General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study.

Objective: The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group.

Home care service employees' contribution to patient safety in clients with dementia who use dietary supplements: a Norwegian survey.

Objective: To explore home care services (HCS) employees' professional experiences with the use of dietary supplements (DSs) in their clients with dementia. We also investigated their attributed professional responsibility concerning this use and their attitudes toward DSs in general. Differences between nurses and nurse assistants were investigated.

Academic detailing as a method of continuing medical education.

Introduction: Academic detailing is an interactive educational outreach to prescribers to present unbiased, non-commercial, evidence-based information, mostly about medications, with the goal of improving patient care. Academic detailing in Norway is an approach for providing continuing medical education to general practitioners (GPs). The basis of academic detailing is a one-to-one discussion between a trained health professional (the academic detailer) and the GP at the GP's workplace.

Pharmacy employees' involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies.

Background: Community-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees' attitudes and professional practice behaviors related to DS.

Direct and indirect risk associated with the use of dietary supplements among persons with dementia in a Norwegian memory clinic.

Background: The use of dietary supplements (DS) is common among persons with dementia. Direct risks associated with DS use include adverse events and DS-drug interactions. A direct risk is a risk caused by the treatment itself.

A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial.

Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors.

Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months.

Application of the MAT-CHDSP to assess guideline adherence and therapy goal achievement in secondary prevention of coronary heart disease after percutaneous coronary intervention.

Purpose: Numerous studies have documented suboptimal adherence to guideline recommendations in secondary prevention of coronary heart disease (CHD(SP)). Clinical practice guidelines (CPGs) are continuously developed to define appropriate patient care, aiming to reduce risk of morbidity and death. The Medication Assessment Tool for CHD(SP) (MAT-CHD(SP)) was developed to assess adherence to CPGs concerning medication therapy and follow-up of patients with CHD(SP).

MAT-CHDSP, a novel medication assessment tool for evaluation of secondary prevention of coronary heart disease.

Background: Quality of health performance is of increasing international importance. The potential value of the implementation of a guideline-based medication assessment tool (MAT) has been evaluated in order to measure and improve adherence to guideline recommendations in secondary prevention of coronary heart disease (CHD).

Method: An existing MAT developed in the UK based on internationally recognised clinical evidence has been further developed [with criteria extended to secondary prevention of CHD only] for application in Norway.

[Concomitant use of warfarin, analgesics and anti-inflammatory agents].

Background: Concomitant use of warfarin and analgesics enhances the risk of bleeding. The frequency of such co-medication has not yet been investigated. The main aim of the present study was to determine the prevalence of concomitant use of warfarin and prescription analgesic drugs in Norway.

Secondary prevention in coronary heart disease: goal achievement and drug prescribing.

Objective: To provide an overview of the degree of treatment goal achievement and drug prescribing in patients with coronary heart disease (CHD) in clinical practice.

Method: Patients undergoing planned or acute percutaneous coronary intervention (PCI) were included. Patients' medical records and the hospital's database on clinical chemistry analyses were studied retrospectively.

Effectiveness of antihypertensive treatment in chronic renal failure: to what extent and with which drugs do patients treated by nephrologists achieve the recommended blood pressure?

Adequate control of blood pressure (BP) is important to slow the progression of chronic renal failure (CRF). The Joint National Committee (JNC) VI recommends BP <130/85 mmHg, or <125/75 mmHg if urinary protein excretion exceeds 1 g/d. Angiotensin converting enzyme inhibitors (ACE-I) are considered as first-line agents.

[New techniques for optimization of thiopurine therapy in leukemia and transplantation].

Background: The majority of chemotherapeutic agents are administered at fixed doses that are close to those maximally tolerated.

Material And Methods: This review is based on current knowledge about the metabolism of thiopurines and the clinical implications of genetic polymorphism in thiopurine-S-methyltransferase (TPMT).

Results: Intracellularly thiopurines, e.

The interaction of 6-mercaptopurine (6-MP) and methotrexate (MTX).

The antimetabolites 6-mercaptopurine (6-MP) and methotrexate (MTX) are the cornerstones in the maintenance treatment of children's acute lymphoblastic leukemia (ALL). The biochemical mechanisms underlying the increased therapeutic efficacy of the combination of these drugs have not yet been elucidated. However, both drugs interact with important pathways.

