Petra A Thürmann

Universität Witten/Herdecke · Chair of Clinical Pharmacology

Introduction: With growing age, multiple chronic diseases may result in polypharmacy. Drugs that should be avoided in older adults are called potentially inappropriate medications (PIM). Beyond PIM, drug-drug interactions (DDI) are known to be related to adverse drug events. This analysis examines the risk of frequent falling, hospital admission, a...

Background Interventions to reduce potentially risky hospitalizations among nursing home residents are highly relevant for patient safety and quality improvement. A catalog of nursing home-sensitive conditions (NHSCs) grounds the policy recommendations and interventions.Methods In two previous research phases, an expert panel developed a catalog of...

Hintergrund: Chronische nicht-tumorbedingte Schmerzen (CNTS) sind eine häufige Erkrankung mit weltweit hoher Prävalenz. Zur Behandlung kommen u.a. Opioide zum Einsatz, deren Pro-Kopf-Verbrauch in Deutschland weltweit mit am höchsten ist. Studien zufolge liegt dabei insbesondere bei gleichzeitigem Bestehen von CNTS und psychischen Faktoren ein erheb...

Hintergrund und Stand (inter)nationaler Forschung: Die Vermeidung von Krankenhauseinweisungen aus dem Pflegeheim wird – auch hinsichtlich der Qualität der Versorgung – international diskutiert [1], [2]. Durch Anpassung der ambulanten Versorgung kann ein Teil dieser Krankenhauseinweisungen vermieden werden. Fragestellung und Zielsetzung: Welche str...

Background Overviews (i.e., systematic reviews of systematic reviews, meta-reviews, umbrella reviews) are a relatively new type of evidence synthesis. Among others, one reason to conduct an overview is to investigate adverse events (AEs) associated with a healthcare intervention. Overviews aim to provide easily accessible information for healthcare...

Background As the number of concomitantly used drugs increases, the prevalence of medication risks increases. These include, for example, drug interactions which may reduce or increase the desired and undesired effects of individual drugs.Objectives The POLypharmacy, drug interActions and Risks (POLAR) project aims to contribute to the detection of...

Background Systematic reviews that synthesize safety outcomes pose challenges (e.g. rare events), which raise questions for grading the strength of the body of evidence. This is maybe one reason why in many potentially inappropriate medication (PIM) lists the recommendations are not based on formalized systems for assessing the quality of the body...

Objective To investigate reporting and methodological characteristics of overviews on adverse (drug-associated) events (AEs) of pharmacological interventions. Study Design and Setting We searched Medline, EMBASE, Epistemonikos, and the Cochrane Database of Systematic Reviews from inception to May 17th, 2021 for overviews exclusively investigating...

Background A complex drug treatment might pose a barrier to safe and reliable drug administration for patients. Therefore, a novel tool automatically analyzes structured medication data for factors possibly contributing to complexity and subsequently personalizes the results by evaluating the relevance of each identified factor for the patient by m...

Registration PROSPERO: CRD42020210645 Introduction We aimed to assess the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors in older patients with type 2 diabetes with inadequate glycaemic control. Methods We included randomized controlled trials (RCTs) in older (⩾65 years) patients with type 2 diabetes. The intervention group was randomized to...

Background: Medications with an unfavorable risk-benefit profile in the elderly, and for which there are safer alternatives, are designated as potentially inappropriate medications (PIM). The RIME trial (Reduction of Potentially Inappropriate Medication in the Elderly) was based on PRISCUS, a list of PIM that was developed in 2010 for the German p...

Background Systematic reviews that synthesize safety outcomes pose challenges (e.g. rare events), which poses questions for grading the strength of the body of evidence. In this contribution, we suggest adaption of the GRADE system for grading the quality of evidence on safety outcomes for developing a potentially inappropriate medication list (PRI...

Background: The safety of drug use by nursing-home residents can be impaired by polypharmacy, potentially inappropriate medications (PIM), and neuroleptics, as well as by a lack of adequate interprofessional coordination in the nursing home. The goal of the HIOPP-3- iTBX Trial was to improve drug safety in nursing-home residents, including a reduc...

The COVID-19 pandemic brought development, evaluation and use of vaccines for older adults into the spotlight. Here, we reflect on the gaps that were highlighted and strategies to fill them, during the pandemic and beyond. This commentary draws on principles we compiled through the geriatric pharmacology subcommittee of the clinical division of the...

This study compared simulations of a physiologically based pharmacokinetic (PBPK) model implemented for cyclosporine with drug levels from therapeutic drug monitoring to evaluate the predictive performance of a PBPK model in a clinical population. Based on a literature search model parameters were determined. After calibrating the model using the p...

Purpose Our objective was to assess the safety of long-term intake of DOACs in older adults with atrial fibrillation (AF). Methods We included RCTs in elderly (≥65 years) patients with AF. A systematic search in MEDLINE and EMBASE was performed on 9/11/2020. For determination of risk of bias, the RoB-2 tool was applied. We pooled outcomes using ran...

