Branislav Milovanovic - Academia.edu (original) (raw)

Papers by Branislav Milovanovic

Health & Social Care in the Community, 2021

Abstract The COVID‐19 pandemic exerted a profound impact on health systems worldwide. Moreover, s... more Abstract The COVID‐19 pandemic exerted a profound impact on health systems worldwide. Moreover, significant concerns were raised in terms of middle‐ and long‐term consequences of postponing care in non‐COVID patients. The primary aim of the study was to describe the remote pharmaceutical care service (telepharmacy) during the COVID‐19 pandemic in the Republic of Srpska (RS), Bosnia and Herzegovina. The secondary aim was to identify service users’ needs and concerns and to describe community pharmacists’ interventions. Ten community pharmacists were appointed by the Pharmaceutical Society of the RS to deliver telepharmacy services. After obtaining users’ verbal permission, pharmacists documented issues discussed with them. The prospective data collection included the period from April 13 to May 21, 2020. Descriptive and statistical analysis was performed using IBM SPSS Statistics software (ver. 22). A total of 71 service users’ charts were analyzed. Telepharmacy users were on average 61.31 ± 13.27 years of age, with almost equal gender distribution. Patients with chronic or acute/subacute conditions were predominant with a share of 84.5%. Chronic diseases were the main reason for searching pharmacists’ consultation (74.6%), 7% had a complaint about worsening of a chronic condition, 9.9% reported only acute/subacute conditions as ambulatory conditions, whereas 15.5% asked information about coronavirus or COVID‐19. The vast majority of patients’ and users’ needs were addressed by a pharmacist during counseling and only 15.5% of the patients required immediate referral to a doctor for refill/prescribing purposes. Remote pharmaceutical care service (telepharmacy) is deemed a convenient model in the RS during the COVID‐19 pandemic. Patients and users presented with explicit and specific needs and concerns, both COVID‐ and non‐COVID‐related, which should not be neglected. Community pharmacists showed a high level of resilience and ability in addressing patients' needs.

International Journal of Clinical Pharmacy, Dec 21, 2019

Background Drug–drug interactions represent one of the causes of adverse therapy outcomes through... more Background Drug–drug interactions represent one of the causes of adverse therapy outcomes through deteriorated efficacy or safety. However, the true extent of harm related to drug–drug interactions is not well established due to a lack of recognition and understanding. Objective The aim of this study was to investigate the association of potential drug–drug interactions with patients variables recorded at admission. Setting A cross-sectional correlation study was performed on the Cardiology ward of the University Clinical Hospital Center in Belgrade, Serbia. Method Data were retrospectively obtained from medical records and LexiInteract was used as the screening tool for potential drug–drug interactions. Main outcome measure Clinical and laboratory parameters recorded at the patients admission. Results A total of 351 patient records entered the analysis, with the mean age of 70 ± 10 years. The prevalence of potentially relevant drug–drug interactions was 61% (N = 213). After controlling for patient characteristics, nine potential drug–drug interactions were significantly associated with laboratory values outside the range and five potential drug–drug interactions with inadequate clinical parameter values. Potential drug–drug interactions were associated with abnormalities in blood count, metabolic parameters, electrolyte imbalance and renal function parameters. Association with inadequate control of systolic, diastolic blood pressure, as well as heart rhythm was also shown. Conclusion Drug–drug interactions were associated with patients clinical and laboratory findings. Our findings may assist in the identification of patients with increased likelihood of suboptimal therapy outcomes. Generating evidence through post-marketing drug–drug interactions research would lead to improvement in clinical decision-support systems, increased effectiveness and utilization in everyday clinical practice.

Journal of Critical Care, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Expert Opinion on Drug Metabolism & Toxicology, Apr 18, 2023

Pharmacy World & Science, 1995

There is ample evidence that the pharmacokinetics of drugs in infants and children may differ mar... more There is ample evidence that the pharmacokinetics of drugs in infants and children may differ markedly from those in adults. The goals of phannacokinetics is to maximize efficacy, minimize toxicity and drug interactions, enhance compliance, and reduce cost of medications. Studies with drugs including anticonvulsants, antimicrobials, digoxin, methotrexate and theophylline have demonstrated that these goals are achievable. Genetic and racial background, underlying disease, concurrent drugs, and nutritional status can influence pharmacokinetics. Population pharmacokinetics can provide useful data even when limited number of samples are available from a large number of patients. Pharmacokinetic monitoring is influenced by numerous factors including dose and dosage form, method of drug administration, times of sample collection, analytical and forecasting methods, and implementation of dosage recommendations. The future of pharmacokinetics, in large part would depend on correlating its parameters to the markers of efficacy and/or toxicity of medications. The ultimate goal of pharmacokinetics should be to improve the quality of life and health outcomes in infants and children.

