Adverse Drug Reactions in a Tertiary Care Emergency Medicine Ward - Prevalence, Preventability and Reporting.

PURPOSE: To identify the prevalence and preventability of adverse drug reactions (ADRs) in an emergency ward setting in a tertiary hospital in Sweden and to what extent the detected ADRs were reported to the Medical Product Agency (MPA). METHODS: In this prospective cross sectional observational study, 706 patients admitted to one of the Emergency Wards, at the Karolinska University Hospital in Solna, Stockholm during September 2008 -September 2009, were included. The electronic patient records were reviewed for patients' demographic parameters, prevalence of possible ADRs and assessment of their preventability. In addition, the extent of formal and required ADR reporting to national registers was studied. RESULTS: Approximately 40 percent of the patient population had at least one possible ADR (n = 284). In the multivariable regression model, age and number of drugs were significantly associated with risk of presenting with an ADR (p<0.01 and p<0.001, respectively). Sex was not identified as a significant predictor of ADRs (p = 0.27). The most common ADRs were cardiovascular, followed by electrolyte disturbances, and hemorrhage. In 18 percent of the patient population ADRs were the reason for admission or had contributed to admission and 24% of these ADRs were assessed as preventable. The under-reporting of ADRs to the MPA was 99%. CONCLUSIONS: ADRs are common in Emergency Medicine in tertiary care in Sweden, but under-reporting of ADRs is substantial. The most frequent ADRs are caused by cardiovascular drugs, and significantly associated with age and number of drugs. However, only a minority of the detected serious ADRs contributing to admission could have been avoided by increased risk awareness.

Which Medication Is the Patient Taking at Admission to the Emergency Ward? Still Unclear Despite the Swedish Prescribed Drug Register.

INTRODUCTION: Correct information on patients' medication is crucial for diagnosis and treatment in the Emergency Department. The aim of this study was to investigate the concordance between the admission chart and two other records of the patient's medication. METHODS: This cohort study includes data on 168 patients over 18 years admitted to the Emergency Ward between September 1 and 30, 2008. The record kept by the general practitioner and the patient record of dispensed drugs in the Swedish Prescribed Drug Register were compared to the admission chart record. RESULTS: Drug record discrepancies of potential clinical significance between the admission chart record and the Swedish Prescribed Drug Register or general practitioner record were present in 79 and 82 percent, respectively. For 63 percent of the studied patients the admission chart record did not include all drugs registered in the Swedish Prescribed Drug Register. For 62 percent the admission chart record did not include all drugs registered in the general practitioner record. In addition, for 32 percent of the patients the admission chart record included drugs not registered in the Swedish Prescribed Drug Register and for 52 percent the admission chart record included drugs not found in the general practitioner record. The most discordant drug classes were cardiovascular and CNS-active drugs. Clinically significant drug record discrepancies were more frequent in older patients with multiple medication and caregivers. CONCLUSION: The apparent absence of an accurate record of the patient's drugs at admission to the Emergency Ward constitutes a potential patient safety hazard. The available sources in Sweden, containing information on the drugs a particular patient is taking, do not seem to be up to date. These results highlight the importance of an accurate list of currently used drugs that follows the patient and can be accessed upon acute admission to the hospital.

Sexual function in patients with end-stage renal disease.

OBJECTIVE: Patients with chronic renal disease have sexual dysfunction to a great degree, but not many studies have been performed to study desire and sexual function in both men and women and the effects of active treatment for end-stage renal disease (ESRD). The aim of this study was to compare sexual function in patients with and without treatment for ESRD, where the patients served as their own controls. MATERIAL AND METHODS: Sexual function was investigated in 117 patients with ESRD using a questionnaire in which the patients compared their sexual function before and after the onset of renal disease. RESULTS: An overall decrease was seen in sexual desire (46%) and initiative (68%), and a pronounced decrease in sexual function, with regard to erection/lubrication (68%) and frequency of intercourse (64%). More than 50% of the patients admitted that the decrease in sexual function affected them considerably. Predialysis patients experienced less sexual dysfunction than patients undergoing active treatment. Women reported a minor ability to enjoy sex compared with men. No other gender differences in sexual dysfunction were identified in this study. No correlation between degree of sexual dysfunction and treatment modality or medication was found. CONCLUSION: A majority of the ESRD patients in this study report a substantial decrease in sexual desire, initiative and ability.

Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria.

BACKGROUND: We wished to determine the optimal duration of follow-up for patients with acute renal failure (ARF) treated with continuous renal replacement therapy (CRRT) and tested the hypothesis that a 6 month follow-up would be the minimum to catch most of the mortalities. In addition, we evaluated the association between mortality and the RIFLE classification in the same patients. METHODS: We analysed the data of 8152 consecutive patients who had been admitted to the intensive care unit (ICU) of a Swedish university hospital between 1995 and 2001. Of that population, 207 patients were treated with CRRT, excluding 16 treated for non-renal indications. RESULTS: ICU mortality in this cohort was 34.8% and 30 day and in-hospital mortalities were 45.9% and 50.2%, respectively. The cohort's all-cause mortality 6 months after inclusion was 59.9%, but 54.6% died as early as after 60 days. Patients in the more severe RIFLE category, F (failure), had a 30 day mortality of 57.9% compared with 23.5% for those in the RIFLE-R (risk) category and 22.0% for RIFLE-I (injury) patients. CONCLUSIONS: In our opinion, a 60 day follow-up is sufficient to catch the majority of deaths in ARF patients treated with CRRT. The patients in the RIFLE-F category had a significantly higher mortality than RIFLE-R and -I patients.