Adverse drug reaction active surveillance: developing a national network in Canada's children's hospitals.

Purpose: Adverse drug reactions (ADRs) rank as the fifth leading cause of death in the western world. The nature and scope of these ADRs in children are not predictable based on post market surveillance reports that rely heavily on adult drug experience. The genotype-specific approaches to therapy in childhood (GATC) national ADR network was established to identify specific ADRs and to improve drug safety through identification of predictive genomic biomarkers of drug risk.

Genotypic Approaches to Therapy in Children (GATC): using information technology to improve drug safety.

Adverse drug reactions (ADRs) are a major cause of morbidity and mortality in children. Current models of ADR surveillance have repeatedly demonstrated little pragmatic value to practicing clinicians. ADR reporting rates in the US and Canada suggest that only 5% of ADRs are reported.

Statin use and the risk of Parkinson disease: a nested case control study.

Using the British Columbia Linked Health Databases, we explored the association between the use of statin drugs and the risk of developing Parkinson disease (PD). We followed a cohort of older adults in the Province of British Columbia from 1997 to 2003. Using a study design of nested case control (case-control study within a cohort), the relative risk of developing PD for statin users was 0.

Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding: a case-control study.

A large number of women receive codeine for obstetric pain while breastfeeding. Following a case of fatal opioid poisoning in a breastfed neonate whose codeine prescribed mother was a CYP2D6 ultrarapid metabolizer (UM), we examined characteristics of mothers and infants with or without signs of central nervous system (CNS) depression following codeine exposure while breastfeeding in a case-control study. Mothers of symptomatic infants (n = 17) consumed a mean 59% higher codeine dose than mothers of asymptomatic infants (n = 55) (1.

Camouflaged sampling and contacting of people from administrative databases: reaching target patients without knowing who they are.

Background: Methods are needed for using confidential data to select and reach patients without compromising their health privacy.

Methods: (a)

Sampling: we created (1) an anonymous list of encrypted personal health numbers (EPHNs) of target patients (e.g.

Drug formulary decision-making in two regional health authorities in British Columbia, Canada.

Objectives: Growing pharmaceutical demands challenge healthcare organizations to set drug funding priorities (i.e. establish a formulary list).

Trends in psychostimulant and antidepressant use by children in 2 Canadian provinces.

Objective: We used population-based administrative prescription medication data to examine regional differences in psychostimulant and antidepressant (AD) use among children from 2 Canadian provinces: British Columbia (BC) and Manitoba (MB).

Method: Using 1997 to 2003 prescription data, annual rates of psychostimulant and AD use were determined for children aged 19 years and under in both provinces. Further comparisons of rates were made according to sex, age group, and specific classes of dispensed medications.

Identifying persons with treated asthma using administrative data via latent class modelling.

Objective: To develop a parsimonious model of the respiratory patient population in British Columbia (BC), Canada through latent class modelling (LCM), using administrative data records and to assess conventional case definitions for asthma in relation to model-based case selection.

Data Sources: 1996-2001 data from linked provincial databases containing fee-for-service physician billing records, hospital inpatient separation abstracts, and prescription drug purchase records for 1.9 million BC respiratory patients.

Non-steroidal anti-inflammatory drug use and the risk of Parkinson disease: a retrospective cohort study.

Using the British Columbia Linked Health Databases, we explored the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of developing Parkinson's disease (PD). We followed a cohort of older adults in the Province of British Columbia from 1997 to 2003. A time-dependent Cox model was used to estimate adjusted rate ratios for users and non-users of NSAIDs.

Designed delays versus rigorous pragmatic trials: lower carat gold standards can produce relevant drug evaluations.

Background: Centralized administrative databases enable low-cost pragmatic randomized trials (PRTs) of drug effectiveness and safety. We simplified the PRT strategy by using designed delays (DD) to evaluate drug policies.

Objectives: To reassess our DD trial of a cost-saving nebulizer-to-inhaler conversion policy and a proposed DD trial of reduced restrictions on Cox-2 inhibitors.

