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Biomedical subjects

U Bergman

Publications and source records attributed to U Bergman.

At least 109 records · Page 6Linked to original sources
PubMed1984

Measurement of drug utilization in Sweden: methodological and clinical implications.

The available sources of information on drug utilization in the Swedish population at large are reviewed. They comprise whole-sale statistics, drug deliveries to hospitals and prescription data. Drug consumption is preferably expressed in defined daily doses (DDD) per capita, where DDD is the average recommended dose on the major indication of the drug. Under ideal circumstances--drugs used continuously on one indication--the number of DDDs per population ought to agree with morbidity data. This turned out to be the case with antidiabetic drugs. The pitfalls with this unit of measurement include major discrepancies between recommended and prescribed doses, and the use of the drug on vastly different indications (such as neurosis and psychosis in the case of neuroleptics). Nevertheless, the DDD methodology may serve as a therapeutic audit in attempts to follow and influence therapeutic habits of health personnel in hospitals and primary health care. Wholesale data combined with individual-based prescription data are particularly useful in this regard.

Data Collection↗
PubMed1982

Theophyllines three times daily - when are the doses actually taken? - Pharmacokinetic ideals versus clinical practice.

We asked patients "At what times of the day do you usually take your medicine?" In contrast to compliance interviews dealing with missed doses, this question was previously shown to give valid information. Here we present results from 126 patients on theophyllines three times daily, the most common dosage schedule for these drugs in Sweden in 1978. Only 2% of the patients stated the ideal 8-h intervals between all doses, while 72% had confined all their doses within 12 h. The first and second intervals ranged from 0 to 11 h with a mean of 5.5 and 6.1 h respectively. The third interval varied from 7 to 18 h with a mean of 12.4 h. Patients might benefit more from their therapy by even-spacing of their intake of theophylline.

Adolescent↗
PubMed1981

Drug-related problems causing admission to a medical clinic.

The association between hospital admission and drug-related problems was evaluated in 285 consecutive admissions to two medical wards in a Swedish university hospital. Standardised definitions and criteria for causality were used. A drug-related problem was judged to have been the main reason for admission of 36 patients, and a strongly contributory reason for 9. These 45 patients comprised 16% of all patients, and 19% of those receiving medication prior to admission. For 19 patients the problem was considered to be failure to achieve the desired therapeutic effect. 11 of these 19 took less medication than prescribed, and an inadequate dose had been presented for the other 8 patients. In 26 patients there was an excessive or otherwise adverse effect. In 10 it was an intentional or accidental poisoning, and 16 had an adverse drug reaction. Non-compliance with the prescribed regimen caused almost half of the drug-related admissions: 11 took too little and 10 took too much of the prescribed drugs. The majority of the other problems could probably have been prevented by better application of pharmacokinetic principles to the prescribing.

Adolescent↗
PubMed1981

Digoxin and Phenytoin analyses as part of consultations in clinical pharmacology: a study on the use of drugs.

The clinical use of digoxin and phenytoin analyses (in 405 and 152 patients, respectively) furnished by our clinical pharmacological laboratory during a five-month period was evaluated prospectively from request forms. Of first-time analyses of digoxin, 12, 38, and 50% fell above, within, and below our recommended range of 1.3-2.6 nmoles/liter, respectively. This was a significant change towards lower values compared to an earlier study. The average daily dose of digoxin was 0.22 mg, and 94% of the doses ranged between 0.13 and 0.25 mg. Thirty percent of the patients on digoxin were reinvestigated once or more, and a greater percentage of the concentrations was then within the recommended range. Mean plasma concentrations of digoxin increased significantly with age, even though the stated daily digoxin dose tended to decrease. Data from a drug surveillance study showed that 10 of 32 patients had a significant change in plasma digoxin concentration after admission to hospital, indicating deviations in compliance with the dosage regimen prior to hospitalisation. Sixty-three percent of the first-time analyses of phenytoin were below our recommended therapeutic range of 40-80 mumoles/liter. This was lower than in a previous retrospective investigation (72%). Eighty-seven percent of the doses ranged between 0.2 and 0.4 g/day, and the average daily dose was 0.3 g. High plasma concentrations were noted more frequently in patients aged 60 years or more, whilst low concentrations were noted more frequently in young patients.

Adolescent↗
PubMed1980

Wide variation in serum chlorpropamide concentration in outpatients.

