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Tenpas AS, Vascimini A, Westwood G, Morris E, Dietrich E, DeRemer C. Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led Chronic Care Management Services at a Rural Family Medicine Clinic. J Pharm Pract 2023; 36:1392-1396. [PMID: 35938485 DOI: 10.1177/08971900221118232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background: Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Objective: Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. Methods: This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Results: Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI -1.70 to -.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI -2.35 to -.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Conclusion: Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.
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Affiliation(s)
- Andrew S Tenpas
- Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA
| | - Angelina Vascimini
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL, USA
| | - Greg Westwood
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Christina DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
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Dietrich E, Bara C, Chassain K, Scard C, Beneton N, Maillard H. Overview of dermatologic tele-expertise in areas of low physician density: A retrospective study at Le Mans general hospital. Ann Dermatol Venereol 2023:S0151-9638(23)00027-3. [PMID: 37270319 DOI: 10.1016/j.annder.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/28/2022] [Accepted: 02/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In areas of low physician density, especially as regards dermatologists in France, there is an increasing interest in tele-expertise. This is particularly the case in the Sarthe department, where the number of physicians continues to decline and access to care was further limited by the COVID 19 epidemic. STUDY DESIGN We retrospectively collected data from tele-expertise requests submitted to Le Mans General Hospital by general practitioners via a dedicated platform between May 6, 2019, and April 9, 2021. RESULTS Six hundred and forty three requests relating to 90 different diagnoses were recorded during this period. One hundred and thirty four patients (20% of requests) were invited to attend a face-to-face consultation within an average of 29 days. DISCUSSION Through the use of tele-expertise at Le Mans Genreal Hospital it was possible to introduce a means of tackling the problem of the lack of dermatologists in the Sarthe department. Rapid responses enabled the number of consultation requests to be reduced, leading to fewer population displacements in the context of the present pandemic. CONCLUSION These initial results are encouraging and confirm that tele-expertise seems a satisfactory option to optimize access to care for populations in areas of low physician density.
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Affiliation(s)
- E Dietrich
- Service de Dermatologie, Centre Hospitalier, Le Mans, France.
| | - C Bara
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - K Chassain
- Service de Dermatologie, Centre Hospitalier, Lorient, France
| | - C Scard
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - N Beneton
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - H Maillard
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
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Tenpas A, Dietrich E, Fitzgerald B, DeRemer C. Financial reimbursement and productivity metrics for pharmacist-led chronic care management services in rural practice settings. Res Social Adm Pharm 2023; 19:778-782. [PMID: 36740524 DOI: 10.1016/j.sapharm.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND The implementation of chronic care management (CCM) services has often been hindered by issues with reimbursement, raising concerns about sustainability. To date, little if any literature has examined the financial feasibility and sustainability of CCM services in rural practice settings. OBJECTIVE Assess financial reimbursement and productivity metrics for pharmacist-led CCM services at a rural, medically underserved family medicine clinic. METHODS This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters, minutes of pharmacist time spent on calls, CCM claims, work relative value units (wRVU), financial reimbursement, and overall personnel costs. RESULTS Over an 8-month period, 46 patients were enrolled in CCM services. Of the 49 CCM calls placed during this time, 31 (63.3%) were billable, though only 20 (64.5% of billable calls) were ultimately reimbursed. Approximately 37% of pharmacist "time-on-task" was not billable. Compared to the $643 required to cover pharmacist time on CCM calls, $822 of reimbursement was collected. This $179 profit, or 27.8% return-on-investment, is similar to results from more urbanized practices. Furthermore, services were "net productive" in wRVU generation, which may appeal to physician stakeholders interested in such targets. CONCLUSIONS Concerns about profitability and sustainability have prevented more widespread CCM implementation. In the present study, pharmacist-led CCM services achieved a 27.8% return-on-investment. Though rural-based CCM services may never attain significant profit margins, this data suggests they can still be financially self-sustaining and "net productive," all while providing high-quality patient care.
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Affiliation(s)
- Andrew Tenpas
- Texas A&M Irma Lerma Rangel College of Pharmacy, 1010 W. Avenue B, Kingsville, TX, 78363, USA.
| | - Eric Dietrich
- University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA.
| | - Brian Fitzgerald
- University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL, 32610, USA.
| | - Christina DeRemer
- University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA.
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Tenpas A, Dietrich E. The Fermi problem: Estimation of potential Billing losses due to Undercoding of Florida Medicare data. Explor Res Clin Soc Pharm 2023; 9:100238. [PMID: 36950456 PMCID: PMC10026023 DOI: 10.1016/j.rcsop.2023.100238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
Billing issues are more commonplace than most healthcare professionals, including pharmacists, even realize. Undercoding-or billing outpatient visits for a lower level of service than may be justified-leads to decreased reimbursement, but almost no data captures what is being sacrificed, especially at the state level. Using publicly available data from the National Ambulatory Medical Care Survey and Centers for Medicare and Medicaid Services, we attempt to approximate just how much Medicare reimbursement is lost annually to undercoding in Florida. We also discuss the hidden dangers of undercoding, including how it could hinder the ability of clinical pharmacists to build sustainable clinical services and contribute to the broader healthcare team.
