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Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students
Clinical Therapeutics/Volume 37, Number 8S, 2015 Oral Communications Morphine decreases ticagrelor concentrations but not its effects: a randomized, double-blind, placebo-controlled trial E.-L. Hobl; B. Reiter; T. Stimpfl; C. Schoergenhofer; M. Schwameis; U. Derhaschnig; and B. Jilma Medical University of Vienna, Vienna, Austria Background: This study examines possible drug-drug interactions between ticagrelor and morphine. Our recent drug interaction trial with clopidogrel shows that morphine decreases the concentrations and effects of clopidogrel, which could lead to treatment failure in susceptible individuals. We hypothesized that the pharmacodynamic consequences of drug-drug interactions would be less between morphine and ticagrelor. Material and Methods: Twenty-four healthy subjects received a loading dose of 180 mg ticagrelor together with placebo or 5 mg morphine intravenously in a randomized, double-blind, placebocontrolled, cross-over trial. Pharmacokinetics were determined by liquid chromatography tandem mass spectrometry, and ticagrelor effects were measured by platelet function tests. Results: Concomitant i.v. injection of morphine slows drug resorption of ticagrelor and its active metabolite (P < 0.05) by one hour and decreases plasma levels of ticagrelor and its active metabolite (by 25%–31%; P ≤ 0.03) and the drug exposure (area under the curve by 22%–23%; P ≤ 0.01). Importantly, however, the effects of ticagrelor on platelet aggregation in whole blood, platelet plug formation, and vasodilator-stimulated phosphoprotein (VASP) phosphorylation are not affected by morphine. Conclusions: Morphine co-administration moderately decreases ticagrelor plasma concentrations but does not inhibit its effects. Therefore, a 180 mg loading dose of ticagrelor appears to provide consistent and reliable platelet inhibition when morphine has to be given for pain relief.
Pregnancy outcome following maternal exposure to pregabalin: a reason for concern? a collaborative entis and motherisk study U. Winterfeld1; P. Merlob2; D. Baud1; V. Rousson1; A. Panchaud1; L.E. Rothuizen1; N. Bernard3; T. Vial3; L.M. Yates4; A. Pistelli5; M. Ellfolk6; G. Eleftheriou7; L.C. de Vries8; P. Bozzo9; A.-P. Jonville-Bera10; M. Kadioglu11; J. Biollaz1; and T. Buclin1 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 2 University of Tel-Aviv, Tel-Aviv, Israel; 3Hospices Civils de Lyon, Lyon, France; 4Regional and Therapeutics Centre, Newcastle upon Tyne, UK; 5Azienda Ospedaliero Universitaria Careggi, Florence, Italy; 6HUSLAB and Helsinki University Central Hospital, Helsinki, Finland; 7Poison Control, Bergamo, Italy; 8 Pharmacovigilance Centre Lareb, Den Bosch and University of Groningen, Groningen, The Netherlands; 9The Hospital for Sick Children, Toronto, Canada; 10CHRU, Tours, France; and 11 Technical University, Trabzon, Turkey Background: While animal studies have shown reproductive toxicity of pregabalin, data on pregnancy outcomes in women exposed to this drug are lacking, despite accepted use in women of childbearing potential. In this study, we primarily investigated the rate for major birth defects and other pregnancy outcomes following maternal use of pregabalin. Material and Methods: This is a multicenter, observational prospective cohort study comparing pregnancy outcomes in women exposed
August 2015
to pregabalin with matched controls (exposed neither to any medications known to be teratogenic nor to any antiepileptic drugs). Data were systematically collected by Teratology Information Services between 2004 and 2013. Results: We obtained data from 173 exposed pregnancies and 692 controls. After exclusion of chromosomal syndromes, major birth defects were reported more frequently in pregnancies exposed to pregabalin during 1st trimester of pregnancy than in the control group (6.6% vs 2.0%; odds ratio 3.5, 95% confidence interval 1.2-9.7, P = 0.004). Moreover, the rate of live births was lower in the pregabalin group (71.1% vs 85.4%, P < 0.001), primarily due to a higher rate of both elective (10.4% vs 4.8%, P = 0.01) and medically indicated (5.2% vs 1.7%, P = 0.02) pregnancy-terminations. The crude rate of spontaneous abortion (15.8% vs 8.7%, P = 0.001) was also higher in the pregabalin group. Conclusions: This study raises a signal for a possible increase in the risk of major birth defects and spontaneous abortion after first trimester exposure to pregabalin. These results call for further confirmation through independent studies.
Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students D.J. Brinkman1,2; J. Tichelaar1,2; M.A. van Agtmael1,2; Th.P.G.M. de Vries1; and M.C. Richir1,2 1 Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands; and 2VU University Medical Center, Amsterdam, the Netherlands Introduction: The objective of this study was to investigate the relationship between students’ self-reported confidence and their objectively assessed competence in prescribing. Material and Methods: We assessed the competence in several prescribing skills of 403 fourth-year medical students at the VU University Medical Center, the Netherlands, in a formative simulated examination on a 10-point scale (1 = very low; 10 = very high). Afterwards, the students were asked to rate their confidence in performing each of the prescribing skills on a 5-point Likert scale (1 = very unsure; 5 = very confident). Their assessments were then compared with their self-confidence ratings. Results: Students’ overall prescribing performance was adequate (7.0 ± 0.8), but they lacked confidence in two essential prescribing skills. Overall, there was a weak positive correlation (r = 0.2; P < 0.01; 95% CI, 0.1–0.3) between reported confidence and actual competence. Conclusions: This study suggests that self-reported confidence is not an accurate measure of prescribing competence, and that students lack insight into their own strengths and weaknesses in prescribing. Future studies should focus on developing validated and reliable instruments so that students can assess their prescribing skills.
