RESUMO
BACKGROUND: Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence. As a consequence the translation of SmPC to clinical practice may lead to non-specific recommendations. For the translation of this information to the real world, it is necessary to evaluate the available knowledge about drug-disease interactions, and to formulate specific recommendations for prescribers and pharmacists. The aim of this paper is to describe a standardized method how to develop practice recommendations for drug-disease interactions by literature review and expert opinion. METHODS: The development of recommendations for drug-disease interactions will follow a six-step plan involving a multidisciplinary expert panel (1). The scope of the drug-disease interaction will be specified by defining the disease and by describing relevant effects of this drug-disease interaction. Drugs possibly involved in this drug-disease interaction are selected by checking the official product information, literature, and expert opinion (2). Evidence will be collected from the official product information, guidelines, handbooks, and primary literature (3). Study characteristics and outcomes will be evaluated and presented in standardized reports, including preliminary conclusions on the clinical relevance and practice recommendations (4). The multidisciplinary expert panel will discuss the reports and will either adopt or adjust the conclusions (5). Practice recommendations will be integrated in clinical decision support systems and published (6). The results of the evaluated drug-disease interactions will remain up-to-date by screening new risk information, periodic literature review, and (re)assessments initiated by health care providers. ACTIONABLE RECOMMENDATIONS: The practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published and implemented in all Clinical Decision Support Systems in the Netherlands. DISCUSSION: The recommendations result in professional guidance in the context of individual patient care. The professional will be supported in the decision making in concerning pharmacotherapy for the treatment of a medical problem, and the clinical risks of the proposed medication in combination with specific diseases.
RESUMO
BACKGROUND: In-line skate injuries are highly preventable by the use of protective gear. We investigated how young Dutch skaters protect themselves and what factors predict the use of protective gear in order to develop campaigns to increase their safety behaviour. METHODS: A survey was conducted to study protection behaviour of 872 Dutch skaters and factors influencing the use of protective gear. Written questionnaires were used, measuring behaviour and social psychological determinants towards the use of protective behaviour. RESULTS: Protective gear was not often used: 36% used wrist guards, 28% used kneepads, 14% used elbow pads and 5% used helmets. The use of protective gear was influenced by social influences, self-efficacy expectations and intention (R2=54%). CONCLUSIONS: The present study shows that young Dutch skaters should improve their safety behaviour in order to prevent skate injuries. Furthermore, the study provides clear recommendations for developing prevention programmes.
