ISSN:1053-8569    

DOI:10.1002/pds.2630030202

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractRecord‐linkage databases have been used to evaluate the safety of approved drugs. Outcome and exposure data collected in these databases are contingent upon temporal contacts between patients and their physicians and pharmacists. We examined the theoretical effect of temporal clustering in physician and pharmacy services on pharmaceutical risk estimates by generating computer modeled datasets of the dates of provider services. Incidence density ratios were estimated for each dataset by comparing the incidence of the hypothetical outcome during exposure to that during no exposure. The presence of clustering in provider services, the risk associated with exposure, the length of the risk period, the number of refills and the underlying physician visit rates were varied by dataset. Biased estimates of the incidence density ratio were obtained in datasets with clustering. The magnitude of bias decreased with increasing length of the risk period, increasing number of refills and increasing physician visit rate. A sample of an HMO record‐linkage database showed evidence of clustering in physician visits at the patient level when the transaction dates for all physician visits were tested for clustering. Researchers using record‐linkage databases or data derived from patient interactions with providers to study the acute risk of pharmaceutical exposures, should consider the possibility of biased risk estimates for outcomes that cluster with other outcomes and exp

ISSN:1053-8569    

DOI:10.1002/pds.2630030203

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractPrescribing rates for the Family Health Service Authorities (FHSAs) of the Northern region were studied for the period June 1989–September 1992. Over three years the total number of items prescribed in the region rose by 13 per cent, and costs rose by 39 per cent. Trends within individual leading British National Formulary (BNF) chapters were different. The number of endocrine items increased substantially faster than average (45 per cent, over three years); gastro‐intestinal (GI) items also showed an above average rise; central nervous system (CNS) and infections items rose by only 6–8 per cent. In terms of cost, there were major rises for both endocrine (89 per cent) and CNS (62 per cent) drugs, but musculoskeletal (MS) prescribing costs were nearly static (+5 per cent). These trends were similar across the nine FHSAs in the Northern region. Significant upturns in the prescribing trends for CNS and endocrine drugs occurred in early 1992 leading to the high overall increases already noted.Despite the pressure for conformity associated with changes in the funding of general practitioners' prescribing budgets, the differences between FHSAs in their absolute prescribing rates have largely remained. Within each therapeutic group the rankings of FHSAs have also shown surprising consistency. Whether these observations are attributable to fundamental differences in patient populations, or merely the consequence of inertia with respect to historic rates, is debatable. The reasons can only be properly determined by focused investigation of data linking prescribing and patient demogra

ISSN:1053-8569    

DOI:10.1002/pds.2630030204

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn Hong Kong, adverse drug reactions (ADRs) are rarely reported. We tried to improve the reporting of ADRs in our medical unit at the Prince of Wales Hospital by promoting the scheme at our regular unit meetings and by including report forms at the time of admission in the case notes of all patients admitted to two general medical wards. Registrars and interns based in these wards were requested to report all ADRs by filling in standard report forms. The hospital records of these patients were then reviewed by one investigator with two aims: (1) to assess the proportions of ADRs being reported; (2) to determine how good junior staff are in reporting ADRs. During a 2‐month period in 1992, 430 patients were reviewed. A total of 122 ADRs were present in 98 patients either at the time of admission (n= 66) or after admission (n= 56), and of these, only six (5 per cent) were correctly reported. The diagnosis was either missed or wrong in 29 cases, which represent 24 per cent of the total number of ADRs. The remaining 71 per cent of ADRs were totally ignored. Possible ways to improve the reporting of ADRs in hospital are discusse

ISSN:1053-8569    

DOI:10.1002/pds.2630030205

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThere are many sources of asymptomatic abnormal liver function tests in clinical trials other than hepatotoxicity. It is, therefore, important to identify these sources by looking at the patient's past and present medical history for diseases or activities that may cause these abnormalities, study the degree and duration of the abnormality and the ratio of the different parameters to see whether they are consistent with the hypothesis that the drug is not hepatotoxic and that another cause is more likely.Diseases and activities that can cause these abnormalities are given and methods of analysis outlined. There is no good evidence that abnormal liver function tests are predictive of hepatotoxicity.

ISSN:1053-8569    

DOI:10.1002/pds.2630030206

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:1053-8569    

DOI:10.1002/pds.2630030207

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:1053-8569    

DOI:10.1002/pds.2630030208

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:1053-8569    

DOI:10.1002/pds.2630030201

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY