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Healthcare Professionals' Knowledge and Behaviors Regarding Drug-Dietary Supplement and Drug-Herbal Product Interactions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074290. [PMID: 35409970 PMCID: PMC8998985 DOI: 10.3390/ijerph19074290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/07/2022]
Abstract
Given the widespread use of dietary supplements (DS) and herbal products (HP), healthcare professionals (HCPs) will increasingly encounter patients who use these preparations with conventional drugs and who need their services to reduce the consequences of adverse therapeutic outcomes. The aim of our survey was to assess the knowledge and behaviors of HCPs regarding the risk of potential drug−dietary supplement (DDSIs) and drug−herbal product (DHPIs) interactions. This cross-sectional survey collected data via on paper-based questionnaire among general practitioners (GPs) (n = 105), specialty doctors (n = 87) and nurses (n = 154). The HCPs were mostly familiar with the interaction of doxycycline with magnesium (83%) and were least familiar with interaction of warfarin with glucosamine (14%). The results on DDSIs and DHPIs knowledge showed that GPs scored significantly higher than nurses (p < 0.001 and p = 0.003, respectively), while specialty doctors scored significantly higher than nurses only on DDSIs knowledge (p < 0.001). Only 28% of respondents reported that they often or always ask patients on drug therapy about the use of DS or HP, and 25% of respondents record such data in the medical documentation of patients. Our results showed that HCPs have sufficient knowledge about most major DDSIs and DHPIs, but insufficient knowledge about most moderate interactions. However, their overall knowledge and behavior regarding the risk of these interactions indicate the need for further continuing education and training.
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Gura KM, Calkins KL, Premkumar MH, Puder M. Use of Intravenous Soybean and Fish Oil Emulsions in Pediatric Intestinal Failure-Associated Liver Disease: A Multicenter Integrated Analysis Report on Extrahepatic Adverse Events. J Pediatr 2022; 241:173-180.e1. [PMID: 34695449 DOI: 10.1016/j.jpeds.2021.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare extrahepatic adverse events during fish oil lipid emulsion (FOLE) or soybean oil lipid emulsion (SOLE) treatment in children with intestinal failure-associated liver disease (IFALD). STUDY DESIGN In this multicenter integrated analysis, bleeding, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), infections, and signs of lipid emulsion intolerance were compared between FOLE recipients (1 g/kg/d) (n = 189) and historical controls who received SOLE (≤3 g/kg/d) (n = 73). RESULTS When compared with SOLE recipients, FOLE recipients had a lower gestational age (30.5 vs 33.0 weeks; P = .0350) and higher baseline direct bilirubin (DB) (5.8 vs 3.0 mg/dL; P < .0001). FOLE recipients had a decreased incidence of bleeding (P < .0001), BPD (P < .001), ROP (P < .0156), bacterial and fungal infections (P < .0001), and lipid intolerance signs (P < .02 for all). Patients with bleeding vs patients without bleeding had higher baseline DB; the ORs for baseline DB (by mg/dL) and treatment (FOLE vs SOLE) were 1.20 (95% CI: 1.10, 1.31; P ≤ .0001) and 0.22 (95% CI: 0.11, 0.46; P ≤ .0001), respectively. In preterm infants, a higher BPD (P < .0001) and ROP incidence (P = .0071) was observed in SOLE recipients vs FOLE recipients. CONCLUSIONS Children with IFALD who received FOLE had fewer extrahepatic adverse events, including a decreased incidence of bleeding, preterm comorbidities, and lipid intolerance signs compared with children with IFALD who received SOLE. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT00910104 and NCT00738101.
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Affiliation(s)
- Kathleen M Gura
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pharmacy (KG), Boston Children's Hospital, Boston, MA; Department of Surgery and the Vascular Biology Program (MPU), Boston Children's Hospital, Boston, MA.
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA
| | - Muralidhar H Premkumar
- Baylor College of Medicine, Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - Mark Puder
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pharmacy (KG), Boston Children's Hospital, Boston, MA; Department of Surgery and the Vascular Biology Program (MPU), Boston Children's Hospital, Boston, MA
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Golanski J, Szymanska P, Rozalski M. Effects of Omega-3 Polyunsaturated Fatty Acids and Their Metabolites on Haemostasis-Current Perspectives in Cardiovascular Disease. Int J Mol Sci 2021; 22:ijms22052394. [PMID: 33673634 PMCID: PMC7957531 DOI: 10.3390/ijms22052394] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
The beneficial effects of long-chain polyunsaturated omega-3 fatty acids (omega-3 PUFAs) in cardioprotection are widely known and generally accepted. In this literature review, we have focused on the known and postulated mechanisms of action of omega-3 PUFAs and their metabolites on various components of the haemostatic system, in particular on blood platelets and endothelium. We have also made an attempt to provide a comprehensive review of epidemiological studies with particular regard to clinical trials. Notably, the results of these studies are contradictory, and some of them failed to report the beneficial effects of taking or supplementing omega-3 PUFAs in the diet. A potential explanation, in our opinion, could be the need to use higher doses of omega-3 PUFAs and a proper ratio of omega-3 and omega-6 PUFAs. An additional problem which is difficult to solve is the use of a proper neutral placebo for interventional studies. Despite some controversies regarding the beneficial effects of supplementation of omega-3 PUFAs in cardiovascular disease, our review suggests that a promising aspect of future studies and applications is to focus on the anti-thrombotic properties of these compounds. An argument supporting this assumption is the recent use of omega-3 PUFAs as a supporting tool for the treatment of COVID-19 complications.