Antibiotics (AB) and antifungals are large, heterogeneous, and commonly prescribed groups of drug... more Antibiotics (AB) and antifungals are large, heterogeneous, and commonly prescribed groups of drugs. Even thou, their use in therapy are considered to be safe, during concomitant use with other drugs the result can be clinically important interaction. Certain classes of AB or antifungal drugs are known to interact with many other drugs, but the interaction potential of them is not uniform among members of the class. Therefore, choosing the appropriate drug allows the possibility to avoid potentially dangerous drug-drug interactions.

British Journal of Clinical Pharmacology, 2009

AUC (mg h-1 l-1) 7.36 Ϯ 1.83 7.79 Ϯ 2.02 6.91 Ϯ 2.74 6.52 Ϯ 1.72 6.18 Ϯ 1.75 5.04 Ϯ 0.97** † CL/F... more AUC (mg h-1 l-1) 7.36 Ϯ 1.83 7.79 Ϯ 2.02 6.91 Ϯ 2.74 6.52 Ϯ 1.72 6.18 Ϯ 1.75 5.04 Ϯ 0.97** † CL/F (l h-1 kg-1) 0.35 Ϯ 0.07 0.32 Ϯ 0.06 0.34 Ϯ 0.14 0.35 Ϯ 0.13 0.38 Ϯ 0.12 0.45 Ϯ 0.10* † t1/2 (h) 3.47 Ϯ 0.56 ‡ 3.77 Ϯ 1.13 3.85 Ϯ 0.91 3.66 Ϯ 1.13 3.13 Ϯ 0.55 3.17 Ϯ 0.50 Vz/F (l kg-1) 1.70 Ϯ 0.29 1.73 Ϯ 0.49 1.77 Ϯ 0.31 1.75 Ϯ 0.42 1.68 Ϯ 0.36 2.04 Ϯ 0.37 † Ro 12-5637 Cmax (mg l-1) 0.27 Ϯ 0.08 0.28 Ϯ 0.13 0.27 Ϯ 0.15 0.27 Ϯ 0.13 0.19 Ϯ 0.10 0.18 Ϯ 0.09 AUC (mg h-1 l-1) 1.13 Ϯ 0.33 1.26 Ϯ 0.38 1.25 Ϯ 0.85 1.19 Ϯ 0.57 0.79 Ϯ 0.48 0.70 Ϯ 0.43

Vojnosanitetski pregled, 2012

Background/Aim. Selective serotonin reuptake inhibitors are the most commonly chosen antidepressa... more Background/Aim. Selective serotonin reuptake inhibitors are the most commonly chosen antidepressants in patients with Parkinson's disease (PD). The aim of our study was to assess the influence of fluoxetine (Flu) on motor functions in patients with PD. Methods. In this prospective, controlled, open-label study, 18 patients with PD and mild depression [(10 ? Hamilton Rating Scale for Depression (HDRS) ? 23)] without dementia [(25 ? Mini-Mental State Examination (MMSE)] were treated with Flu. Both single and repeated dose effects of Flu were assessed on days 1-80. Plasma concentrations of Flu and norfluoxetine (NORFlu) were correlated with the results of selected motor function performance scores: The Unified Parkinsons Disease Rating Score (UPDRS), Finger Tapping Test (FTT) and Purdue Pegboard Test (PPT). Severity of PD, depression and dementia were evaluated using standard tests [(Hoehn and Yahr stages (HY), activity of daily living (ADL), UPDRS, HDRS, MMSE)]. Results. Steady-st...

Croatian Medical Journal, 2011

Aim To analyze potential and actual drug-drug interactions reported to the Spontaneous Reporting ... more Aim To analyze potential and actual drug-drug interactions reported to the Spontaneous Reporting Database of the Croatian Agency for Medicinal Products and Medical Devices (HALMED) and determine their incidence. Methods In this retrospective observational study performed from March 2005 to December 2008, we detected potential and actual drug-drug interactions using interaction programs and analyzed them. Results HALMED received 1209 reports involving at least two drugs. There were 468 (38.7%) reports on potential drug-drug interactions, 94 of which (7.8% of total reports) were actual drug-drug interactions. Among actual drugdrug interaction reports, the proportion of serious adverse drug reactions (53 out of 94) and the number of drugs (n = 4) was significantly higher (P < 0.001) than among the remaining reports (580 out of 1982; n = 2, respectively). Actual drug-drug interactions most frequently involved nervous system agents (34.0%), and interactions caused by antiplatelet, anticoagulant, and non-steroidal anti-inflammatory drugs were in most cases serious. In only 12 out of 94 reports, actual drug-drug interactions were recognized by the reporter. Conclusion The study confirmed that the Spontaneous Reporting Database was a valuable resource for detecting actual drug-drug interactions. Also, it identified drugs leading to serious adverse drug reactions and deaths, thus indicating the areas which should be in the focus of health care education.