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Affiliation(s)
- Andrew Tenpas
- Texas A&M Irma Lerma Rangel College of Pharmacy, 1010 W. Avenue B, Kingsville, TX 78363, United States of America
- Corresponding author.
| | - Eric Dietrich
- University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, FL 32610, United States of America
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Dietrich E, Grimaux X, Martin L, Samimi M. Etiological diagnosis of macroglossia: Systematic review and diagnostic algorithm. Ann Dermatol Venereol 2022; 149:228-237. [PMID: 36229262 DOI: 10.1016/j.annder.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of this literature review was to list the different etiologies of macroglossia reported in the literature, to identify characteristics that might guide diagnosis, and to create a diagnostic algorithm. METHODS The bibliographic search was carried out between October 2019 and July 2020 in the PubMed research base using the keywords "macroglossia" (MESH) and/or "tongue enlargement". RESULTS Of the 1711 references identified, 615 articles were excluded, and 1096 abstracts were reviewed. We classified the different etiologies identified according to their mechanism and whether they were congenital or acquired. The etiologies are divided into the following categories: genetic malformation syndromes, non-syndromic congenital malformations, endocrinopathies, neuromuscular diseases, storage disorders, infectious, inflammatory, traumatic, and iatrogenic diseases. CONCLUSION Based on this review, we propose a diagnostic algorithm for macroglossia according to the characteristics described. The most common diagnoses among acquired causes were amyloidosis (13.7%), endocrinopathies (8.8%), myopathies (4%) and tongue tumors (6.7%). The most common congenital causes were aneuploidy, lymphatic malformations, and Beckwith-Wiedemann syndrome, which is the main cause of congenital macroglossia, even if it appears isolated.
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Affiliation(s)
- E Dietrich
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France.
| | - X Grimaux
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France
| | - L Martin
- Dermatology Department, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49000 Angers, France
| | - M Samimi
- Dermatology Department, Centre Hospitalier Universitaire de Tours, 2 boulevard Tonnellé, 37000 Tours, France
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DeRemer CE, Perez NA, Middleton K, Konopack J, Dietrich E. Impact of an ambulatory care pharmacist on provider relative value units in a rural clinic. Exploratory Research in Clinical and Social Pharmacy 2022; 5:100098. [PMID: 35478518 PMCID: PMC9030713 DOI: 10.1016/j.rcsop.2021.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Collaborative team-based care models have been shown to improve the quality of care provided to patients and may increase productivity along with patient access to care. Productivity is often tracked via work relative value units (wRVU). The primary objective of this project was to evaluate how a collaborative practice model affects tracked productivity. Methods Data regarding wRVU were retrospectively extracted from the electronic medical record from a single center. De-identified data points included total number of patients seen and level of service billed for the visit. Visits were grouped as collaborative (physician-pharmacist) or independent (physician alone). Relative value unit totals were calculated separately for individual physicians and pharmacy visits and also combined for collaborative team wRVU totals. Wilcoxon and descriptive statistics were used for analysis. All statistical analyses were performed using SAS v 9.4 (Cary, NC). Results A total of 624 patient visits were reviewed. Total number of patients seen by physicians working in collaboration was on average 19.25 per day versus 12.9 per day for those working independently. When evaluating only the average per encounter wRVU for each provider removing collaborative patients, the three providers who worked in the collaborative model averaged 1.45, 1.48, and 1.55 wRVU per patient respectively, compared to those who worked singularly (1.37 and 1.30). This was found to be statistically significant in the unadjusted mixed model (P = 0.0476), but not maintained once adjusted. Conclusion Physicians working in collaboration with a pharmacist were able to bill at a higher level on average suggesting more productivity.
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Dietrich E, Davis K, Talana A, Holland N, Akhavan N, Panna D, Wright A, Huber K. Three‐year clinical interventions from an outpatient multidisciplinary direct oral anticoagulant monitoring service. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric Dietrich
- University of Florida College of Pharmacy, Gainesville Florida
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Kyle Davis
- United Therapeutics, Durham North Carolina
| | - Amy Talana
- Center for Living Well, Kissimmee Florida
| | - Neal Holland
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Neeka Akhavan
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Danielle Panna
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Ashleigh Wright
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
| | - Katherine Huber
- UF Internal Medicine at Tower Hill University of Florida College of Medicine, Gainesville Florida
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Dawwas GK, Barnes GD, Dietrich E, Cuker A, Leonard CE, Genuardi MV, Lewis JD. Cardiovascular and major bleeding outcomes with antiplatelet and direct oral anticoagulants in patients with acute coronary syndrome and atrial fibrillation: A population-based analysis. Am Heart J 2021; 242:71-81. [PMID: 34450051 DOI: 10.1016/j.ahj.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are replacing warfarin for stroke prevention in patients with atrial fibrillation (AF). OBJECTIVE To assess the effectiveness and safety of concomitant treatment with antiplatelet-DOAC compared to antiplatelet-warfarin in patients with acute coronary syndrome (ACS) and AF. DESIGN Retrospective propensity score-matched cohort study using United States-based commercial healthcare database from January 2016 to June 2019. PARTICIPANTS New-users of antiplatelet-DOAC and antiplatelet-warfarin who initiated the combined therapy within 30 days following incident ACS diagnosis. MEASUREMENTS Primary study outcomes were recurrent cardiovascular diseases (CVD) (ie, a composite of stroke and myocardial infarction) and major bleeding events identified via discharge diagnoses. We controlled for potential confounders via propensity score matching (PSM). We generated marginal hazard ratios (HRs) via Cox proportional hazards regression using a robust variance estimator while adjusting for calendar time. RESULTS After PSM, a total of 2,472 persons were included (1,236 users of antiplatelet-DOAC and 1,236 users of antiplatelet-warfarin). The use of antiplatelet-DOAC (vs. antiplatelet-warfarin) was associated with a reduced rate of recurrent CVD (adjusted HR 0.72, 95% confidence interval [CI], 0.56-0.92) and major bleeding events (adjusted HR, 0.49, 95% CI 0.33-0.72). LIMITATIONS Residual confounding. CONCLUSIONS In real-world data of AF patients with concurrent ACS, the use of antiplatelet-DOAC following ACS diagnosis was associated with a lower rate of recurrent CVD and major bleeding events compared with antiplatelet-warfarin. These findings highlight a potential promising role for DOACs in patients with ACS and AF requiring combined antiplatelet therapy.