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Leonberg-Yoo AK, Johnson D, Persun N, Bahrainwala J, Reese PP, Naji A, Trofe-Clark J. Use of Dietary Supplements in Living Kidney Donors: A Critical Review. Am J Kidney Dis 2020; 76:851-860. [PMID: 32659245 DOI: 10.1053/j.ajkd.2020.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/28/2020] [Indexed: 11/11/2022]
Abstract
Dietary supplement use is high among US adults, with the intention by users to promote overall health and wellness. Kidney donors, who are selected based on their overall good health and wellness, can have high utilization rates of dietary supplements. We provide a framework for the evaluation of living kidney donors and use of dietary supplements. In this review, dietary supplements will include any orally administered dietary or complementary nutritional products, but excluding micronutrients (vitamins and minerals), food, and cannabis. Use of dietary supplements can influence metabolic parameters that mask future risk for chronic illness such as diabetes and hypertension. Dietary supplements can also alter bleeding risk, anesthesia and analgesic efficacy, and safety in a perioperative period. Finally, postdonation monitoring of kidney function and risk for supplement-related nephrotoxicity should be part of a kidney donor educational process. For practitioners evaluating a potential kidney donor, we provide a list of the most commonly used herbal supplements and the effects on evaluation in a predonation, perioperative donation, and postoperative donation phase. Finally, we provide recommendations for best practices for integration into a comprehensive care plan for kidney donors during all stages of evaluation. We recommend avoidance of dietary supplements in a kidney donor population, although there is a paucity of data that identifies true harm. Rather, associations, known mechanisms of action, and common sense suggest that we avoid use in this population.
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Affiliation(s)
- Amanda K Leonberg-Yoo
- Renal-Electrolyte & Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David Johnson
- Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA; Alexion Pharmaceuticals, Inc, Boston, MA
| | - Nicole Persun
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA
| | - Jehan Bahrainwala
- Renal-Electrolyte & Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter P Reese
- Renal-Electrolyte & Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ali Naji
- Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA; Transplantation Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Trofe-Clark
- Renal-Electrolyte & Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA.
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Park HJ, Lee S, Park CM, Yoo K, Seo JM. Reversal of Intestinal Failure-Associated Liver Disease by Increasing Fish Oil in a Multi-Oil Intravenous Lipid Emulsion in Adult Short Bowel-Syndrome Patients. JPEN J Parenter Enteral Nutr 2020; 45:204-207. [PMID: 32181905 DOI: 10.1002/jpen.1823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intestinal failure-associated liver disease (IFALD) is a serious complication of parenteral nutrition (PN). We report 2 cases of IFALD, which occurred in adult patients while on a regimen of multi-oil intravenous lipid emulsion containing fish oil. METHODS Patients initially received PN containing 1-g/kg/d SMOFlipid 20% (SMOFlipid). When IFALD developed, lipid composition in PN was altered to include higher proportions of fish oil. RESULTS Case 1 was a 23-year-old man with short-bowel syndrome. He had been fully dependent on PN for approximately 11 months with a direct bilirubin level of 15.1 mg/dL. Doses of 0.15-g/kg/d pure fish oil and 0.3-0.6-g/kg/d SMOFlipid were administered for 56 days, and IFALD was resolved 59 days after adding fish oil. Case 2 was an 85-year-old man who received extensive small-bowel resection because of internal herniation and small-bowel necrosis. He had elevated direct bilirubin levels and was diagnosed with IFALD. Fish-oil treatment was initiated after 50 days of receiving PN. The average daily amount of fish oil given was 0.14 g/kg/d. IFALD was resolved 44 days after adding Omegaven (Fresenius Kabi Austria Gmbh, Austria). CONCLUSION Two patients with advanced IFALD showed reversal of cholestasis by altering the lipid content of their PN to include more fish oil.
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Affiliation(s)
- Hyo Jung Park
- Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Pharmaceutical Services, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sanghoon Lee
- Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keesang Yoo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Meen Seo
- Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Epstein NE. Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery. Surg Neurol Int 2018; 9:251. [PMID: 30637169 PMCID: PMC6302553 DOI: 10.4103/sni.sni_372_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.
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Affiliation(s)
- Nancy E Epstein
- Clinical Professor of Neurological Surgery, School of Medicine, State University of N.Y. at Stony Brook, and Chief of Neurosurgical Spine/Education at NYU Winthrop Hospital, Mineola, NY 11501, USA
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