The effect of additional drug therapy as metaphylaxis in patients with cystinuria: a systematic review.

INTRODUCTION: To systematically review the effect of additional drug therapy as metaphylaxis in patients with cystinuria. EVIDENCE ACQUISITION: A literature search of three databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA-guidelines enclosing articles published up to May 2019. A total of 1117 articles were screened. Thirty-four publications met the inclusion criteria for this review. EVIDENCE SYNTHESIS: Male-female ratio in the studied cohorts was 49.9% - 50.1%. The majority of studies showed a positive effect in reducing stone events and/or urinary cystine excretion. D-Penicillamine showed success in 13/14 (92%) studies, whereas Tiopronin-treatment showed a reduction in all (8/8; 100%) studies. All studies on Captopril (4/4) showed a decrease, however not all significant. The same is true for studies on Thiols in combination with Captopril (2/2). Furthermore, Tiopronin showed less side effects compared to D-penicillamine, respectively 30% and 37%. Captopril showed the least adverse events, with one event in nine patients. CONCLUSIONS: The evidence on benefit of additional drug therapy in patients with cystinuria is scarce. All studied medications showed an effect on stone event and urinary cystine excretion, when used in addition to hyperhydration, alkalization and a diet low on methionine. Based on this systematic review, no drug can be preferred over another. An important aspect in the choice of drug is the risk of side effects. Therefore, the choice of additional drug should be personalized for every patient where the risk of side effects should be taken into consideration.

Analysis of medication information exchange at discharge from a Dutch hospital.

BACKGROUND: At hospitalisation and discharge the risk of errors in medication information transfer is high. OBJECTIVE: To study the routes by which medication information is transferred during discharge from Deventer Hospital, and to improve medication information transfer. SETTING: Eight hospital wards of the Deventer Hospital. METHOD: From December 6 to 17th 2010, the following data was recorded across eight hospital wards: the identification number of discharged patients, the date of discharge and the route by which medication information was transferred. The possible route categories recorded were the Pharmacy Service Point, the hospital's public pharmacy, and "other" routes (which had to be specified). Validation of the data was performed by cross-checking the information collected by the hospital's Admission Office, the Pharmacy Service Point and the hospital's public pharmacy, in addition to electronic patient files, interviews with ward staff and, where necessary, interviews with the concerned patients. Main outcome measure Route of medication information transfer at discharge in all discharged patients. RESULTS: A total of 629 patients were included in the study. The routes of transfer were: Pharmacy Service Point 281 patients (44 %), the hospital's public pharmacy 54 patients (9 %), and other routes 44 patients (7 %). Other routes were most recorded at the children's ward, the short stay and cardiology ward. In 250 patients (40 %), there was no transfer of information by the Pharmacy Service Point because they were registered as using no medication or as experiencing no medication changes during hospitalisation. CONCLUSION: Medication information was transferred for 53 % of the discharged patients, which is close to the maximum achievable result. Further improvement of medication transfer in Deventer Hospital can be made by adjusting the current procedure and by educating the ward staff about the importance and the clinical practice of this procedure.