Neurotoxicology and teratology, May 1, 2017

Benzodiazepines and benzodiazepine-related medications (BBRMs) are anxiolytics and hypnotics acti... more Benzodiazepines and benzodiazepine-related medications (BBRMs) are anxiolytics and hypnotics acting on γ-amino butyric acid (GABA)A receptors. BBRMs are assumed to have a low potential for major congenital malformations, but research on more subtle and protracted developing symptoms of these medications is lacking. Therefore, we prospectively investigated the association between BBRM use in pregnancy and long-term effects on child behavior in a large population-based cohort study. The study population consisted of 104 children prenatally exposed to BBRM, 527 children exposed to maternal prenatal anxiety or phobic anxiety symptoms (without exposure to BBRM), and 5609 control children. At child age, 6years, Oppositional Defiant Disorder (ODD), Aggressive Behavior and Anxiety Problems were assessed by the Child Behavior Checklist (CBCL) reported by the mother and the Teacher Report Form (TRF). Children prenatally exposed to BBRM had higher scores of ODD and aggressive behavior, but not...

Vojnosanitetski pregled, 2014

Background/Aim. Dysautonomia appears in almost all patients with Parkinson?s disease (PD) in a ce... more Background/Aim. Dysautonomia appears in almost all patients with Parkinson?s disease (PD) in a certain stage of their condition. The aim of our study was to detect the development and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the potential association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. Methods. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor complications. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Results. Autonomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic...

Clinical Neurophysiology, 2010

The knowledge of parameters which describe oxygen and nutrients supply to tissues is essential fr... more The knowledge of parameters which describe oxygen and nutrients supply to tissues is essential from standpoint of diagnostics and follow-up of pathologies of brain. Due to their low spatial resolution MR angiographic techniques cannot visualize blood flow inside bulk tissue. MR perfusion imaging is technique which use drop in tissue signal during the first pass of contrast agent in order to obtain the haemodynamic parameters which describe perfusion. Calculation of those values requires determination of time course of change of agent concentration in both tissue and feeding artery. Decrease in MR signal is proportional to intravascular concentration of contrast agent, which provides basis for calculation of regional cerebral volume (rCBV), regional cerebral flow (rCBF) and mean transition time (MTT) and corresponding maps of these parameters. Such maps can pinpoint to changes in perfusion of brain tissue which can be consequence or cause of pathologic changes. Perfusion MRI can help in more precise definition of the area affected by stroke and, in comparison with diffusion weighted imaging, in assessing volume which can be potentially saved with aid of thrombolytic therapy. Maps of perfusion parameters provide information on existence and follow-up of tumor angiogenesis which further helps in differentiation and grading of brain tumors. Perfusion technique can also contribute in distinguishing between radiation therapy effects and recurrent tumors.

Neuropsychiatric Disease and Treatment, 2010

Novel Treatment of Epilepsy, 2011

Central European Journal of Medicine, 2014

Gentamicin is readily used for suspected or proven sepsis in neonates, yet it shows considerable ... more Gentamicin is readily used for suspected or proven sepsis in neonates, yet it shows considerable inter-individual pharmacokinetic variability, which limits achievements of therapeutic levels. Hence, the aim of this study was to compare peak and trough gentamicin concentrations according to dosing regimen, to evaluate pharmacokinetic parameters, and to consider adjustments of dosing regimen. Babies with infection were treated with 1 h infusion, and daily dose of 5 or 7.5 mg/kg depending on the age. Patients were randomized into two groups: I — dosing interval 12 h (n=8), II — 24 h (n=11). Two steady-state blood samples were obtained. Pharmacokinetic parameters were calculated using one-compartment model. The results showed a difference (p<0.05) in peak gentamicin concentrations between the groups, and tendency of lower trough levels in the group II. Calculated pharmacokinetic parameters included the volume of distribution (Vd) 0.52±0.47 l/kg, clearance (CL) 0.055±0.036 l/hkg and a...

Arhiv za farmaciju

Due to frequent clinical trial failures and consequently fewer new drug approvals, the need for i... more Due to frequent clinical trial failures and consequently fewer new drug approvals, the need for improvement in drug development has, to a certain extent, been met using model-based drug development. Pharmacometrics is a part of pharmacology that quantifies drug behaviour, treatment response and disease progression based on different models (pharmacokinetic - PK, pharmacodynamic - PD, PK/PD models, etc.) and simulations. Regulatory bodies (European Medicines Agency, Food and Drug Administration) encourage the use of modelling and simulations to facilitate decision-making throughout all drug development phases. Moreover, the identification of factors that contribute to variability provides a basis for dose individualisation in routine clinical practice. This review summarises current knowledge regarding the application of pharmacometrics in drug development and clinical practice with emphasis on the population modelling approach.

Frontiers in Pharmacology, Mar 26, 2020

IntroductionWhile medicine shortages are complex, their mitigation is more of a challenge. Prospe... more IntroductionWhile medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice.MethodologyA semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns.ResultsThe participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy.ConclusionThe study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe.

Journal of Medical Biochemistry

Summary Background The progression of the nonalcoholic fatty liver disease to nonalcoholic steato... more Summary Background The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with NASH. Setting: Outpatient hepatology clinic. Methods A prospective trial was conducted. The first cohort included patients with biopsy-proven NASH, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in NASH group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications. Results All 33 NASH patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of med...