ORCID Profile
0000-0003-1046-9577
Current Organisation
University of South Australia
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Publisher: Informa UK Limited
Date: 03-2022
DOI: 10.2147/CA.S347799
Publisher: Informa UK Limited
Date: 2010
Publisher: Elsevier BV
Date: 07-2016
Publisher: Wiley
Date: 24-02-2017
DOI: 10.1002/JPPR.1291
Publisher: JMIR Publications Inc.
Date: 27-06-2016
DOI: 10.2196/JMIR.5726
Publisher: Informa UK Limited
Date: 2010
Publisher: Springer Science and Business Media LLC
Date: 26-05-2017
DOI: 10.1007/S11096-017-0490-Y
Abstract: Background There is a relative paucity of information to characterise potential changes in medication regimen complexity and prevalence of prescribing of potentially inappropriate medications after hospitalisation, both in Australia and elsewhere. Objective To evaluate medication regimen complexity and the prevalence of potentially inappropriate medications before and after admission to hospital. Setting General medical units of a tertiary care hospital in Australia. Methods Retrospective cohort study of patients aged 65 years and above. Medication complexity was measured by using the Medication Regimen Complexity Index (MRCI). Main outcome measure The primary outcome was the change in the Medication Regimen Complexity Index for all prescribed medications after hospitalization. Results A convenience s le of 100 patients was included in the study. There was a significant change in the mean medication complexity score (as measured using the MRCI), increasing from 29 at the time of admission to 32 at the time of discharge (p < 0.05). Factors such as baseline medication regimen complexity (pre-admission MRCI) and length of stay in the hospitals appear to influence the change in medication complexity. However, the proportion of patients prescribed at least one potentially inappropriate medicine (PIM) decreased significantly, from 52% pre-hospitalization to 42% at discharge (p = 0.04). Conclusions Relative to the time of admission, overall medication complexity increased and the proportion of patients who were prescribed PIMs decreased after hospitalisation.
Publisher: Wiley
Date: 06-2011
DOI: 10.1002/J.2055-2335.2011.TB00678.X
Abstract: The Beers criteria are used to identify potentially inappropriate medications (PIMs) in the elderly. Few studies have examined the Beers criteria in elderly hospitalised patients in Australia. To identify the prevalence of PIM use in elderly patients admitted to an Australian hospital using the 2003 Beers criteria. A prospective cross‐sectional study of 100 elderly inpatients was undertaken using the Beers criteria to identify and compare PIM on admission and discharge. Logistic regression analysis examined the risk factors for PIM use. 42% of patients had at least one PIM on admission compared to 39% at discharge. The most common PIMs were amitriptyline, senna, amiodarone and benzodiazepines (nitrazepam and diazepam). Excluding senna, the prevalence decreased to 36% at admission and 24% at discharge. At admission (including and excluding senna), PIM was not significantly associated with age, gender, living arrangements, number of comorbidities and number of medications. At discharge, PIM (including senna) was significantly associated with age (OR 1.1 95%CI 1.02–1.3 p = 0.02), female gender (OR 3.6 95%CI 1.3–10 p = 0.01) and number of medications (OR 1.2 95%CI 1.0–1.3 p = 0.02). When senna was excluded PIM at discharge was only significantly higher in female patients (OR 5.4 95%CI 1.7–16.9 p = 0.004). The Beers criteria detected a high prevalence of PIM use in elderly hospitalised patients.
Publisher: Informa UK Limited
Date: 2012
Publisher: Managed Care and Healthcare Communications, LLC
Date: 10-10-2022
Publisher: Wiley
Date: 09-2010
DOI: 10.1002/J.2055-2335.2010.TB00534.X
Abstract: Hyperkalaemia has been reported with high‐dose trimethoprim (20 mg/kg/day) and standard‐dose trimethoprim (6 mg/kg/day) plus sulfamethoxazole use. To investigate changes in plasma potassium concentrations in patients prescribed standard‐dose trimethoprim 300 mg daily for urinary tract infections. A retrospective cohort study of hospital patients with urinary tract infections treated with trimethoprim or other antibacterials (control group) for more than 5 days. Plasma potassium concentration, creatinine and urea were compared at baseline and at the completion of treatment. There were 31 patients in the trimethoprim group and 65 patients in the control group. End–of–therapy mean plasma potassium concentrations increased significantly from baseline in the trimethoprim group (4.2 ± 0.4 mmol/L to 4.5 ± 0.5 mmol/L p = 0.002) but not in the control group. End–of–therapy mean plasma potassium concentrations were also higher in the trimethoprim group (4.5 ± 0.5 mmol/L vs 4.2 ± 0.5 mmol/L p = 0.007). 65% of the trimethoprim group developed end–of–therapy hyperkalaemia versus 39% of the control group. Mean creatinine concentration in the trimethoprim group increased by an average of 21% from baseline but did not change in the control group. The trimethoprim group showed no change in mean urea concentration but a decrease was noted in the control group. Treating urinary tract infections with trimethoprim 300 mg daily for more than 5 days was associated with an increase in plasma potassium concentration.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2015
DOI: 10.1007/S00228-015-1819-X