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Tenpas A, Dietrich E. Simplifying medical decision-making for clinical pharmacists. Res Social Adm Pharm 2021; 18:3072-3075. [PMID: 34384715 DOI: 10.1016/j.sapharm.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
Intense lobbying by the American Medical Association (AMA) and related professional organizations led to significant changes to requirements for documentation of outpatient clinical services. As of 2021, providers are now free to choose between either time or medical decision-making (MDM) when "leveling" such services. Despite this change, many providers and clinical pharmacists may not yet realize its full billing implications. This article discusses why these billing changes occurred, what those changes actually mean in clinical practice, and how the three factors used to determine MDM can be utilized by clinical pharmacists in daily practice. Finally, a brief introduction to other potential billing codes open to pharmacists and discussion of MDM documentation requirements is included.
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Affiliation(s)
- Andrew Tenpas
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Eric Dietrich
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, 1225 Center Drive, Gainesville, FL, 32610, USA.
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Dawwas GK, Dietrich E, Cuker A, Barnes GD, Leonard CE, Lewis JD. Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation : A Population-Based Cohort Study. Ann Intern Med 2021; 174:910-919. [PMID: 33780291 DOI: 10.7326/m20-6194] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are increasingly used in place of warfarin, but evidence about their effectiveness and safety in patients with valvular atrial fibrillation (AF) remains limited. OBJECTIVE To assess the effectiveness and safety of DOACs compared with warfarin in patients with valvular AF. DESIGN New-user retrospective propensity score-matched cohort study. SETTING U.S.-based commercial health care database from 1 January 2010 to 30 June 2019. PARTICIPANTS Adults with valvular AF who were newly prescribed DOACs or warfarin. MEASUREMENTS The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of intracranial or gastrointestinal bleeding. RESULTS Among a total of 56 336 patients with valvular AF matched on propensity score, use of DOACs (vs. warfarin) was associated with lower risk for ischemic stroke or systemic embolism (hazard ratio [HR], 0.64 [95% CI, 0.59 to 0.70]) and major bleeding events (HR, 0.67 [CI, 0.63 to 0.72]). The results for the effectiveness and safety outcomes remained consistent for apixaban (HRs, 0.54 [CI, 0.47 to 0.61] and 0.52 [CI, 0.47 to 0.57], respectively) and rivaroxaban (HRs, 0.74 [CI, 0.64 to 0.86] and 0.87 [CI, 0.79 to 0.96], respectively); with dabigatran, results were consistent for the major bleeding outcome (HR, 0.81 [CI, 0.68 to 0.97]) but not for effectiveness (HR, 1.03 [CI, 0.81 to 1.31]). LIMITATION Relatively short follow-up; inability to ascertain disease severity. CONCLUSION In this comparative effectiveness study using practice-based claims data, patients with valvular AF who were new users of DOACs had lower risks for ischemic stroke or systemic embolism and major bleeding than new users of warfarin. These data may be used to guide risk-benefit discussions regarding anticoagulant choices for patients with valvular AF. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Ghadeer K Dawwas
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.K.D., C.E.L., J.D.L.)
| | - Eric Dietrich
- College of Pharmacy, University of Florida, Gainesville, Florida (E.D.)
| | - Adam Cuker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.C.)
| | | | - Charles E Leonard
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.K.D., C.E.L., J.D.L.)
| | - James D Lewis
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.K.D., C.E.L., J.D.L.)
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Dietrich E, Le Corre Y, Dupin N, Dréno B, Cartier I, Granry JC, Martin L. Benefits of simulation using standardized patients for training dermatology residents in breaking bad news. Ann Dermatol Venereol 2021; 148:156-160. [PMID: 33487487 DOI: 10.1016/j.annder.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/29/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Simulation in healthcare is a rapidly developing teaching method in the training of technical procedures. It is also used to enable caregivers to learn how to inform patients of serious illness and complex health status. However, its use is not widespread in the field of dermatology. This study investigated the utility of simulation as regards disclosing melanoma diagnosis, taking resident physician satisfaction as a primary endpoint. MATERIALS AND METHODS Fifteen dermatology residents were recruited as trainees. Four scenarios were allocated based on length of residency. An introductory briefing was held prior to the training sessions. Debriefing took place on completion of the diagnosis disclosure consultation. The participants completed questionnaires after the simulation session, after debriefing, and 3 months after the simulation session. The primary endpoint was usefulness of the session felt by trainees several months after the simulation. RESULTS The majority of participants (93.3%) thought the session helped with stress management, improved their attitude and control over their reaction (86.6%), and improved their communication skills (100%). They rated the usefulness of the simulation at 7.79/10 on average (range: 5-10). DISCUSSION According to our findings the resident physicians involved, particularly those with the least experience, were satisfied with this type of learning technique. Any difficulties encountered by these residents were brought to light and addressed during debriefing. CONCLUSION There would appear to be real benefits to be reaped from simulation, whatever the stage of medical training at which it takes place. Simulation should become an increasingly important part of contemporary pregraduate specialty programs.
