Barbara Maat

Impact of CYP2C19 genotyping on clopidogrel therapy adjustments in patients with stroke or TIA

Ala Keyany, Tessa Leenders, Barbara Maat

OBJECTIVE: Clopidogrel is an antiplatelet medication routinely used for the prevention of stroke. However, patients with impaired cytochrome P450 (CYP)2C19 enzyme activity exhibit lower levels of the active clopidogrel metabolite, resulting in reduced therapeutic response. At the Elisabeth-TweeSteden Hospital (ETZ), all patients …

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4CPS-053 Reducing oxycodone prescription and use in orthopaedic patients after hip or knee arthroplasty: a pre-post intervention study

M Phaff, R Geuze, Barbara Maat

Background and Importance Surgical procedures such as total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with risks of long-term opioid use. Implementing interventions that effectively reduce these risks remains a challenge. Aim and Objectives To assess the effect of …

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4CPS-043 A digital assistant for self-reporting medication allergy history (ChaRM-A): discrepancies between medication allergy history documentation by patients supported by a digital assistant and pharmacy technicians

S Heeren, B Apaydin, E Derissen, Guus Geurt Schoonman et autres

Background and Importance Electronic personal health records (ePHRs) increasingly allow patients to manage their own medical data. Integration of a digital assistant (DA; ie, a conversational agent) into ePHRs may be of added value as a supportive tool to help better engage …

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5PSQ-140 Beliefs, practices and knowledge regarding the use and risks of opioids among clinicians

M Smit, Mark MPM Jansen, Barbara Maat, T Jaspers et autres

Background and Importance Opioid prescriptions increased significantly between 2008 and 2017, raising concerns about misuse and leading to the development of prescribing guidelines and awareness efforts. Previous studies mainly explored opioid prescribing for chronic non-malignant pain in primary care. However, less is …

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Digital clinical decision support to improve pharmacotherapy in hospitalized obese patients: A prospective intervention study

Ala Keyany, Ilse Groenen, Barbara Maat

Background In obese patients, standard medication dosing is often suboptimal and requires dose adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimize this. Objective This study aimed to assess the effect of eCDS …

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4CPS-025 Medication extravasation management and outcomes in patients who experienced an extravasation of medication during hospital admission: a mixed-method study

Barbara Maat, A Bandringa, Ala Keyany, Sameer D. Saini

Background and Importance Intravenous (IV) medication administration, a routine procedure in hospitalised patients, carries risks of complications such as extravasations. Extravasations, the unintentional leakage of a vesicant drug into surrounding tissue, can result in tissue damage and necessitates prompt intervention. Current literature …

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Patient Perspectives on a Digital Assistant for Medication Reconciliation: An Interview Study Comparing Socioeconomic Groups

Kim Tenfelde, Ayla Dijkmans, Nadine Bol, Mart P. Kicken et autres

Medication reconciliation, the process of documenting a patient's medication, is currently a time-consuming and labor-intensive process. To make medication reconciliation more efficient, digital assistants (DAs) offer a promising solution. Especially since human-like digital interfaces tend to be appreciated by more vulnerable populations …

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4CPS-022 The effect of digital clinical decision support on pharmacotherapy in hospitalised (morbidly) obese patients: a prospective intervention study

Ala Keyany, Inske Groenen, Sarbjit S. Saini, Barbara Maat

Background and Importance The pharmacokinetics and dynamics of medication can be altered in (morbidly) obese patients. Standard medication doses may be suboptimal in these patients and adjustments based on body mass index (BMI) or body weight (BW) may be needed. Digital clinical …

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Smaller nadroparin dose reductions required for patients with renal impairment: A multicenter cohort study

Renate C.A.E. van Uden, Tessa C. C. Jaspers, Karina Meijer, Karlijn J. van Stralen et autres

Background Guidelines advise 50 % and 25 % dose reduction of the therapeutic nadroparin dose (86 IU/kg) in patients with eGFR 15–29 and 30-60 ml/min respectively. For monitoring, peak anti-Xa levels are suggested. Data lack whether this results in therapeutic anti-Xa levels …

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Digital clinical decision support to improve pharmacotherapy in (morbidly) obese patients: a prospective intervention study.

Ala Keyany, Ilse Groenen, Sarbjit S. Saini, Barbara Maat

Abstract Background In (morbidly) obese patients standard medication dosing is suboptimal and requires adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimise this. Aim To assess the effect of eCDS on adjustments to …

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PB0464 Smaller Nadroparin Dose Reductions Required for Patients with Renal Impairment: A Multicenter Study

Roy van Uden, Tessa C. C. Jaspers, Karina Meijer, K. van Stralen et autres

4CPS-040 Electronic clinical decision support for pharmacotherapeutic interventions to reduce anticholinergic burden in older hospitalised patients

Barbara Maat, M Van Geel, T Leenders, A Keyany et autres

Background and Importance Patients’ anticholinergic burden is the cumulative effect of taking one or more anticholinergic medications. It is associated with adverse outcomes such as falls, cognitive impairment, delirium and increased morbidity, especially in elderly. Previous studies demonstrated that hospitalisation may increase …

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