Adherence to dabigatran among New Zealand patients S.K. Jayathissa1; A. Lim2; J. Wyeth3; S. Garret3; S.A. Yee3; S. Metcalfe3; and M. Weatherall4 1 Hutt Valley Health Lower Hutt, Wellington, New Zealand; 2 University of Auckland, Auckland, New Zealand; 3PHARMAC, Wellington, New Zealand; and 4University of Otago, Wellington, New Zealand Background: Dabigatran, a direct thrombin inhibitor, is the only drug funded in New Zealand for stroke prevention in patients with
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Pregnancy outcome following maternal exposure to pregabalin: a reason for concern? a collaborative entis and motherisk study U. Winterfeld1; P. Merlob2; D. Baud1; V. Rousson1; A. Panchaud1; L.E. Rothuizen1; N. Bernard3; T. Vial3; L.M. Yates4; A. Pistelli5; M. Ellfolk6; G. Eleftheriou7; L.C. de Vries8; P. Bozzo9; A.-P. Jonville-Bera10; M. Kadioglu11; J. Biollaz1; and T. Buclin1 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 2 University of Tel-Aviv, Tel-Aviv, Israel; 3Hospices Civils de Lyon, Lyon, France; 4Regional and Therapeutics Centre, Newcastle upon Tyne, UK; 5Azienda Ospedaliero Universitaria Careggi, Florence, Italy; 6HUSLAB and Helsinki University Central Hospital, Helsinki, Finland; 7Poison Control, Bergamo, Italy; 8 Pharmacovigilance Centre Lareb, Den Bosch and University of Groningen, Groningen, The Netherlands; 9The Hospital for Sick Children, Toronto, Canada; 10CHRU, Tours, France; and 11 Technical University, Trabzon, Turkey Background: While animal studies have shown reproductive toxicity of pregabalin, data on pregnancy outcomes in women exposed to this drug are lacking, despite accepted use in women of childbearing potential. In this study, we primarily investigated the rate for major birth defects and other pregnancy outcomes following maternal use of pregabalin. Material and Methods: This is a multicenter, observational prospective cohort study comparing pregnancy outcomes in women exposed
August 2015
to pregabalin with matched controls (exposed neither to any medications known to be teratogenic nor to any antiepileptic drugs). Data were systematically collected by Teratology Information Services between 2004 and 2013. Results: We obtained data from 173 exposed pregnancies and 692 controls. After exclusion of chromosomal syndromes, major birth defects were reported more frequently in pregnancies exposed to pregabalin during 1st trimester of pregnancy than in the control group (6.6% vs 2.0%; odds ratio 3.5, 95% confidence interval 1.2-9.7, P = 0.004). Moreover, the rate of live births was lower in the pregabalin group (71.1% vs 85.4%, P < 0.001), primarily due to a higher rate of both elective (10.4% vs 4.8%, P = 0.01) and medically indicated (5.2% vs 1.7%, P = 0.02) pregnancy-terminations. The crude rate of spontaneous abortion (15.8% vs 8.7%, P = 0.001) was also higher in the pregabalin group. Conclusions: This study raises a signal for a possible increase in the risk of major birth defects and spontaneous abortion after first trimester exposure to pregabalin. These results call for further confirmation through independent studies.
Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students D.J. Brinkman1,2; J. Tichelaar1,2; M.A. van Agtmael1,2; Th.P.G.M. de Vries1; and M.C. Richir1,2 1 Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands; and 2VU University Medical Center, Amsterdam, the Netherlands Introduction: The objective of this study was to investigate the relationship between students’ self-reported confidence and their objectively assessed competence in prescribing. Material and Methods: We assessed the competence in several prescribing skills of 403 fourth-year medical students at the VU University Medical Center, the Netherlands, in a formative simulated examination on a 10-point scale (1 = very low; 10 = very high). Afterwards, the students were asked to rate their confidence in performing each of the prescribing skills on a 5-point Likert scale (1 = very unsure; 5 = very confident). Their assessments were then compared with their self-confidence ratings. Results: Students’ overall prescribing performance was adequate (7.0 ± 0.8), but they lacked confidence in two essential prescribing skills. Overall, there was a weak positive correlation (r = 0.2; P < 0.01; 95% CI, 0.1–0.3) between reported confidence and actual competence. Conclusions: This study suggests that self-reported confidence is not an accurate measure of prescribing competence, and that students lack insight into their own strengths and weaknesses in prescribing. Future studies should focus on developing validated and reliable instruments so that students can assess their prescribing skills.
Adherence to dabigatran among New Zealand patients S.K. Jayathissa1; A. Lim2; J. Wyeth3; S. Garret3; S.A. Yee3; S. Metcalfe3; and M. Weatherall4 1 Hutt Valley Health Lower Hutt, Wellington, New Zealand; 2 University of Auckland, Auckland, New Zealand; 3PHARMAC, Wellington, New Zealand; and 4University of Otago, Wellington, New Zealand Background: Dabigatran, a direct thrombin inhibitor, is the only drug funded in New Zealand for stroke prevention in patients with
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