Zusammenfassung Hintergrund Die cluster-randomisierte multizentrische Interventionsstudie „HIOPP-3 iTBX - Angemessene und sichere Medikation für Pflegeheimbewohner/innen mit Hilfe einer interprofessionellen Toolbox“ hat die Verbesserung der Arzneimitteltherapiesicherheit bei Pflegeheimbewohner/-innen, insbesondere die Reduktion von Neuroleptika un...

Please find detailed information on our protocol in the attached PDF file.

Background: Frailty in elderly patients is associated with an increased risk of poor health outcomes, including falls, delirium, malnutrition, hospitalisation, and mortality. Because polypharmacy is recognised as a possible major contributor to the pathogenesis of geriatric frailty, reducing inappropriate medication exposure is supposed to be a pr...

Neuropathic pain is a debilitating and commonly treatment-refractory condition requiring novel therapeutic options. Accumulating preclinical studies indicate that the potassium channel Slack (KNa1.1) contributes to the processing of neuropathic pain, and that Slack activators, when injected into mice, ameliorate pain-related hypersensitivity. Howev...

Was ist neu? Vor- und Nachteile des Polypill-Konzepts Polypills können die Therapieadhärenz erhöhen, während insbesondere die Aspekte aus ärztlicher Sicht Therapiesicherheit und -flexibilität das Thema aktueller Diskussionen sind. Die Polypill in der Primärprävention Aufgrund der Nichtberücksichtigung individueller Risikofaktoren durch ihren „Masse...

Background Helium in oxygen (HELIOX) can relieve airway obstruction and lower the work of breathing because it increases the threshold at which turbulent gas flow is induced. Less turbulent and more laminar flow lowers the work of breathing. According to guidelines, the fraction of Helium in HELIOX should be maximized (e.g. to 79%). Here, we invest...

Background Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication re...

Objective: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. Study design and setting: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-...

Bedingt durch den demografischen Wandel nimmt die Anzahl an älteren, pflegebedürftigen Menschen in Deutschland stetig zu. Ältere und hochbetagte Menschen in Heimen leiden häufig an mehreren chronischen Erkrankungen, was zur Verordnung einer Vielzahl von Arzneimitteln und einem hohen Risiko für unerwünschte Arzneimittelwirkungen (UAW) führt. Vor all...

Since 1 October 2016, all legally insured persons are entitled to a nationwide medication plan (BMP) under certain conditions (according to § 31a SGB V, E-Health Law). The catalogue of measures of the 3rd Action Plan 2013-2015 for the improvement of drug therapy safety (AMTS) provided for the testing of a medication plan in practice, including its...

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of an uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified...

Nicht wenige der urologischen Patienten befinden sich im fortgeschrittenen Lebensalter. Dieser Umstand muss auch bei der Therapie mit Arzneimitteln berücksichtigt werden. Folgende Faktoren spielen hierbei eine wesentliche Rolle: Multimorbidität, Polypharmazie mit einem erhöhten Risiko für unerwünschte Wechselwirkungen, verlangsamte renale Eliminati...

Objective: The safety of potentially inappropriate medications (PIMs) in elderly patients is still debated. Using the PRISCUS list, we examined the incident all-cause hospitalization risk associated with PIMs compared to PIM alternatives during the 180 days post individual first pharmacy dispensing (index date). Methods: Routine claims data from...

Background and aims: Appropriate use of sedatives and analgesics is essential to keep critically ill patients comfortable and to prevent prolonged mechanical ventilation time and length of stay in ICU. Aim of this study was to analyse the long-term effect of an algorithm-based individual analgesic-sedative protocol on mechanical ventilation time a...

Aim: Two inhaler devices (Respimat® and HandiHaler®) are available for tiotropium, a long-acting anticholinergic agent. We aimed to analyse drug utilization, off-label usage, and generalizability of the TIOSPIR trial results for both devices. Methods: Patients aged ≥18 years exhibiting at least one documented prescription of tiotropium in the da...

The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medica...

After the SMART trial evaluating the safety of salmeterol (long-acting beta-2-agonist (LABA)) in asthma patients, regulatory actions were taken to promote a guideline-adherent prescribing of LABA only to patients receiving inhaled corticosteroids (ICS). We aim to analyse LABA- and ICS-related prescription patterns after the SMART trial in Germany....

For some years patient safety has been an important topic for the design of the healthcare systems in many countries. In Germany we are still in the starting phase of this development. Here, patient safety is not a main focus for research and there is only little funding for these topics. Thus most findings on patient safety have been derived in fo...

PurposeAuthorisation was suspended on 1 August 2013 for tetrazepam-containing medicines. The aim of the study was to assess relevance and pattern of tetrazepam use by estimating the prevalence of prescribing and to analyse prescribing indications and duration. This information is needed to generate baseline data for further evaluation of prescribin...

Background The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. T...

Respiratory drugs are widely used in children to treat labeled and non-labeled indications but only some data are available quantifying comprehensively off-label usage. Thus, we aim to analyse drug utilisation and off-label prescribing of respiratory drugs focusing on age- and indication-related off-label use. Patients aged ≤18 years documented in...

