The latest medical research on Clinical Pharmacology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about clinical pharmacology gathered by our medical AI research bot.

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Prevalence of pretreatment and acquired HIV-1 mutations associated with resistance to lamivudine or rilpivirine: a systematic review.

Antiviral Therapy

Pretreatment and acquired drug resistance mutations (DRMs) can limit antiretroviral therapy effectiveness.

We review prevalence of DRMs with resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), focusing on lamivudine and rilpivirine, from 127 articles with >100,000 individuals with HIV-1 infection.

Estimated global prevalence of pretreatment resistance to any NRTI was 4% and to any NNRTI was 6%. Most prevalent DRMs resistant to lamivudine or rilpivirine were at positions E138 (4%), V179 (1%), and M184 (1%). Estimated acquired DRM prevalence was 58% for any NRTIs and 67% for any NNRTIs, most frequently at positions M184 (58%) and Y181 (21%).

This review suggests low risk of lamivudine- or rilpivirine-resistant mutations in treatment-naive, HIV-1-infected individuals.

Treatment of hepatitis C in two paediatric patients using sofosbuvir during haematopoietic stem cell transplantation.

Antiviral Therapy

We report the first two pediatric cases of sofosbuvir treatment during high-intensity myeloablative conditioning and engraftment phases of hematopo...

Utilization of oral anticoagulants in Korean nonvalvular atrial fibrillation patients.

International Journal of Epidemiology

Background Although the majority of clinical guidelines indicate the use of NOAC (nonvitamin K antagonist oral anticoagulant) over vitamin K antago...

Item-based analysis of the effects of duloxetine in depression: a patient-level post hoc study.

Neuropsychopharmacology

Oft-cited trial-level meta-analyses casting doubt on the usefulness of antidepressants have been based on re-analyses of to what extent the active ...

Magnetic seizure therapy (MST) for major depressive disorder.

Neuropsychopharmacology

Electroconvulsive therapy (ECT) is effective for major depressive disorder (MDD) but its effects on memory limit its widespread use. Magnetic seizu...

Chronic non-discriminatory social defeat is an effective chronic stress paradigm for both male and female mice.

Neuropsychopharmacology

Stress-related mood disorders are more prevalent in females than males, yet preclinical chronic stress paradigms were developed in male rodents and...

The effect of methylphenidate on social cognition and oxytocin in children with attention deficit hyperactivity disorder.

Neuropsychopharmacology

The current study aimed to explore the possible effect of stimulants on oxytocin (OT), a neuropeptide which regulates social behavior, as a mediato...

A systematic review examining the effectiveness of medicines information services for patients and the general public.

International Journal of Epidemiology

Hospital-based patient medicines helpline services (PMHS) and medicines information services for the general public (MISGP) are available in many countries to support people with their medicines. Our aim was to examine the available evidence regarding the effectiveness of PMHS and MISGP.

Searches were conducted using Medline, EMBASE, CINAHL, Scopus and Web of Science, on 11 August 2018. Forward and backward citation searches were conducted, grey literature was searched, and study quality/risk of bias was assessed. Findings were synthesised in a narrative synthesis. Where appropriate, weighted means were calculated.

Thirty-two studies were identified for inclusion (17 published articles, 15 conference abstracts). Eighteen studies were conducted within the United Kingdom. Mean quality assessment was moderate (51%), and risk of bias was high (63%). PMHS and MISGP are both typically perceived as positive (e.g. 94% and 91% of participants were satisfied with using a PMHS and MISGP, respectively). For PMHS, the advice received is reported to be usually followed (94%, and 66% for MISGP). For both services, users report several positive outcomes (e.g. problems resolved/avoided, feeling reassured and improved health). PMHS may also be effective for correcting medicines-related errors (up to 39% of calls may concern such errors) and for potentially avoiding medicines-related harm (48% of enquiries concerned situations that were judged to have the potential to harm patients).

Findings suggest that both PMHS and MISGP may be beneficial sources of medicines-related support. However, the moderate quality and high risk of bias of studies highlight that more high-quality research is needed.

Evaluation of the Safety of Intravenous Thiamine Administration in a Large Academic Medical Center.

Journal of Pharmacy and Pharmacology

Previous literature describes increased incidence of infusion-related reactions when administering thiamine doses greater than 100 mg as an intravenous (IV) push. The purpose of this evaluation was to assess the safety of administering higher doses of thiamine as IV push compared to infusion.

A single-center, retrospective review was performed from June to October 2017. Included patients were aged 18 years or older and received 1 dose of IV thiamine 200 mg or greater. Patients were divided into 2 groups: group 1 included patients who received 200-mg IV push and, group 2 included patients who received any dose greater than 200 mg. The primary objective was to quantify and compare rate of adverse reactions between the 2 groups. Institutional thiamine prescribing practices were examined. Wilcoxon Rank Sum and Fischer exact tests were performed.

