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Biomedical subjects

M L Bouvy

Publications and source records attributed to M L Bouvy.

11 recordsLinked to original sources
PubMed2003

Predicting mortality in patients with heart failure: a pragmatic approach.

OBJECTIVE: To develop a comprehensive and easily applicable prognostic model predicting mortality risk in patients with moderate to severe heart failure. DESIGN: Prospective follow up study. SETTING: Seven general hospitals in the Netherlands. PATIENTS: 152 outpatients with heart failure or patients admitted to hospital because of heart failure, who were included in a randomised trial to assess the impact of a pharmacist led intervention to improve drug compliance. Duration of follow up was at least 18 months. MAIN OUTCOME MEASURES: Multivariable logistic regression modelling was used to evaluate information from history, physical examination (for example, blood pressure), drug use, and quality of life questionnaires that independently contributed to the prediction of death. The area under receiver operating characteristic curves (AUC) was used to estimate the predictive ability of the prognostic models. RESULTS: During the 18 months of follow up, 51 patients (34%) died. Independent predictors of mortality were diabetes mellitus, a history of renal dysfunction (or higher creatinine), New York Heart Association (NYHA) functional class III or IV, lower weight or body mass index, lower blood pressure, ankle oedema, and higher scores on a disease specific quality of life questionnaire. The use of beta blockers was predictive of a better prognosis. These factors were used to derive various prediction formulas. A model based on medical history, weight, presence of oedema, and lower blood pressure had an AUC of 0.77. Addition of use of beta blockers to this model improved the AUC to 0.80. Addition of NYHA class increased the AUC to 0.84. Data on quality of life did not improve the AUC further (AUC 0.85). CONCLUSIONS: A prognostic model produced on the basis of easily obtainable information from medical history and physical examination can adequately stratify heart failure patients according to their short term risk of death.

Adult↗
PubMed2002

Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention.

INTRODUCTION: Opioid-induced constipation is a common problem and can cause serious complications. It is widely advised that laxatives should be started concurrently with opiates, unless there is a clear indication not to do so. OBJECTIVE: This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the effect of pharmacy-based interventions to promote the use of laxatives in patients starting opioids. METHODS: Twenty-six community pharmacies identified all patients who received a first prescription for a strong opioid during January and February of 1998, 1999 or 2000. Pharmacists collected information on patient, drug and prescriber characteristics (age, gender, use of opiates and laxatives). A separate questionnaire was used to collect data on pharmacy-based interventions to promote the simultaneous prescribing of laxatives with the opiates. RESULTS: Overall, 37% of the patients receiving an opioid started taking laxatives within 5 days. The percentage of patients who received laxatives simultaneously with opioids increased from 31% in 1998 to 35% in 1999 and 42% in 2000. In 117 (43%) of the opioid prescriptions, pharmacy-based intervention had taken place before the prescription date. Of these, 48.7% was accompanied by a laxative. Opioid prescriptions (n=152) without a pharmacy based intervention were accompanied in 27.6%. After adjustment for covariates (including time trends), pharmacy-based intervention increased the probability of concomitant laxative use 1.9 [95% CI 1.1-3.3] times. DISCUSSION: This study shows that the widely used guideline to start a laxative when prescribing an opioid is not always followed in daily practice. In addition, we showed that pharmacy-based intervention contributed to increasing laxative use in patients receiving opioids.

Aged↗
PubMed2001

Long-term therapy with spironolactone.

OBJECTIVE: To evaluate the duration of therapy with spironolactone in daily practice. METHOD: A retrospective follow-up of a cohort of patients with a first prescription for spironolactone between January 1, 1990 and December 31, 1996 and at least one hospital discharge for CHF in the preceding year. RESULTS: 243 patients met the inclusion criteria and were followed until the end of data collection. The average starting dosage of spironolactone was 55 mg. 143 patients (58.8%) discontinued spironolactone therapy before the end of follow-up. 98 patients (40.8%) discontinued within 6 months of follow-up. Of the 137 patients (56.4%) who did use spironolactone and an ACE-inhibitor concomitantly, only 45 (32.8%) continued this combination until the end of follow-up. The remainder of the patients discontinued either the ACE-inhibitor (10.9%) or spironolactone (12.4%) or both (43.8%). CONCLUSION: While the reasons for discontinuation remain unclear, our data suggest that it is difficult to keep patients on both drugs. It is not certain whether these findings from past spironolactone use can be extrapolated to future use. Patients in the general population received higher average spironolactone dosages compared to the RALES study (55 mg vs. 26 mg), possibly resulting in more adverse effects and partly explaining the high discontinuation rate.