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Affiliation(s)
- E Dietrich
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49100 Angers, France
| | - Y Le Corre
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49100 Angers, France
| | - N Dupin
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49100 Angers, France
| | - B Dréno
- Department of Dermatology, Tarnier University Hospital (Paris), 89, rue d'Assas, 75005 Paris, France
| | - I Cartier
- Department of Dermatology, Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J-C Granry
- Psychology Unit, Cancerology Coordination Center, 4, rue Larrey, 49100 Angers, France
| | - L Martin
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49100 Angers, France; All'Sims Healthcare Simulation Center, 4, rue Larrey, 49100 Angers, France.
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Dietrich E, Fields C, Hoffman DD, Prentner R. Editorial: Epistemic Feelings: Phenomenology, Implementation, and Role in Cognition. Front Psychol 2020; 11:606046. [PMID: 33192954 PMCID: PMC7652734 DOI: 10.3389/fpsyg.2020.606046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Dietrich
- Department of Philosophy, Binghamton University, Binghamton, NY, United States
| | - Chris Fields
- Independent Researcher, Caunes-Minervois, France
| | - Donald D Hoffman
- Department of Cognitive Science, University of California, Irvine, Irvine, CA, United States
| | - Robert Prentner
- Department of Cognitive Science, University of California, Irvine, Irvine, CA, United States
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13
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Dawwas GK, Dietrich E, Smith SM, Davis K, Park H. Comparative Effectiveness and Safety of Direct-acting Oral Anticoagulants and Warfarin in Patients with Venous Thromboembolism and Active Cancer: An Observational Analysis. Clin Ther 2020; 42:e161-e176. [PMID: 32768247 DOI: 10.1016/j.clinthera.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/18/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE There is limited evidence to support the use of direct-acting oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and active cancer. This study aimed to assess the effectiveness of DOACs versus warfarin for the prevention of recurrent VTE and major bleeding events in patients with VTE and active cancer. METHODS We identified patients with incident VTE and active cancer who newly initiated treatment with DOACs or warfarin from Truven Health MarketScan Commercial Claims and Medicare supplemental databases. Patients were followed up from treatment initiation (index date) until the occurrence of >7-day gap in treatment, the start of the study comparator, an outcome of interest (recurrent VTE or major bleeding), inpatient death, disenrollment, or end of the study period, whichever occurred first. We controlled for confounders via propensity score matching and estimated the hazard ratios (HRs) using Cox proportional hazards regression models. FINDINGS A total of 9952 patients were included in the matched cohort (4976 DOACs users and 4976 warfarin users). Patient characteristics were well balanced after matching. We observed a lower incidence of recurrent VTE (3 vs 5 per 100 person-years) and major bleeding events (2 vs 3 per 100 person-years) in the DOAC group compared to warfarin group, respectively. In Cox regression models, use of DOACs (vs warfarin) was associated with a lower risk of recurrent VTE (hazard ratio (HR), 0.59; 95% CI, 0.42-0.82) and major bleeding events (HR, 0.64; 95% CI, 0.44-0.94). IMPLICATIONS On the basis of our findings, among patients with VTE and active cancer, DOACs offer superior effectiveness with a lower risk of bleeding when compared with warfarin for the secondary prevention of VTE.
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Affiliation(s)
- Ghadeer K Dawwas
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kyle Davis
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
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Pissavini M, Tricaud C, Wiener G, Lauer A, Contier M, Kolbe L, Trullás Cabanas C, Boyer F, Meredith E, de Lapuente J, Dietrich E, Matts PJ. Validation of a new in vitro Sun Protection Factor method to include a wide range of sunscreen product emulsion types. Int J Cosmet Sci 2020; 42:421-428. [PMID: 32390187 PMCID: PMC8246923 DOI: 10.1111/ics.12625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/04/2020] [Indexed: 12/02/2022]
Abstract
In 2017, Cosmetics Europe performed a double‐blinded ring test of 24 emulsion‐type sunscreen products, across 3 in vivo test laboratories and 3 in vitro test laboratories, using a new candidate in vitro SPF test method. Based on the results of this work, an article was published showing how data derived from a new lead candidate method conform to new International Standards (ISO) acceptance criteria for alternative SPF test methods (Any alternative method should consider the matrix effect and if required, specify the matrix applicability of the method; Criterion 1a: Systematic differences between methods should be negligible: 95% of all individual results of an alternative method are within the range of ±2× reproducibility standard deviation of the in vivo method, that is overall bias must be below 0.5× reproducibility standard deviation of the in vivo method; Criterion 1b: Measurement uncertainty of an alternative method should be below the measurement uncertainty of the in vivo method. Candidate method predicted values must fall within the full ‘funnel’ (SPF 6‐50+) limits proposed by Cosmetics Europe (derived from the same minimum test design, that is using the ISO24444 Method to measure at least 24 products across at least 3 laboratories using at least 5 test subjects/laboratory, in a blinded fashion).). Of the 24 sunscreen products tested, the majority of emulsions were of the oil‐in‐water (O/W) type, whereas only one was water‐in‐oil (W/O) and there were no products with a mineral‐only sun filter system. In order to confirm the scope of this method, therefore, a new study was conducted that included 73 W/O (12 mineral + organic, 44 mineral only and 17 organic only) and 3 O/W mineral‐only, emulsion‐type sunscreen products (a total of 76 new sunscreen products). When combined with the previous 24 products (tested in 3 different laboratories), this yielded a new data set comprising a total of 100 emulsion‐type sunscreen products, with SPF values ranging from 6 to 50+ (with a total of 148 data points). These products were tested using the double‐plate in vitro SPF test method and compared with the ISO TC217/WG7 acceptance criteria for alternative SPF test methods. Over 95% of paired in vitro: in vivo SPF values lay within the upper and lower limits of the ISO acceptance criteria funnel, with no bias. This new in vitro SPF test method, therefore, meets the minimum requirements for an alternative SPF test method to ISO24444:2010, for emulsion‐type sunscreen products (which make up the majority of marketed sunscreen products).