Increased concentrations of methylated 6-mercaptopurine metabolites and 6-thioguanine nucleotides in human leukemic cells in vitro by methotrexate.

The effect of methotrexate (MTX) on 6-mercaptopurine (6-MP) metabolism was studied in four human leukemic cell lines in vitro. CCRF-CEM, WI-L2, TBJ, and HL-60 all expressed thiopurine methyltransferase (TPMT) activity. The cells were grown in horse serum-supplemented RPMI 1640 medium to which was added 4 microM of 6-MP or 4 microM of 6-MP and 20 nM of MTX.

Analysis of methylated 6-mercaptopurine metabolites in human red blood cells: comparison of two methods.

Blood samples from 34 recipients of kidney transplants who were on multidrug therapy including azathioprine were analyzed using two methods in parallel for red blood cell (RBC) concentrations of methylated 6-mercaptopurine (6-MP) metabolites. Chemical hydrolysis with high-performance liquid chromatography (HPLC) showed values ranging from 0 to 20,259 pmol/8 x 10(8) RBCs, compared with enzymatic hydrolysis with HPLC that resulted in values ranging from 16 to 22,252 pmol/100 microl packed RBC. Results of the two methods were highly correlated; the coefficient of correlation (r) was equal to 0.

Possibilities for therapeutic drug monitoring of azathioprine: 6-thioguanine nucleotide concentrations and thiopurine methyltransferase activity in red blood cells.

The objectives of this study were to establish monitoring of azathioprine (AZA) treatment in renal allograft recipients by red blood cell (RBC) 6-thioguanine nucleotide (6-TGN) measurements and to characterize the variability of RBC thiopurine methyltransferase (TPMT) activity and the effects on 6-TGN levels and the incidence of rejection episodes. In 82 renal allograft recipients, the effect of standard AZA dosage (3 mg/kg tapered to 1 mg/kg) was compared with higher dosages (3 mg/kg for several days) under 6-TGN monitoring. The authors measured TPMT in these patients and in a group not receiving AZA.

Methotrexate increases red blood cell concentrations of 6-methylmercaptopurine ribonucleotide in rats in vivo.

Purpose: To elucidate the effect of methotrexate (MTX) on 6-mercaptopurine (6-MP) metabolism in rats.

Methods: Fourteen rats were given 6-MP 20 mg/kg daily for 7 days. Seven of the rats were also given MTX 20 mg/kg on days 5 and 7.

Inhibition of human thiopurine methyltransferase by furosemide, bendroflumethiazide and trichlormethiazide.

Results: Incubation in vitro of human recombinant and erythrocyte (RBC) thiopurine methyl transferase (TPMT) with furosemide, bendroflumethiazide and trichlormethiazide demonstrated inhibition of both enzyme preparations, with IC50 values of 170 microM, 360 microM and 1 mM, respectively. Kinetic studies revealed that the inhibition was mixed or non-competitive with regard both to the thiopurine substrate 6-mercaptopurine (6-MP) and the methyl donor S-adenosyl-L-methionine.

Conclusion: Since S-methylation is a major pathway in the metabolism of thiopurines, our data point to the possibility of a clinically significant diuretic-thiopurine interaction in patients treated simultaneously with these drugs.

Intraindividual variability in red blood cell thiopurine methyltransferase activity.

Objective: Long-term (13 weeks) and circadian (24 hours) intraindividual variability in red blood cell (RBC) thiopurine methyltransferase (TPMT) activity in healthy subjects was studied.

Methods: RBC TPMT activity was measured radiochemically.

Results: The variability in RBC TPMT activity was low and was only slightly higher than the imprecision of he TPMT assay.

Erythrocyte fraction affects red blood cell thiopurine methyltransferase activity.

Red blood cell (RBC) thiopurine methyltransferase (TPMT) metabolizes the cytotoxic drugs 6-mercaptopurine and azathioprine. RBC TPMT activity has been reported to predict clinical outcome in children with acute lymphoblastic leukaemia and in kidney transplant patients. We first suspected that the erythrocyte fraction affected the calculated TPMT activity when we examined intraindividual TPMT activities in kidney transplant recipients.