Adult↗
PubMed2001

Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors.

BACKGROUND: In previous research, lapses in dosing of paroxetine or sertraline were associated with significantly more discontinuation symptoms and deterioration of depressive symptomatology compared with fluoxetine. AIMS: To evaluate dosing lapses in patients chronically treated with selective serotonin reuptake inhibitors (SSRIs) in uncontrolled circumstances. METHOD: In a prospective observational study we evaluated compliance data in chronic users of SSRIs using electronic drug exposure monitors. RESULTS: During a 3-month follow-up we found that 50/69 (72.5%) patients missed at least one dosing day and 20/69 (29.0%) missed two or more consecutive days. CONCLUSIONS: About 30% of patients treated with short-acting SSRIs had dosing lapses of 2 or more days, which, as described in prior studies, is long enough to result in clinically relevant deterioration of mental status.

Adolescent↗
PubMed2000

Use of sympathomimetic drugs leads to increased risk of hospitalization for arrhythmias in patients with congestive heart failure.

BACKGROUND: Sympathomimetic agents have a direct positive chronotropic effect on heart rate and may cause hypokalemia, even when administered by inhalation. In selected patients (e.g., patients with congestive heart failure [CHF]) this can lead to arrhythmias. Despite the potential adverse effects of these agents, they are used frequently in patients with CHF, due to a high incidence of respiratory comorbidity. This study investigates the effects of sympathomimetics on the incidence of hospitalizations for arrhythmias in patients with CHF. METHODS: In a cohort of 1208 patients with a validated hospital discharge diagnosis of CHF, we identified 149 cases with a readmission for arrhythmias, and compared these in a nested matched case-control design with 149 controls from the remainder of the cohort with no hospital readmission for any cardiac cause. Conditional logistic regression was used to calculate the risk for hospitalization for arrhythmias associated with exposure to sympathomimetic agents, expressed as odds ratios. RESULTS: Of 149 case patients, a total of 33 (22.1%) were treated with any sympathomimetic agent, and 6 patients (4.0%) were treated with systemic sympathomimetics. The use of any sympathomimetic drug was associated with an increased risk of admission for arrhythmia (odds ratio, 4.0; 95% confidence interval, 1.0-15.1). For systemic sympathomimetic drugs, the corresponding odds ratio was 15.7 (95% confidence interval, 1.1-228.0). CONCLUSIONS: The results of this study strongly suggest an increased risk of hospitalization for arrhythmias in patients with CHF treated with sympathomimetic drugs. Sympathomimetics should be given under close surveillance to patients with CHF.

Aged↗
PubMed1999

[Clinical researchers and pharmaceutical industry. The examples of troglitazone and mibefradil].

A newly introduced drug may find many obstacles in its path. The intensity of marketing of new drugs can have unwanted effects. When new drugs are prescribed for a population that differs widely from that in clinical trials, unforeseen side effects can occur. The examples of troglitazone and mibefradil illustrate these mechanisms. It is the responsibility of the drug manufacturers and prescribers to let new drugs gradually find their therapeutic position. Otherwise exaggeration of untoward effects may lead to the speedy and possibly premature withdrawal of the drugs.

Antihypertensive Agents↗
PubMed1999

Women with angina pectoris receive less antiplatelet treatment than men.

In a study investigating the prevalence of underprescription of platelet therapy for women with angina pectoris, the complete medication histories of patients were examined and indicators of possible comorbidity and comedication were recorded. A higher percentage of women than men were not treated with any form of antithrombotic treatment (37% versus 18%), suggesting a serious, and possibly hazardous, undertreatment with acetylsalicylic acid (ASA) in women compared with men.

Aged↗
PubMed1992

Acitretin (Neotigason). A review of pharmacokinetics and teratogenicity and hypothesis on metabolic pathways.

Acitretin was introduced as a replacement for etretinate, the ethyl ester of acitretin. Acitretin is eliminated at a much faster rate than etretinate. Although both drugs are teratogens, the replacement was important especially as it allowed for a much shorter post-medication period in which pregnancy should be precluded. Recent findings showed the presence of etretinate in the plasma of acitretin-treated patients. This article gives a review of known metabolic pathways of the retinoids and tries to elucidate the possible conversion of acitretin into etretinate after acitretin ingestion.

Abnormalities, Drug-Induced↗