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Renal Function In Older People - Validity of the Gfr-Estimating Equations And Implication for Clinical Practice
Parallel Session Abstracts Results: Students reported improved skills and indicated that they had acquired knowledge they were unlikely to have gained elsewhere in the curriculum. The quality of specific aspects of care delivered by students was comparable with that of regular care. Conclusions: Students should take the lead in their own education, coached by the senior teacher. Medical students should be trained as professionals with responsibility for patient care.
chronic kidney disease (CKD), as well as for drug dosage adaptation. The prevalence of CKD is very high in the elderly, due to physiological aging of the kidney, to lifelong pathological insults, and to comorbidities. However, the GFR estimating equations, such as the Cockcroft-Gault, MDRD, and CKD-EPI equations, have not been developed specifically in elderly patients. The presentation will review the performances of the GFR estimating equations in studies which included elderly patients, and discuss which methodology should be preferred in this population.
Literature Reference 1. Learning in student-run clinics: a systematic review. T. Schutte ea. Medical Education 2015:49:249–263
Alert fatigue – an overdose of drug information? I.H. van der Sijs Erasmus University Medical Center, Rotterdam, the Netherlands Educational Objectives: At the end of this presentation, the participants should be able to explain what alert fatigue is, and what its causes and consequences are. Furthermore, they understand how both alert fatigue and potential measures to avoid it can be investigated. Purpose: Define alert fatigue, its causes, consequences and investigational challenges. Methods: Literature review, disguised observation, retrospective analysis of alert overrides, think-aloud study, chart review. Results: Alert Fatigue is the mental state that is the result from alerts consuming too much time and energy, which can cause relevant alerts to be unjustifiably overridden among clinical irrelevant ones. Unjustified overriding is a medication error that may result in adverse drug events, although this causal relationship has not been confirmed in studies yet. Alert fatigue is often caused by low specificity of alerts, but other error-producing conditions in the electronic prescribing system, insufficient training, and cultural aspects may also play a role. The optimal specificity and sensitivity are unknown, as are other aspects affecting alert fatigue. To investigate alert fatigue, override reasons are an important source of information, but often difficult to obtain. Clinical pharmacologists may play a role in determining cut-off points for alert generation. Conclusions: Alert fatigue is a ubiquitous problem and much is still unknown. To gain optimal benefit of electronic prescribing with clinical decision support, more research should be performed on this topic.
Literature References 1. Van der Sijs IH. Drug Safety Alerting in Computerized Physician Order Entry. Unraveling and Counteracting Alert Fatigue (PhD Thesis http://repub.eur.nl/pub/16936). 2. Coleman J et al. On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop. BMC. BMC Med Inform Decis Mak. 2013;13:111.
Renal Function In Older People - Validity of the Gfr-Estimating Equations And Implication for Clinical Practice E. Vidal-Petiot Department of Physiology – Hopital Bichat, Paris, France Glomerular filtration rate (GFR) is the best marker of renal function. Its evaluation is mandatory for diagnosis and classification of
August 2015
Variability In Drug Response and Clinical Reality: the Example of Psychiatric Diseases E. Vieta Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain Educational Objectives: At the conclusion of this presentation, the participants should be able to demonstrate a deep understanding of the major causes of heterogeneity and variability of drug response in clinical practice, and in particular in the area of psychiatry. Purpose: To identify and summarize the main factors involved in drug response variability in patients with mental disorders, and its implications. Methods: A systematic review of the topic was carried out using “variability”, “drug response” and mental disorders” as PubMed key words. Results: The systematic review yielded 741 PubMed publications. After careful screening, 18 were considered truly relevant for the study purpose. The current evidence, based on the 18 selected publications, indicates that Psychiatry is an area with blurred borders between conditions and high variability of treatment response. Conclusions: Drugs do not have the same effects in all patients. Part of that variability may be genetically mediated and part may be environment-dependent. Psychiatry is an area of medicine where variability of drug response is particularly high. The results of clinical trials cannot be directly extrapolated to individuals. Even drugs with very similar mechanism of action may work differently in the same patient and the same drug may work differently in the same patient across different illness episodes. Drugs for psychiatric conditions cannot be judged exclusively based on their efficacy and tolerability. Stratification is needed in psychiatry to identify specific subpopulations that may be more or less responsive to given drugs.
Literature References 1. Vieta E, Pappadopulos E, Mandel FS, Lombardo I. Impact of geographical and cultural factors on clinical trials in acute mania: lessons from a ziprasidone and haloperidol placebo-controlled study. Int J Neuropsychopharmacol. 2011 Sep;14(8):1017–1027. 2. Vieta E. Personalized medicine applied to mental health: Precision psychiatry. Rev Psiquiatr Salud Mental, 2015, in press.