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Affiliation(s)
- M Pissavini
- Coty-Lancaster SAM, 2, rue de la Lujerneta, Monaco, 98000, Monaco
| | - C Tricaud
- L'Oréal, 188 rue Paul Hochart, Chevilly Larue, 94550, France
| | - G Wiener
- Edgewell Personal Care, Ormond Beach, FL, 32174, USA
| | - A Lauer
- Chanel PB, 135 avenue Charles de Gaulle, Neuilly sur Seine, 92200, France
| | - M Contier
- LVMH Recherche Parfums et Cosmétiques, 185 avenue de Verdun, Saint Jean de Braye, 45800, France
| | - L Kolbe
- Beiersdorf AG, Unnastrasse 48, Hamburg, 20245, Germany
| | | | - F Boyer
- Pierre Fabre Dermo Cosmetique, Hôtel Dieu, 2 Rue Viguerie BP3071, Toulouse cedex, 3 31 025, France
| | - E Meredith
- CTPA, Sackville House, 40 Piccadilly, London, W1J 0DR, UK
| | - J de Lapuente
- AC MARCA, Avenida Carrilet 293-297, L'Hospitalet del Llobregat, Barcelona, 08907, Spain
| | - E Dietrich
- Cosmetics Europe - The Personal Care Association, Avenue Herrmann-Debroux 40, Brussels, B-1160, Belgium
| | - P J Matts
- Procter & Gamble, Greater London Innovation Centre, Rusham Park, Whitehall Ln, Egham, TW20 9NW, UK
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15
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Affiliation(s)
- Justin A Wasko
- Department of Pharmacy, University of Minnesota Medical Center, Minneapolis
| | - Eric Dietrich
- College of Pharmacy, University of Florida, Gainesville
| | - Kyle Davis
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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16
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Miller SA, St Onge EL, Taylor JR, Dietrich E, Anderson KV, DeRemer CE. Ambulatory care elective: Introduction to core practice concepts. Curr Pharm Teach Learn 2020; 12:331-338. [PMID: 32273072 DOI: 10.1016/j.cptl.2019.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/05/2019] [Accepted: 12/04/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Introduction to various pharmacy practice environments is effectively accomplished through concentrated elective courses. The ambulatory care elective utilized innovative active learning strategies to enhance chronic disease management, foster empathy, and introduce strategic planning in an ambulatory care center. EDUCATIONAL ACTIVITY AND SETTING A new two-credit hour ambulatory elective course was offered to third-year pharmacy students in a four-year doctor of pharmacy program. This 30-hour, 2-week long course, ran simultaneously between three campuses, and included six modules. The course employed lectures, active learning activities, shadowing, role playing, and a simulation. FINDINGS Course evaluations and student reflections indicate high satisfaction with the course and reveal value in the simulation. SUMMARY Active learning sessions in this third-year pharmacy elective allowed application of lecture materials to explore the focused practice of ambulatory care. Discussion topics were varied, allowing students to gauge the breadth of opportunities offered in ambulatory pharmacy, while also appreciating the scope of skills required for successful and sustainable practice. Students valued the chronic disease state simulation, which provided a unique approach to foster personal attributes.
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Affiliation(s)
- Shannon A Miller
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, 6550 Sanger Road, Orlando, FL 32827, United States.
| | - Erin L St Onge
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, 6550 Sanger Road, Orlando, FL 32827, United States.
| | - James R Taylor
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
| | - Katherine Vogel Anderson
- Department of Pharmacotherapy and Translational Research, Division of General Internal Medicine, University of Florida Colleges of Pharmacy and Medicine, 1225 Center Drive, Gainesville, FL 32610, United States.
| | - Christina E DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
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17
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Dawwas GK, Smith SM, Dietrich E, Lo-Ciganic WH, Park H. Comparative effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism. Am J Health Syst Pharm 2020; 77:188-195. [DOI: 10.1093/ajhp/zxz307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Purpose
Compared with conventional therapy (enoxaparin followed by warfarin), the direct-acting oral anticoagulant apixaban is thought to offer similar protection against recurrent venous thromboembolism (VTE) with lower bleeding risk. However, evidence regarding the heterogeneity of treatment effect from real-world data is lacking. The study described here aimed to compare the effectiveness and safety of use of apixaban versus warfarin in patients with VTE.