Abstract: Evidence regarding the relationship between red blood cell methotrexate polyglutamate concentration and response to treatment and adverse drug reactions in patients using methotrexate for inflammatory arthropathies is complex and in some respects appears conflicting. Accordingly, we undertook a systematic analysis of available evidence to determine the clinical utility of dosing methotrexate to a target red blood cell methotrexate polyglutamate concentration. A systematic literature review was conducted to identify all studies that had reported an association between red blood cell methotrexate polyglutamate concentration and disease activity or adverse drug reactions in users of methotrexate for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis or psoriatic arthritis. No randomised controlled trials were identified. Thirteen studies (ten in patients with rheumatoid arthritis and three in patients with juvenile idiopathic arthritis) were identified. All studies evaluated an association between red blood cell methotrexate polyglutamate concentration and response to treatment, and eight evaluated an association with toxicity. Eight studies identified lower disease activity with at least one higher red blood cell methotrexate polyglutamate concentration, although there was at least moderate potential for bias in all of these studies. Relatively large increases in concentration appeared to be required to produce a meaningful reduction in disease activity. Only one study identified an association between red blood cell methotrexate polyglutamate concentration and methotrexate-induced side effects, although studies were likely underpowered to detect this type of association. The manner in which data were presented in the included studies had many limitations that h ered its conclusive assessment, but red blood cell methotrexate polyglutamate concentrations appear to be a potentially useful guide to treatment in patients with inflammatory arthropathies, but the specific polyglutamate that should be monitored and how monitoring could be integrated into treat-to-target approaches should be clarified before it can be routinely implemented.
Publisher: Pan African Medical Journal
Date: 2013
Publisher: Informa UK Limited
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 03-08-2012
DOI: 10.1007/S11096-012-9681-8
Abstract: The elderly population is increasing worldwide. Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs, the elderly are predisposed to adverse drug reactions. Prescribing of potentially inappropriate medications (PIMs) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality. This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP (screening tool of older people's prescriptions) criteria amongst a s le of hospitalised elderly inpatients in South Australia. Medical, surgical and rehabilitation wards of a public teaching hospital in Adelaide, South Australia. Pre-admission prevalence of PIM. Medication management plans of 100 patients of ≥65 years old were prospectively studied to determine the prevalence of pre-admission PIM use. Sixty-five criteria of STOPP were applied to identify PIMs. The total number of pre-admission medications screened during the study period was 949 the median number of medicines per patient was nine (range 2-28). Overall the STOPP criteria identified 138 PIMs in 60 % of patients. The most frequently encountered PIM was opiates prescribed in patients with recurrent falls (12.3 %), followed by benzodiazepines in fallers (10.1 %) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses (9.4 %). The number of medications were found to have a positive correlation with pre-admission PIM use (r(s) = 0.49, P < 0.01). Pre-admission PIM use is highly prevalent among the studied population. Strategies to reduce PIM use should be undertaken by physicians and pharmacists. The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2012
DOI: 10.1007/S11096-012-9644-0
Abstract: Gastrointestinal disorders frequently present symptoms which are often self-treated. To record demographic profile of patients visiting community pharmacies for self-treatment with medications for gastrointestinal disorders, the number of these patients who fulfilled irritable bowel syndrome diagnostic criteria, and to judge the appropriateness of their treatment requests. Singapore community pharmacies. The multicentre study was conducted using ROME III adapted criteria on adults above 18 years who have self-selected medicinal products for treatment of irritable bowel syndrome or gastrointestinal symptoms in the community pharmacy. Among those seeking self-medication, 36.8 % fulfilled criteria for irritable bowel syndrome, with irritable bowel syndrome-mixed (16.3 %) being the most prevalent subtype. For patients not fulfilling criteria for irritable bowel syndrome diagnosis, rates for other functional gastrointestinal disorders were constipation (20.5 %), dyspepsia (16.3 %), gastroesophageal reflux disease (12.1 %), diarrhoea (8.9 %), bloating (4.2 %), and heartburn (3.2 %). There were more females with gastrointestinal complaints. Overall, 21.6 % of the total participants had recently sought medical attention for their gastrointestinal complaint. 20 % of patients selected inappropriate medication for their gastrointestinal complaints, and the antacids class had the highest incidence of inappropriate medication use. Possible co-existing relationships were seen between gastroesophageal reflux disease with dyspepsia, irritable bowel syndrome with gastroesophageal reflux disease, irritable bowel syndrome with dyspepsia, and diarrhoea with constipation. Patients who fulfilled criteria for irritable bowel syndrome had a high tendency to self-treat their gastrointestinal symptoms. Constipation complaints were also common. Around one in five patients self-medicated gastrointestinal symptoms inappropriately, with antacids being the most common.
No related grants have been discovered for Stefan Kowalski.