We bring you the latest news from the healthcare about the health care in the United Kingdom. Do your have news for us? Contact the editor. Watch also this special movie.

zondag 15 oktober 2017

DTB: Prescribing PPIs

Prescribing PPIs

Proton pump inhibitors (PPIs) are widely prescribed and many people remain on them for years. In some, there may be good justification for long-term use; for example, in those with oesophageal stricture, Barrett's oesophagus or a history of a bleeding gastrointestinal ulcer, or to provide gastroprotection in those at high risk of gastrointestinal complications from taking NSAIDs. However, PPIs are often not used in line with clinical guidelines.1,2 In addition, there are concerns that many people take them for long periods to manage less serious conditions (e.g. indigestion) and may prefer taking them to addressing factors such as diet, obesity or alcohol that may be contributing to their symptoms. Although PPIs are well-tolerated, there is increasing evidence that they may be associated with a range of long-term adverse effects. Here, we review the safety of PPIs and consider whether long-term prescribing needs to be reassessed.

Read more

Live attenuated influenza vaccine for children

For many years, the UK seasonal influenza vaccination programme has been offered to people at higher risk from the complications of influenza infection, including those aged over 65 years and anyone aged over 6 months who is in a clinical risk group.1 In 2012, the Joint Committee on Vaccination and Immunisation (JCVI) recommended extending seasonal influenza vaccination to children aged 2–16 years who are not in a clinical risk group.2 In contrast to the vaccination programme for adults, which uses an injectable inactivated influenza vaccine, children are being offered a live attenuated influenza vaccine (LAIV) that is administered intranasally.2 Here, we consider the evidence for the use of the intranasal influenza vaccine for children who are not in a clinical risk group.

Read more

Hospitalisations caused by inappropriate medication use

A study has examined the use of potentially inappropriate medicines (PIMs) on hospitalisation rates, and also estimated the rate of hospitalisation during exposure to individual PIMs in older adults.1 The authors point out that inappropriate medicines pose a particular risk to older people due to cognitive and physiological changes associated with the ageing process. The increased risk of harm from exposure to PIMs among older people may also be linked to multimorbidity, polypharmacy and interactions between complex medication regimens.

The retrospective population-based cohort study of almost 1.5 million older adults in Italy used a regional administrative healthcare database. Medicines were assessed using the Maio criteria, a modified version of the Beers criteria used in Italy.1,2 The Maio criteria consist of three categories of PIMs: medicines that 'should always be avoided', medicines that are 'rarely appropriate' and medicines that have 'some indications' for use...

Read more

Telemedicine versus standard care for inflammatory bowel disease

A randomised trial based in four hospitals in the Netherlands has compared a telemedicine system for inflammatory bowel disease (IBD) with standard care.1

The system assessed in the study was myIBDCoach, which was developed to work for all subtypes of IBD. It includes monthly monitoring modules, which contain questions on disease activity, medication use, treatment adherence, treatment satisfaction, adverse effects (including infections), factors affecting disease (e.g. nutritional status, smoking, stress) and patient-reported outcome measures on quality of life and work productivity.

The 12-month trial included 909 outpatients, aged 18–75 years, with IBD who were randomly assigned to the myIBDCoach system or standard care. The primary outcomes were the number of outpatient visits and patient-reported quality of care. Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits and operations. At 12 months, the mean number of outpatient visits to a gastroenterologist or nurse was...

Read more

Effectiveness of self-management interventions for COPD

A Cochrane systematic review has assessed the efficacy of self-management interventions for COPD (22 studies, 3,854 participants).1 The review included randomised controlled trials that compared the effectiveness of COPD self-management interventions (that included an action plan for acute exacerbations of COPD) with usual care. Outcomes included health-related quality of life (HRQoL) and respiratory-related hospital admissions. Disease management programmes that could be classified as, or confused with, pulmonary rehabilitation were excluded.

For the purpose of the review, an action plan referred to specific behaviour to be initiated when respiratory symptoms deteriorated and included a description of when, where and how the patient should act.1 The content of the self-management interventions was described as diverse and could include components that were directed towards achieving behaviour change (e.g. smoking, exercise and diet).

Follow-up time ranged from 2 to 24 months. The review found a statistically significant improvement in...