Uk Translational Medicine and Therapeutics (Tmat) Phd Training D.J. Webb Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, UK Within the last 10 years, 2 major UK funding bodies (Medical Research Council [MRC] and Wellcome Trust) have supported clinical PhD programmes designed to build capacity in clinical pharmacology and therapeutics, focusing on the translational difficulties in
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chronic kidney disease (CKD), as well as for drug dosage adaptation. The prevalence of CKD is very high in the elderly, due to physiological aging of the kidney, to lifelong pathological insults, and to comorbidities. However, the GFR estimating equations, such as the Cockcroft-Gault, MDRD, and CKD-EPI equations, have not been developed specifically in elderly patients. The presentation will review the performances of the GFR estimating equations in studies which included elderly patients, and discuss which methodology should be preferred in this population.
Literature Reference 1. Learning in student-run clinics: a systematic review. T. Schutte ea. Medical Education 2015:49:249–263
Alert fatigue – an overdose of drug information? I.H. van der Sijs Erasmus University Medical Center, Rotterdam, the Netherlands Educational Objectives: At the end of this presentation, the participants should be able to explain what alert fatigue is, and what its causes and consequences are. Furthermore, they understand how both alert fatigue and potential measures to avoid it can be investigated. Purpose: Define alert fatigue, its causes, consequences and investigational challenges. Methods: Literature review, disguised observation, retrospective analysis of alert overrides, think-aloud study, chart review. Results: Alert Fatigue is the mental state that is the result from alerts consuming too much time and energy, which can cause relevant alerts to be unjustifiably overridden among clinical irrelevant ones. Unjustified overriding is a medication error that may result in adverse drug events, although this causal relationship has not been confirmed in studies yet. Alert fatigue is often caused by low specificity of alerts, but other error-producing conditions in the electronic prescribing system, insufficient training, and cultural aspects may also play a role. The optimal specificity and sensitivity are unknown, as are other aspects affecting alert fatigue. To investigate alert fatigue, override reasons are an important source of information, but often difficult to obtain. Clinical pharmacologists may play a role in determining cut-off points for alert generation. Conclusions: Alert fatigue is a ubiquitous problem and much is still unknown. To gain optimal benefit of electronic prescribing with clinical decision support, more research should be performed on this topic.
Literature References 1. Van der Sijs IH. Drug Safety Alerting in Computerized Physician Order Entry. Unraveling and Counteracting Alert Fatigue (PhD Thesis http://repub.eur.nl/pub/16936). 2. Coleman J et al. On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop. BMC. BMC Med Inform Decis Mak. 2013;13:111.
Renal Function In Older People - Validity of the Gfr-Estimating Equations And Implication for Clinical Practice E. Vidal-Petiot Department of Physiology – Hopital Bichat, Paris, France Glomerular filtration rate (GFR) is the best marker of renal function. Its evaluation is mandatory for diagnosis and classification of
August 2015
Variability In Drug Response and Clinical Reality: the Example of Psychiatric Diseases E. Vieta Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain Educational Objectives: At the conclusion of this presentation, the participants should be able to demonstrate a deep understanding of the major causes of heterogeneity and variability of drug response in clinical practice, and in particular in the area of psychiatry. Purpose: To identify and summarize the main factors involved in drug response variability in patients with mental disorders, and its implications. Methods: A systematic review of the topic was carried out using “variability”, “drug response” and mental disorders” as PubMed key words. Results: The systematic review yielded 741 PubMed publications. After careful screening, 18 were considered truly relevant for the study purpose. The current evidence, based on the 18 selected publications, indicates that Psychiatry is an area with blurred borders between conditions and high variability of treatment response. Conclusions: Drugs do not have the same effects in all patients. Part of that variability may be genetically mediated and part may be environment-dependent. Psychiatry is an area of medicine where variability of drug response is particularly high. The results of clinical trials cannot be directly extrapolated to individuals. Even drugs with very similar mechanism of action may work differently in the same patient and the same drug may work differently in the same patient across different illness episodes. Drugs for psychiatric conditions cannot be judged exclusively based on their efficacy and tolerability. Stratification is needed in psychiatry to identify specific subpopulations that may be more or less responsive to given drugs.
Literature References 1. Vieta E, Pappadopulos E, Mandel FS, Lombardo I. Impact of geographical and cultural factors on clinical trials in acute mania: lessons from a ziprasidone and haloperidol placebo-controlled study. Int J Neuropsychopharmacol. 2011 Sep;14(8):1017–1027. 2. Vieta E. Personalized medicine applied to mental health: Precision psychiatry. Rev Psiquiatr Salud Mental, 2015, in press.
Uk Translational Medicine and Therapeutics (Tmat) Phd Training D.J. Webb Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, UK Within the last 10 years, 2 major UK funding bodies (Medical Research Council [MRC] and Wellcome Trust) have supported clinical PhD programmes designed to build capacity in clinical pharmacology and therapeutics, focusing on the translational difficulties in
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