Genotypic approaches to therapy in children: a national active surveillance network (GATC) to study the pharmacogenomics of severe adverse drug reactions in children.

A striking failure of modern medicine is the debilitating and lethal consequences of adverse drug reactions (ADRs), which rank as one of the top 10 leading causes of death and illness in the developed world with direct medical costs of 137-177 billion annually US dollars in the USA. Although many factors influence the effect of medications (e.g.

Pharmacogenomics and its implications for autoimmune disease.

A striking failure of modern medicine is the debilitating and lethal consequences of adverse drug reactions (ADRs) which rank as one of the top ten leading causes of death and illness in the developed world with direct medical costs of 137-177 billion US dollars annually in the USA. Although many factors influence the effect of medications (i.e.

Paediatric adverse drug reaction reporting: understanding and future directions.

Background: Severe adverse drug reactions (ADRs) are an important cause of childhood morbidity and mortality. 95% of ADRs are likely not reported, less than 25% of marketed drugs can be advertised as safe and effective in children; yet over 50% of Canadian children receive prescription drugs annually.

Objectives: To increase understanding of reported ADRs in Canadian children.

Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study.

Aim: To determine the effect of implementing a clinical pathway, using evidence-based clinical practice guidelines, for the emergency care of children and adolescents with asthma.

Methods: A prospective, before-after, controlled trial was conducted, which included patients aged 1-18 years who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department. Data were collected for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes.

Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia.

Objective: Does the use of nifedipine and magnesium sulfate together increase serious magnesium-related effects?

Study Design: This was a retrospective chart review of women who were admitted to BC Women's Hospital and Health Centre (1997-2001) and were given intravenous magnesium sulfate for preeclampsia. Serious magnesium-related effects were compared among 162 cases who received magnesium sulfate and contemporaneous nifedipine and 215 control subjects who received magnesium sulfate and either another antihypertensive (n=32 women) or no antihypertensive (n=183 women) medication. Chi-squared test, Fisher's exact test, or the Student t test was used for data comparison between cases and each control group.

Quantifying adverse drug events : are systematic reviews the answer?

Quantifying adverse drug events (ADEs) is critical to clinicians, consumers and policy makers. Most ADE information comes from large clinical trials. Systematic reviews have become a popular tool in quantifying the efficacy of different therapeutic interventions and ADE data collected in randomised trials may be helpful in quantifying the risk associated with a specific pharmacological agent.

Macrolide therapy for Chlamydia pneumoniae in the secondary prevention of coronary artery disease: a meta-analysis of randomized controlled trials.

Study Objective: As recent studies have shown that antibiotic therapy to eradicate Chlamydia pneumoniae may be beneficial in the secondary prevention of coronary artery disease, and studies to date may have lacked statistical power, we conducted a meta-analysis of randomized controlled trials to determine the role of antibiotic therapy in this patient population.

Design: Systematic review and meta-analysis of randomized controlled trials.

Patients: A total of 12,032 patients from nine studies.

Clinical and economic consequences of a reimbursement restriction of nebulised respiratory therapy in adults: direct comparison of randomised and observational evaluations.

Objective: To compare the results of a randomised and an observational evaluation of the same policy that restricted reimbursement for nebulised respiratory medications in adult patients in a community setting.

Designs: Cluster randomised controlled trial and observational time series with historical controls.

Setting: Pharmacare, the government funded drug benefits plan for elderly people and patients receiving social assistance in British Columbia, Canada.

Evidence-based pharmacotherapy: review of basic concepts and applications in clinical practice.

Objective: To introduce concepts that may assist pharmacists in the use and application of scientific evidence in clinical practice. These concepts are followed by examples of clinical trials as well as case scenarios that guide the reader through solving clinical problems using the tools discussed in the article.

Background: The introduction of evidence-based practice in the 1990s has had a positive impact on the practices of medicine and pharmacy.