Methods
We conducted a retrospective cohort analysis of commercial and Medicare supplemental databases (data coverage period, 2014-2017) among patients with a diagnosis of VTE who were new users of apixaban or warfarin. We controlled for confounding using propensity score [PS] 1:4 matching. Cox proportional hazard models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity of treatment effect was assessed among patients with provoked VTE versus unprovoked VTE.
Results
After PS matching, a total of 36,907 patients were included in the cohort (n = 8,094 apixaban users and n = 28,813 warfarin users). In Cox regression models, the use of apixaban versus warfarin was associated with lower risks of recurrent VTE (HR, 0.54; 95% CI, 0.45-0.65) and major bleeding events (HR, 0.67; 95% CI, 0.54-0.84); these results remained consistent in patients with provoked VTE and those with unprovoked VTE.
Conclusion
This population-based analysis of patients with VTE extends results of randomized clinical trials indicating lower risks of development of recurrent VTE and major bleeding events with use of apixaban versus warfarin in real-world settings. The observed benefits of apixaban extended to selected subgroups of the VTE population, including patients with provoked VTE.
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Affiliation(s)
- Ghadeer K Dawwas
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, and Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
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18
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Dietrich E, Fox Hall T. Moral treatment for all. Animal Sentience 2020. [DOI: 10.51291/2377-7478.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Dietrich E, Desai R, Garg M, Park H, Smith SM. Reimbursement of ambulatory blood pressure monitoring in the US commercial insurance marketplace. J Clin Hypertens (Greenwich) 2019; 22:6-15. [PMID: 31873973 DOI: 10.1111/jch.13772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for confirming hypertension diagnosis and ongoing hypertension monitoring. However, reimbursement in the United States is variable and low compared with other advanced health care systems. We examined the reimbursement of ABPM and factors associated with successful reimbursement. A retrospective analysis of IBM MarketScan® commercial claims database was conducted for patients ≥18 years with ≥1 ABPM claim from January 2012 to December 2016. The date of first the ABPM claim was used as the index date. Per-beneficiary ABPM episode reimbursements were calculated by aggregating all ABPM-related reimbursements within a 30-day post-index window, considered as an ABPM episode. Multivariable logistic regression was used to identify predictors of successful reimbursement. Of 20 875 beneficiaries with ABPM claims, 16 920 (81.0%) were reimbursed. The median reimbursement per beneficiary for an ABPM episode was $89 (Inter Quartile Range [IQR], $62, $132), driven primarily by reimbursement for the full procedure (median, $86; IQR, $66, $110). Comparing benefit plan types, consumer-directed health plans provided the highest median reimbursement ($96; IQR, $61, $175). Successful reimbursement was associated with female patient sex (adjusted OR [aOR], 1.20; 95% CI, 1.11-1.28), having a health maintenance organization (aOR 2.11; 95% CI, 1.82-2.43) or point of service (aOR 2.08; 95% CI, 1.74-2.49) as benefit plan types, claim filing by a specialist (aOR 1.26; 95% CI, 1.14-1.40) and services provided at an outpatient hospital (aOR 1.17; 95% CI, 1.01-1.35). Among commercially insured Americans, our data suggest significant variability in successful reimbursement. Accordingly, more uniform criteria for ABPM reimbursement may facilitate greater use of guideline-recommended monitoring.
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Affiliation(s)
- Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, Gainesville, FL, USA.,Division of General Internal Medicine, Department of Medicine, College of Medicine, Gainesville, FL, USA
| | - Raj Desai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Mahek Garg
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, Gainesville, FL, USA.,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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20
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Carpenter E, Singh D, Dietrich E, Gums J. Andexanet alfa for reversal of factor Xa inhibitor-associated anticoagulation. Ther Adv Drug Saf 2019; 10:2042098619888133. [PMID: 31807265 PMCID: PMC6880028 DOI: 10.1177/2042098619888133] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Review of clinical data on andexanet alfa for the reversal of factor Xa (FXa)
inhibitor associated anticoagulation. Data sources: In the present review, we identified articles via PubMed
using the combined keywords andexanet alfa, apixaban, enoxaparin, edoxaban,
and rivaroxaban. Additional online searches via PubMed,
Google Scholar, and Lexicomp were conducted for both prescribing and cost
information. Portola Pharmaceuticals was contacted for information used for
United States Food and Drug Administration approval of andexanet alfa. Study selection and data extraction: English-language clinical trials and reviews published between January 2008
and April 2019 were included for review. Bibliographies of selected articles
were reviewed manually for relevant publications, focusing on reversal
strategies for apixaban, enoxaparin, edoxaban, or rivaroxaban associated
anticoagulation using andexanet alfa. Review articles were excluded. Data synthesis: The safety and tolerability of andexanet alfa were evaluated in one phase I,
two phase II, and one phase III clinical trials. The use of andexanet alfa
for reversing FXa inhibitor-associated anticoagulation were evaluated in the
phase III ANNEXA-4 study. Conclusions: Studies evaluating laboratory parameters for coagulation show that andexanet
alfa rapidly neutralizes the anticoagulant effects of apixaban, enoxaparin,
edoxaban, and rivaroxaban. Clinical studies show that andexanet alfa
improves markers related to coagulation, and reverses major bleeding in
healthy volunteers and patients with life-threatening bleeding. Interruption
of anticoagulation may result in thromboembolic and ischemic events. The use
of andexanet alfa requires close monitoring for signs and symptoms of
thromboembolic events, ischemic events, and cardiac arrest. Furthermore,
anticoagulation should be resumed following the administration of andexanet
alfa as soon as medically appropriate.
