DLP BfArM / BAH DLP yearly PSUR 6-month-PSUR yearly PSUR bis DLP (List of Union PSUR Submission Reference Dates and Frequency (List of Union Frequency of Reference Dates and submission of Periodic Frequency of submission of Safety Update Reports, Periodic Safety Update 30 Nov. 2012) Reports, 30 Nov.
    [Show full text]
  • Diosmectite for Chemotherapy-Induced Diarrhea
    Edinburgh Research Explorer Chemotherapy-induced diarrhoea in dogs and its management with smectite Citation for published version: Fournier, Q, Serra, JC, Williams, C & Bavcar, S 2021, 'Chemotherapy-induced diarrhoea in dogs and its management with smectite: results of a monocentric open-label randomized clinical trial ', Veterinary and Comparative Oncology, vol. 19, no. 1, pp. 25-33. https://doi.org/10.1111/vco.12631 Digital Object Identifier (DOI): 10.1111/vco.12631 Link: Link to publication record in Edinburgh Research Explorer Document Version: Peer reviewed version Published In: Veterinary and Comparative Oncology General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 27. Sep. 2021 1 1 Chemotherapy-induced diarrhea in dogs and its management with 2 smectite: results of a monocentric open-label randomized clinical trial 3 Word count: 3810 4 Number of figures and tables: 2 tables, 3 figures 5 Data availability statement: The data that support the findings of this study are available 6 from the corresponding author upon reasonable request. 2 7 Abstract 8 Chemotherapy-induced diarrhea (CID) is a frequent chemotherapy adverse event in dogs.
    [Show full text]
  • An Approach to Acute and Chronic Diarrhoea
    Leader in digital CPD Earn 3 for Southern African Gastroenterology healthcare professionals free CEUs An approach to acute and chronic diarrhoea Learning objectives You will learn: • The causes of and risk factors for acute and chronic diarrhoea • How to screen and diagnose acute and chronic diarrhoea • The general principles of treating diarrhoea, with a focus on anti-diarrhoeal agents used adjunctively to oral rehydration and, if necessary, antimicrobials. Introduction In the healthy adult, diarrhoea is often viewed as a ‘nuisance’ disease. However, serious complications including severe dehydration and renal failure can occur and may necessitate admission to hospital. Elderly people and those in long-term care have an increased risk of death as a consequence of diarrhoea. Diarrhoea is reported to cause more deaths, an estimated 2.5 million annually, than any other condition Oral rehydration in children under five years of age living in resource-poor countries. In South Africa, therapy is central to diarrhoea accounts for 19% of deaths of children under five years of age; dehydration 1-3 the management of is the key factor in these deaths. acute diarrhoea, being Diarrhoea is classified as acute (short-term, less than 7 days), prolonged (a form of sufficient in most acute diarrhoea lasting more than 7 days), or chronic (long-term, more than 2 weeks patients to prevent in children or 4 weeks in adults). It is also classified as mild, moderate, or severe, complications due to with dehydration reflecting severity of symptoms. Oral rehydration
    [Show full text]
  • Partial Agreement in the Social and Public Health Field
    COUNCIL OF EUROPE COMMITTEE OF MINISTERS (PARTIAL AGREEMENT IN THE SOCIAL AND PUBLIC HEALTH FIELD) RESOLUTION AP (88) 2 ON THE CLASSIFICATION OF MEDICINES WHICH ARE OBTAINABLE ONLY ON MEDICAL PRESCRIPTION (Adopted by the Committee of Ministers on 22 September 1988 at the 419th meeting of the Ministers' Deputies, and superseding Resolution AP (82) 2) AND APPENDIX I Alphabetical list of medicines adopted by the Public Health Committee (Partial Agreement) updated to 1 July 1988 APPENDIX II Pharmaco-therapeutic classification of medicines appearing in the alphabetical list in Appendix I updated to 1 July 1988 RESOLUTION AP (88) 2 ON THE CLASSIFICATION OF MEDICINES WHICH ARE OBTAINABLE ONLY ON MEDICAL PRESCRIPTION (superseding Resolution AP (82) 2) (Adopted by the Committee of Ministers on 22 September 1988 at the 419th meeting of the Ministers' Deputies) The Representatives on the Committee of Ministers of Belgium, France, the Federal Republic of Germany, Italy, Luxembourg, the Netherlands and the United Kingdom of Great Britain and Northern Ireland, these states being parties to the Partial Agreement in the social and public health field, and the Representatives of Austria, Denmark, Ireland, Spain and Switzerland, states which have participated in the public health activities carried out within the above-mentioned Partial Agreement since 1 October 1974, 2 April 1968, 23 September 1969, 21 April 1988 and 5 May 1964, respectively, Considering that the aim of the Council of Europe is to achieve greater unity between its members and that this