Serum chlorpropamide concentrations (s-CPA) were determined and related to clinical findings in 83 outpatients with maturity onset diabetes. The daily doses of CPA (mg/kg) varied six-fold, but s-CPA ranged 18-fold between the patients. There was a significant correlation between dose and s-CPA (r = 0.61), which rose to 0.75 in the 30 patients who had prescribed no other drugs. Patients given other drugs concomitantly were over-represented amongst subjects with extreme values of apparent plasma clearance of CPA. There was no correlation either between serum creatinine or age and s-CPA. Of the 83 patients 40 (48%) had acceptable blood and urinary glucose values according to our criteria; but as 17 were overweight, only 23 patients (28%) had acceptable clinical control. Of the remaining 60 patients, too low a dose was being given to only 12, and dietary failure was the most probable explanation in the others. Thirteen patients (16%) probably did not need CPA. It is likely that this is a partial explanation for the high utilisation of oral antidiabetic drugs in Sweden. There was no general correlation between dose or s-CPA and blood glucose values, but analysis of s-CPA may still be of value in explaining unexpected changes in clinical control.

Adult↗
PubMed1980

Auditing hospital drug utilisation by means of defined daily doses per bed-day. A methodological study.

The utilisation of hypnotics, sedatives, and minor tranquillisers (HSmT) was studied by means of drug-delivery and hospital occupancy statistics for 1975-1977 in a Swedish university hospital. A total of 0.53 so-called defined daily doses (DDD)/bed-day were delivered in 1975, implying that every second patient might have regularly been prescribed HSmT. The benzodiazepines were predominant with 71% of the deliveries. Five major drugs accounted for 88%. The drug pattern and the range of DDD/day-bed (0.09-1.18) differed considerably between the departments. Drugs not recommended by the hospital's Pharmacy and Therapeutics Committe accounted only for 3% of deliveries. In a drug surveillance study performed in two medical wards, HSmT were prescribed for 43% of 274 patients. Drug delivery and prescription data were in broad agreement. Drug information activities in the hospital had a clearly discernable influence on the delivered DDD/bed-day. This measure is an inexpensive indicator of drug utilisation in a hospital and a suitable basis for therapeutic audit.

Anti-Anxiety Agents↗
PubMed1980

Plasma atropine concentrations determined by radioimmunoassay after single-dose i.v. and i.m. administration.

The plasma concentrations of atropine following i.v. or i.m. administration to surgical patients were determined by radioimmunoassay. When atropine sulphate 1 mg was given i.v. there was a rapid initial removal of the drug from the circulation in the first 10 min; thereafter the plasma concentration decreased more slowly. Atropine i.m. was rapidly absorbed with peak concentrations occurring at 30 min following injection. The plasma atropine concentration then decreased slowly, probably because of uptake of atropine by muscarinic cholinergic receptors. The chronotropic effect of atropine appeared to correspond to the concentration in plasma following i.m. administration. We conclude that i.m. atropine, as a premedication, should be given not later than 30 min before induction of anaesthesia.

Adolescent↗
PubMed1979

Why are psychotropic drugs prescribed to out-patients? A methodological study.

The prescription of psychotropic drugs at a multidoctor district health centre in northern Sweden in 1973, was analysed by means of problem-oriented medical records. Of the 22,000 inhabitants of the district 10,700 consulted the health centre. Psychotropic drugs were prescribed for 11.3% of the patients, corresponding to 5% of the inhabitants of the area. Sixty per cent of the patients received one psychotropic prescription and 90% not more than three. Two-thirds of prescriptions were for women. Hypnotics, sedatives and minor tranquillisers constituted 64% of all prescriptions, major tranquillisers 24% and antidepressants 12%. One fifth of the patients obtained drugs belonging to more than one of the major psychotropic groups during the year. Insomnia, psychoneurosis and depression made up two-thrids of the indications for psychotropic drug therapy. More than thirty different psychotropic drugs were prescribed for the two major indications. There was considerable variation in how the different doctors prescribed drugs for the same indication. Fifty-nine different drug products were prescribed, of which the commonest five constituted more than half of the total number. Individual doctors used from 22 to 38 different psychotropic drugs.

Adolescent↗
PubMed1978

Epidemiology of adverse drug reactions to phenformin and metformin.

Adverse drug reactions (ADRs) to phenformin and metformin reported to the Swedish Adverse Drug Reaction Committee during 1965--77 were analysed in relation to sales and prescription data. The biguanides accounted for 0.6% of all reported adverse drug reactions but for 6% of the fatal cases (all phenformin). Sixty-four ADRs to phenformin and eight to metformin were classified as causal relation "probable" or "not excluded." Fifty-one of these reactions (71%) were lactic acidosis, all but one being reactions to phenformin. After 1973 phenformin was prescribed less in Sweden and metformin became predominant. A nationwide prescription survey during 1975--6 disclosed no differences in age and sex between patients receiving phenformin and metformin. The mean daily doses prescribed in 1976 were 74 mg of phenformin and 1.5 g of metformin. The numbers of ADRs to the two drugs reported during 1975--7 were related to use. The relative incidences of ADRs reported for phenformin and metformin did not differ. Significantly more cases of lactic acidosis and deaths were reported for phenformin.

Acidosis↗