Read more

SGLT2 inhibitors and cardiovascular outcomes

A large observational study has investigated the cardiovascular effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors in new users compared with new users of other glucose-lowering drugs.1 Previously published studies in patients with type 2 diabetes and a high cardiovascular risk profile have reported reductions in cardiovascular outcomes with the SGLT2 inhibitors inhibitors empagliflozin and canagliflozin.2,3

This observational study compared cardiovascular mortality and morbidity in people with type 2 diabetes (mean age 61 years), of whom 25% had cardiovascular disease.1 The study, which had a mean follow-up of 0.9 years, assessed data from nearly 100,000 patients who had a prescription dispensed for glucose-lowering drugs in Denmark, Norway and Sweden between 2012 and 2015. Each new user of an SGLT2 inhibitor was matched with three users of other glucose-lowering drugs. Comparator drugs included insulin, dipeptidyl peptidase-4 inhibitors, sulfonylureas, glucagon-like peptide-1 receptor agonists...

Read more

High-dose vitamin D for the prevention of RTI in young children

The effect of different doses of vitamin D for prevention of wintertime respiratory tract infections (RTI) in pre-school children has been assessed in a randomised trial.1 A recent meta-analysis of 25 trials in adults and children found that vitamin D had a modest effect of preventing acute RTIs among all participants (adjusted odds ratio 0.88, 95% CI 0.81 to 0.96; number-needed-to-treat 33), with a more pronounced effect in those with low vitamin D status (baseline circulating 25-hydroxyvitamin D levels <25nmol/L).2 This latest study investigated whether high-dose vitamin D would produce a more marked effect.

The trial was conducted during the winter months between September 2011 and June 2015 among children aged 1 to 5 years in Toronto, Canada. A total of 703 children (mean age 2.7 years) were randomised to receive oral supplements of either 2,000iu per day of vitamin D (high-dose group) or 400iu...

Read more

Oral antifungals for toenail onychomycosis

Efficacy and safety of oral treatments for fungal toenail infection have been assessed in a Cochrane review (48 studies, 10,200 participants).1 Study duration ranged from 4 months to 2 years and participants mainly had subungual fungal infection of the toenails. The review's authors found that terbinafine was more effective than placebo (8 studies, 1,006 participants) for clinical cure (risk ratio [RR] 6.00, 95% CI 3.96 to 9.08) and mycological cure (RR 4.53, 95% CI 2.47 to 8.33). Azoles (9 studies, 3,440 participants) were also more effective than placebo for clinical cure (RR 22.18, 95% CI 12.63 to 38.95) and mycological cure (RR 5.86, 95% CI 3.23 to 10.62). Azoles studied included itraconazole, fluconazole, albaconazole, posaconazole and ravuconazole. There were no significant differences in adverse events between active-treatment and placebo groups.

There was moderate-quality evidence that terbinafine was more effective than azoles for achieving clinical cure (RR 0.82,...

Read more

Risk of severe liver injury with {blacktriangledown} daclizumab (Zinbryta)

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning on the risk of severe liver injury with daclizumab.1 The MHRA has advised that, while an urgent EU-wide review of new information on liver safety is under way, initiation of daclizumab in multiple sclerosis (MS) should be restricted to patients with limited treatment options. Prescribers should promptly review patients already on treatment to assess whether it continues to be appropriate for them. The review should include a discussion with the patient of the risks. All patients receiving daclizumab should have their liver function closely monitored.

Daclizumab is licensed for the treatment of relapsing forms of MS in adult patients with highly active disease, despite a full and adequate course of treatment with at least one disease modifying therapy or in those with rapidly evolving severe relapsing MS who are unsuitable for treatment with other disease...

Read more

Flagging risk

As a publication that regularly reviews new medicines, DTB recognises the challenge facing prescribers as they attempt to balance the benefits and harms of drug treatment. Assessing whether a medicine (new or old) will result in a net benefit to a patient requires careful interpretation of the evidence on efficacy and adverse effects.1,2 In 1990, we noted that a realistic appraisal of a drug's safety "requires knowledge of the frequency and seriousness of the drug's unwanted effects and interactions, including their predictability and reversibility, whether they are related to dosage and duration of treatment, risk factors, the precautions needed to prevent or minimise them and how much effort these entail".3 With the introduction of adaptive licensing pathways, more complex pharmaceutical products and an increasing number of drugs that regulatory authorities have stipulated will need further study of adverse events once the drugs are...

Read more