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Affiliation(s)
- Elise Carpenter
- Parkview Regional Medical Center, 11109 Parkview Plaza Dr, Fort Wayne, IN 46845, USA
| | - Divita Singh
- Howard University College of Pharmacy, Washington, DC, USA
| | - Eric Dietrich
- University of Florida College of Pharmacy, Gainesville, FL, USA
| | - John Gums
- University of Florida College of Pharmacy, Gainesville, FL, USA
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21
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Dietrich E, Davis K, Chacko L, Rahmanian KP, Bielick L, Quillen D, Feller D, Porter M, Malaty J, Carek PJ. Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2). South Med J 2019; 112:244-250. [PMID: 30943545 DOI: 10.14423/smj.0000000000000959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Factors contributing to hospital readmission have rarely been sought from the patient perspective. Furthermore, it is unclear how patients and physicians compare in identifying factors contributing to readmission. The objective of the study was to identify and compare factors contributing to hospital readmission identified by patients and physicians by surveying participants upon hospital readmission to a teaching medicine service. METHODS Patients 18 years and older who were discharged and readmitted to the same service within 30 days and the physicians caring for these patients were surveyed to identify factors contributing to readmission. Secondary outcomes included comparing responses between groups and determining level of agreement. Patients could be surveyed multiple times on subsequent readmissions; physicians could be surveyed for multiple patients. RESULTS A total of 131 patients and 37 physicians were consented. The mean patient age was 60.1 years (standard deviation 16.8 years) and 55.6% were female; 56.4% were white, and 42.1% were black/African American. In total, 179 patient surveys identified "multiple medical problems" (48.6%), "trouble completing daily activities" (45.8%), and "discharged too soon" (43.6%) most frequently as contributing factors; 231 physician surveys identified "multiple medical problems" (45.0%) and "medical condition too difficult to care for at home" (35.6%) most frequently as contributing factors. Paired survey results were available for 135 readmissions and showed fair agreement for only 1 factor but no agreement for 5 factors. CONCLUSIONS Patients identified previously unknown factors contributing to readmission. Little agreement existed between patients and physicians. Additional research is needed to determine how best to address patient-identified factors contributing to readmission.
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Affiliation(s)
- Eric Dietrich
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Kyle Davis
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Lisa Chacko
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Kiarash P Rahmanian
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Lauren Bielick
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - David Quillen
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - David Feller
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Maribeth Porter
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - John Malaty
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Peter J Carek
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
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22
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Weitzel KW, Duong BQ, Arwood MJ, Owusu-Obeng A, Abul-Husn NS, Bernhardt BA, Decker B, Denny JC, Dietrich E, Gums J, Madden EB, Pollin TI, Wu RR, Haga SB, Horowitz CR. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics 2019; 20:1103-1112. [PMID: 31588877 PMCID: PMC6854439 DOI: 10.2217/pgs-2019-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Benjamin Q Duong
- Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Aniwaa Owusu-Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Barbara A Bernhardt
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Decker
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua C Denny
- Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Eric Dietrich
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - John Gums
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Ebony B Madden
- National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA
| | - Toni I Pollin
- Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rebekah Ryanne Wu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Carol R Horowitz
- Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Smith SM, Desai R, Dietrich E, Park H. Abstract P2067: Trends in Ambulatory and Home Blood Pressure Monitoring Use for Confirmation of Hypertension or Resistant Hypertension Among the Commercially-Insured in the U.S., 2008-2017. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Out-of-office BP measurement, including ambulatory and home BP monitoring (ABPM, HBPM, respectively) are considered the gold standard for hypertension and treatment-resistant hypertension (TRH) confirmation, but their real-world use is not well-studied. We examined recent trends in submitted claims for ABPM and HBPM among commercially-insured U.S. adults with suspected hypertension or TRH.
Methods:
Using Truven commercial claims data (2008–2017), we identified adults (age ≥18 years) with hypertension, and ≥1 antihypertensive medication fill. We evaluated CPT codes for claims submitted for ABPM and HBPM from 6 months before to 1 month after initial antihypertensive drug use (incident treated hypertension [ITH] cohort) or the first occurrence of overlapping use of ≥4 antihypertensive drugs (incident TRH cohort). We excluded persons without continuous enrollment during the 7-month observation period.
Results:
Overall, 3,378,645 patients with ITH and 335,200 with incident TRH met inclusion criteria. Of those with ITH, 13,063 (3.9 per 1,000 persons) had ≥1 ABPM or HBPM claim between 6 months prior to and 1 month after initiating treatment. The annual proportion of patients with ≥1 claim ranged from 1.6 to 3.0 per 1,000 for ABPM and 1.3 to 2.1 per 1,000 for HBPM. Among those with incident TRH, 1126 (3.4 per 1,000) had ≥1 ABPM or HBPM claim between 6 months prior to and 1 month after initiating a fourth agent. The annual proportion with ≥1 claim ranged from 1.2 to 2.0 per 1,000 persons for ABPM and 1.1 to 2.9 per 1,000 for HBPM. From 2008 to 2017, use of ABPM modestly increased in the ITH cohort and decreased in the TRH cohort; no time trends were observed with HBPM. Sensitivity analyses suggested that ABPM was used most often for diagnosis confirmation (especially in the ITH cohort), followed by treatment monitoring, whereas HBPM was distributed more evenly.