Objective: Empirical results indicate an increased risk for cardiovascular (CV) adverse drug events (ADE) in chronic obstructive pulmonary disease (COPD) patients treated with beta-2-agonists (B2A) and muscarinic antagonists (MA). A systematic review (including a meta-analysis for drug classes with sufficient sample size) was conducted assessing t...

Chronische Schmerzen und psychiatrische Erkrankungen treten häufig gemeinsam auf. So liegt bei circa 60 % der Patienten mit chronischen Schmerzen eine psychoneurologische Komorbidität vor, häufig eine depressive Symptomatik [1]. Zwischen den eingesetzten Analgetika und Psychopharmaka gibt es eine Vielzahl von Wechselwirkungen unterschiedlicher klin...

Polypharmazie wird üblicherweise als die gleichzeitige Verordnung von fünf oder mehr verschiedenen Arzneimitteln pro Tag definiert. Welche Kombinationen Sie vermeiden sollten, bzw. wann weniger mehr ist, lesen Sie auf den folgenden Seiten.

Self-medication, including both the use of over-the-counter (OTC) drugs and the use of formerly prescribed drugs taken without a current physician's recommendation, is a public health concern; however, little data exist regarding the actual risk. We aimed to analyse self-medication-related adverse drug reactions (ADRs) leading to hospitalisation. I...

For some years patient safety has been an important topic for the design of the healthcare systems in many countries. In Germany we are still in the starting phase of this development. Here, patient safety is not a main focus for research and there is only little funding for these topics. Thus most findings on patient safety have been derived in fo...

A significant proportion of the elderly population is affected by multimorbidity and polypharmacy. Drug safety in this population is characterised by age-associated changes in pharmacokinetics and pharmacodynamics, an increased risk for drug-drug interactions, an unmanageable situation of side effects and co-morbidities, and a questionable adherenc...

Purpose The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people , which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. Methods A preliminary PIM list was developed, based on the German PRISCUS list of potentially ina...

The PRISCUS list is a valuable tool for identifying potentially inadequate medication in elderly patients (1). To what extent are medications from this list being prescribed in a university-based hospital? At Freiburg University Medical Center, a computerized physician order entry system (MEONA) has been in use since early 2008 (2). To increase med...

Purpose: The aim of this study was to estimate the prevalence of potentially inappropriate medication (PIM) in the elderly as indicated by Germany's recently published list (PRISCUS) and to assess factors independently associated with PIM prescribing, both overall and separately for therapeutic groups. Methods: Claims data analysis (Health Insur...

Since direct patient care is only one of the many fields of clinical pharmacologists world wide, the contribution of the discipline to the provision of healthcare is frequently underestimated. Besides therapeutic monitoring and pharmacogenetic services, particularly drug information services run by clinical pharmacology departments have been establ...

Even after the recent approval of newer oral anticoagulants for clinical use, the vitamin K antagonist phenprocoumon remains an important treatment option for many patients. In order to quantify the hitherto "accepted" risks of phenprocoumon treatment, we analyzed adverse drug reactions (ADRs) that led to hospitalization on the internal medicine wa...

A significant proportion of the elderly population is affected by multimorbidity and polypharmacy. Drug safety in this population is characterised by age-associated changes in pharmacokinetics and pharmacodynamics, an increased risk for drug-drug interactions, an unmanageable situation of side effects and co-morbidities, and a questionable adherenc...

Multimorbidity, polymedication and functional impairment together with diminished everyday competence and communication ability predispose nursing home residents to adverse drug events (ADE). The high number of psychiatric drug prescriptions is a characteristic feature. The project “Medication Safety in Nursing Homes”, funded by the Federal Ministr...

Uzara glycosides (UG) extracted from Xysmalobium undulatum are used for treating non-specific diarrhea.Cross-reactivity has been described for UG in digitalis glycoside assays but digitalis-like cardiac effects are controversially discussed. Therefore, we performed a randomized, singleblind cross-over study in 18 healthy volunteers receiving a comm...

Therapy for adverse drug reactions (ADRs) often results in the application of blood components. This study aims to assess the demand for blood components and the resulting economic burden (hospital perspective) in German hospitals induced by ADRs leading to admissions to departments of internal medicine. In this prospective study, ADRs leading to h...

Studies on pharmacokinetics and pharmacodynamics of high-dose methotrexate chemotherapy (HD-MTX) in elderly primary central nervous system lymphoma (PCNSL) patients are rare. MTX exposure time has recently been proposed as an outcome determining factor in PCNSL. We investigated 49 immunocompetent PCNSL patients (female N = 30, male N = 19, median a...

Immediate-release nifedipine is on the PRISCUS list of drugs that should not be given to elderly patients. We studied the use of this calcium-channel blocker under real-life conditions. In 2009, we carried out a cross-sectional study based on the Statutory Health Insurance Sample AOK Hesse/KV Hesse with a sample size of 260 672 insurees. We used an...