    [Show full text]
  • Review Article Role of Antidiarrhoeal Drugs As Adjunctive Therapies for Acute Diarrhoea in Children
    Hindawi Publishing Corporation International Journal of Pediatrics Volume 2013, Article ID 612403, 14 pages http://dx.doi.org/10.1155/2013/612403 Review Article Role of Antidiarrhoeal Drugs as Adjunctive Therapies for Acute Diarrhoea in Children Christophe Faure Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada H3T 1C5 Correspondence should be addressed to Christophe Faure; [email protected] Received 25 October 2012; Revised 2 January 2013; Accepted 2 January 2013 Academic Editor: Catherine Bollard Copyright © 2013 Christophe Faure. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute diarrhoea is a leading cause of child mortality in developing countries. Principal pathogens include Escherichia coli, rotaviruses, and noroviruses. 90% of diarrhoeal deaths are attributable to inadequate sanitation. Acute diarrhoea is the second leading cause of overall childhood mortality and accounts for 18% of deaths among children under five. In 2004 an estimated 1.5 million children died from diarrhoea, with 80% of deaths occurring before the age of two. Treatment goals are to prevent dehydration and nutritional damage and to reduce duration and severity of diarrhoeal episodes. The recommended therapeutic regimen is to provide oral rehydration solutions (ORS) and to continue feeding. Although ORS effectively mitigates dehydration, it has no effect on the duration, severity, or frequency of diarrhoeal episodes. Adjuvant therapy with micronutrients, probiotics, or antidiarrhoeal agents may thus be useful. The WHO recommends the use of zinc tablets in association with ORS.The ESPGHAN/ESPID treatment guidelines consider the use of racecadotril, diosmectite, or probiotics as possible adjunctive therapy to ORS.
    [Show full text]
  • Efficacy of Dioctahedral Smectite in Treating Patients Of
    doi:10.1111/j.1440-1746.2007.04895.x GASTROENTEROLOGY Efficacy of dioctahedral smectite in treating patients of diarrhea-predominant irritable bowel syndrome Full-Young Chang, Ching-Liang Lu, Chih-Yen Chen and Jiing-Chyuan Luo Division of Gastroenterology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan Key words Abstract abdominal bloating, diosmectite, functional gastrointestinal disorder, irritable bowel Background and Aim: Dioctahedral smectite (DS) is natural adsorbent clay useful in syndrome, Rome criteria. treating acute diarrhea. The aim of this study was to determine DS efficacy on patients with diarrhea-predominant irritable bowel syndrome (D-IBS in a phase III-, 8-week- Accepted for publication 23 November 2006. randomized, double-blind, placebo-controlled trial. Methods: The 104 patients who met the D-IBS Rome II criteria were randomized to Correspondence receive either DS (n = 52) or placebo (n = 52) treatment for 8 weeks (three sachets daily). Dr Full-Young Chang, Division of The primary efficacy endpoint was the changes of the visual analog scale (VAS) score of Gastroenterology, Taipei Veterans General IBS overall disorder and pain/discomfort-related symptoms after treatment on days 28 and Hospital, 201 Shih-Pai Road, Section 2, Taipei, 56, respectively. Other outcome measures included improvement of bowel movement Taiwan 11217. Email: [email protected] disorders. The therapeutic global response was assessed by the patients and investigators at each visit, as was drug safety. Results: Both treatments diminished overall disorder at each visit (P < 0.01), with respect to primary efficacy. This effect was further observed in DS-treated patients on day 56 (P = 0.0167).
    [Show full text]