Sixty-six percent of patients were male, and the median age was 55 years (interquartile range [IQR]: 44-63). Fifty percent received 200-mg IV push, 20% received a combination of IV infusion and IV push, and 30% received IV infusion. Adverse reactions possibly due to thiamine administration occurred in 4 (2.0%) patients. One patient received 200 mg via IV infusion, while 3 received 200 mg via IV push. There was no significant difference in adverse reaction rate between IV push and IV infusion administrations (P = .640).

Our results support administering thiamine doses of 200 mg or less as an IV push. Given lack of robust safety data, it is recommended to continue to dilute doses greater than 200 mg and infuse over 30 minutes.

The assessment of environmental and external cross-contamination in preparing ready-to-administer cytotoxic drugs: a comparison between a robotic system and conventional manual production.

International Journal of Epidemiology

The primary aim of the study was to compare environmental and external (cross-) contamination of traces of cytostatics, during preparation of 5-fluorouracil and cyclophosphamide using a robotic system (APOTECAchemo) or the conventional manual compounding procedure. The secondary aim was to validate the cleaning procedure of the robot.

Eighty ready-to-administer (RTA) infusion bags with 5-fluorouracil, cyclophosphamide or sodium chloride were compounded using both techniques on 3-5 days. Wipe samples were taken from several locations in the compounding room before and after cleaning, and also from the technician's gloves. These samples were analysed for 5-fluorouracil and cyclophosphamide concentrations using GC/MS/MS.

A total of 284 wipe samples were collected during the study (113 from the manual and 171 from the robotic process). External contamination on the outside of infusion bags was 3.75% for both manual and robotic compounding. For manual compounding, external cross-contamination occurred on 2.5% of the prepared infusion bags. External cross-contamination occurred on 1.25% of the infusion bags for the robotic procedure. Inside the compounding room, 9% of the environmental wipe samples were contaminated in case of manual production and 24% for robotic compounding. Since 50% of the contaminated environmental samples for the robotic system were taken after cleaning, the cleaning procedure was extended and parameter setting for cyclophosphamide handling was performed. After this, residual environmental or external contamination was no longer detectable.

Comparison of both preparation methods showed that external (cross-)contamination of infusion bags was lower using the robotic system. An optimized cleaning procedure showed the best results in environmental contamination for the robot.

Internet-based pharmacy and centralised dispensing: an exploratory mixed-methods study of the views of family practice staff.

International Journal of Epidemiology

Over the last decade, technological advances, market competition and increasing pressures for efficiencies across healthcare systems have resulted in changes to the processes and policies involved in medicines prescribing and dispensing. The aim of this study was to explore the views of family practice staff, including GPs, on the perceived impact of changes associated with remote dispensing and the increasing availability of distance-selling pharmacies.

Exploratory mixed-methods study using qualitative focus groups and an online cross-sectional survey distributed to a non-probability sample of staff from family practices across England. Survey items were developed based on existing literature and initial thematic analysis from the focus groups and adapted using cognitive interviewing techniques.

Findings suggest that family practice staff believe that where and how prescriptions are dispensed impacts on their practice and patients. Frequent contact with distance-selling pharmacies is not common; however, highlighted concerns included patient safety issues and the potential threat to the loss of valued elements and sustainability of community pharmacy and dispensing practices. Identified concerns and experiences are unlikely to be routinely discussed within or between practices, limiting opportunities for shared learning and consideration of the potential impact of changes to dispensing processes and policies.

Further research is needed to confirm these exploratory findings, due to the low response rate and sample size. Findings, nevertheless, highlight how wider changes in dispensing processes may have unintended consequences on other aspects of the healthcare system.

An exploration of patient safety culture in Kuwait hospitals: a qualitative study of healthcare professionals' perspectives.

International Journal of Epidemiology

Patient safety culture (PSC) represents a key component of the quality of care offered by healthcare professionals. Therefore, it is crucial to understand the factors that influence the implementation of a safe culture. This study explored the knowledge and attitudes of healthcare professionals in Kuwait towards the factors that might affect the PSC.

A qualitative study using semi-structured interviews with healthcare professionals was conducted between February and June 2018 at two major hospitals in Kuwait. Both hospitals had been accredited and have been applying the safety programmes recommended by the Kuwaiti Ministry of Health. Participants were purposively selected where 20 healthcare professionals were interviewed. The interviewees comprised of six physicians, six clinical pharmacists, six nurses and two members of the patient safety committee. Inclusion criteria involved healthcare professionals who had more than 1-year clinical experience, have interest in patient safety and had a good level of English. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview transcripts was conducted to identify the emergent themes.

Thematic analysis of the interviews yielded three major themes related to 'management', 'regulations and policies' and 'healthcare professionals'. Management issues included managerial support, resources, safety environment and staff training. Regulations and policies highlighted issues related to policies and procedures and incident reporting system. Healthcare professionals' theme covered factors related to knowledge, communication and teamwork among healthcare professionals.

This study gave insight into how healthcare professionals perceive the current PSC in Kuwait. Despite their positive attitudes and knowledge towards patient safety, various barriers were reported that hinder optimal PSC. These barriers were related to support, staffing, resources and response to error.