An analysis and comparison of commonly available United Kingdom prescribing resources.

BACKGROUND AND OBJECTIVE: Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. METHODS: We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. RESULTS: Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. DISCUSSION: We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. CONCLUSION: Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their ability to provide assistance to prescribers.

Managing hypertension in the very elderly: effect of adverse drug reactions (ADRs) on achieving targets.

The Hypertension in the Very Elderly trial (HYVET), demonstrated the benefit of antihypertensive treatment in patients >or=80 years. However, patients in this age group are at increased risk of drug interactions and adverse effects. We conducted a retrospective cohort study, in hypertensive patients aged >or=80 years, to determine whether it is possible to follow the HYVET guidelines in an everyday clinical setting. We identified 100 patients aged >or=80 years referred to the Hypertension Clinic, University Hospital Birmingham, over a 10-year period. Most patients were referred to the clinic because of poorly controlled blood pressure despite treatment and all had 24 h ambulatory blood pressure monitoring (ABPM) as part of their assessment. All patients tolerated ABPM, and a 'white coat' effect was demonstrated in 33 patients. In 64 out of 100 patients (57 on treatment), the ABPM confirmed poor blood pressure control. Despite this, 26 of these patients had an antihypertensive either stopped (15), and /or reduced (3) or left unchanged (9) at clinic because of documented adverse drug reactions (ADRs). In 36 out of 100 patients, no additional antihypertensive therapy was needed because the blood pressure was either well-controlled on treatment (28), over-treated (4), or normotensive with a white coat effect (4). Despite this, antihypertensive agents were either stopped (10), and or reduced (5) because of ADRs in half the patients (14) from the well-controlled group. In conclusion, 40% patients had documented ADRs overall which limited further intervention, suggesting that implementation of the HYVET recommendations in clinical practice may be difficult.

Does surgical removal of mucosal associated lymphoid tissue protect against adult coeliac disease? A case controlled study.

BACKGROUND AND AIMS: Surgical resection of mucosa associated lymphoid tissue has been suggested as a protective mechanism against the development of inflammatory bowel disease. Mucosal T-cell activity plays a pivotal role in coeliac disease pathogenesis. We aimed to determine if the development of adult coeliac disease is influenced by appendectomy or tonsillectomy. METHODOLOGY: Three hundred patients over 16 years of age with biopsy proven coeliac disease were identified from two hospital databases in South Yorkshire. From these databases, appendectomy and tonsillectomy status was determined and compared with 1033 coeliac disease antibody-negative controls (volunteers recruited from general practice). Logistic regression was performed to correct for the age differences between the two groups; cross-table analysis was performed. RESULTS: Thirteen percent of coeliac disease patients and 12.2% of controls had previous appendectomy (P = 0.71; odds ratio 1.08; 95% confidence interval 0.72-1.62). 20.7% of coeliac disease patients and 24.5% of the controls had previous tonsillectomy (P = 0.17; odds ratio 0.80; 95% confidence interval 0.59-1.10). CONCLUSIONS: No significance was demonstrated in either the appendectomy or tonsillectomy group. Surgical removal of mucosal associated lymphoid tissue does not appear to prevent the development of adult onset coeliac disease.