American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Jul 2007
Comparative StudyResource use associated with topiramate in migraine prophylaxis.
The effect of topiramate prophylaxis on medication use and medical resource use for migraine patients was studied. ⋯ Migraine patients within commercially insured health plans incurred substantial resource use. Within six months following initiation of topiramate preventive therapy, reductions in acute migraine medication and medical resource use were observed among this population of migraine sufferers.
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To summarize key recommendations and supporting evidence from the most recent Institute of Medicine (IOM) report, Preventing Medication Errors. ⋯ Preventing Medication Errors lays out a blueprint for change in medication safety. The report makes clear that providers have m any opportunities to improve. Technologies, such as computerized order entry, bar-coding and smart pumps and computerized ADE monitoring, will undoubtedly play a key role, and institutions should be thinking seriously about implementing a number of these. The report also emphasizes how essential a culture change, combined with well-designed technologies, will be necessary to achieve the next level of safety called for in the IOM report.
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Am J Health Syst Pharm · Jul 2007
ReviewStress ulcer prophylaxis in hospitalized patients not in intensive care units.
A review is presented of the evidence behind the current use of therapies for the prevention of stress-related mucosal disease and bleeding in the nonintensive care unit (ICU), general medicine population. ⋯ AST is commonly misused in hospitals, with as many as 71% of patients in general medicine wards receiving some sort of AST without an appropriate indication. Anticoagulant therapy has been identified as a risk factor for GI bleeding in hospitalized patients, but prophylaxis with AST has not been found to lower that risk. Although PPIs, H2-antagonists, and antacids are often viewed as safe, patients--particularly those with complicated disease states and complex drug regimens--should not be unduly exposed to the adverse effects and drug interactions associated with those agents. Many such patients treated with the drugs while hospitalized continue to receive AST as outpatients. The cost of inappropriate stress ulcer prophylaxis in medicine patients was found in one trial to exceed $111,000 for one year. The use of AST for the prevention of stress ulcers in general medicine patients is currently not recommended or supported in the clinical literature.