Conclusion:
Our findings suggest ABPM is used rarely for guiding treatment initiation decisions among those with incident hypertension or apparent TRH. Claim submissions for HBPM were similarly low,
but a significant proportion of HBPM may occur without attempting reimbursement. Future research is needed to understand the factors responsible for low utilization, billing and coverage of these services.
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Talana AS, Huber K, Sorin M, Stalvey C, Davis K, Dietrich E. Patient-level adherence and interventions in an interdisciplinary DOAC clinic. Thromb Res 2019; 179:34-36. [DOI: 10.1016/j.thromres.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
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25
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Kolbe L, Pissavini M, Tricaud C, Trullás Cabanas C, Dietrich E, Matts PJ. Anti-inflammatory / anti-oxidant activity of ingredients of sunscreen products? Implications for SPF. Int J Cosmet Sci 2019; 41:320-324. [PMID: 31087383 PMCID: PMC6852040 DOI: 10.1111/ics.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Sun Protection Factor (SPF) of sunscreen products is derived from testing in vivo their ability to prevent erythema ("sunburn"). Recently, certain articles have raised concerns that sunscreen products may actively suppress erythema via anti-inflammatory / anti-oxidant (AI/AO) activity. These articles reason that this may result in a higher labelled SPF value than that provided by the efficacy of the UVR filters alone, giving consumers a "false sense of security". On the other hand, since inflammatory processes are known to play a role in the mechanisms of photodamage / skin cancer induction and propagation, AI/AO activity may provide valuable incremental photoprotective benefit (provided that there is no interference with visible erythema). The objective of these studies, therefore, was to investigate the potential of AI/AO ingredients to suppress UVR-induced erythemal response in human skin, in vivo. METHODS In vivo studies with SPF30 sunscreen formulations containing a variety of AI/AO ingredients were performed according to the International Standard ISO24444:2010 method. While ISO24444:2010 requires assessment of erythema at 20 ± 4h post-irradiation, an additional assessment at 5 h post-irradiation was also used to determine potential delay in erythema development. RESULTS None of the formulations, containing a variety of AI/AO ingredients, influenced SPF determination in comparison to the vehicle formulation. CONCLUSION Our in vivo results demonstrate that commonly-used AI/AO ingredients, at concentrations typically used in sunscreen products, neither influence SPF value nor delay erythemal response, i.e., the measured SPF reflects the true photoprotective capacity of the product.
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Affiliation(s)
- L. Kolbe
- Beiersdorf AGUnnastrasse 4820245HamburgGermany
| | - M. Pissavini
- Coty‐Lancaster SAM2, rue de la Lujerneta 98000MonacoMonaco
| | - C. Tricaud
- L’Oréal188 rue Paul Hochart94 550Chevilly LarueFrance
| | | | - E. Dietrich
- Cosmetics Europe ‐ The Personal Care AssociationAvenue Herrmann‐Debroux 40B‐1160BrusselsBelgium
| | - P. J. Matts
- Procter & Gamble, Greater London Innovation CentreEghamUK
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Dawwas GK, Brown J, Dietrich E, Park H. Can apixaban prevent venous thromboembolism better than rivaroxaban? - Authors' reply. Lancet Haematol 2019; 6:e181-e182. [PMID: 30926080 DOI: 10.1016/s2352-3026(19)30049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Ghadeer K Dawwas
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA.
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Dawwas GK, Brown J, Dietrich E, Park H. Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis. Lancet Haematol 2018; 6:e20-e28. [PMID: 30558988 DOI: 10.1016/s2352-3026(18)30191-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Apixaban and rivaroxaban, both direct-acting oral anticoagulants, are being increasingly used in routine clinical practice because of their fixed dosing and favourable pharmacological profiles. Differences in the risk of recurrent venous thromboembolism and major bleeding events between the two drugs are currently unknown. We aimed to compare the effectiveness and safety of apixaban and rivaroxaban in prevention of recurrent venous thromboembolism and major bleeding events in patients with venous thromboembolism. METHODS We did a retrospective cohort analysis of data from the Truven Health MarketScan commercial and Medicare Supplement claims databases in the USA. We analysed data for adult patients with newly diagnosed venous thromboembolism (deep vein thrombosis or pulmonary embolism) who were new users of apixaban or rivaroxaban between Jan 1, 2014, and Dec 31, 2016. Patients who did not initiate the study drugs within 30 days of their diagnosis, those without 12 months of continuous enrolment in medical and pharmacy benefits, and those who used other anticoagulants during the baseline period were excluded. The primary effectiveness outcome was the incidence of recurrent venous thromboembolism and the primary safety outcome was the incidence of major bleeding events. Cox-proportional hazard models after propensity score matching were used to calculate the hazard ratio (HR) and 95% CI. FINDINGS After propensity score matching, 15 254 patients were included in the cohort (3091 apixaban users and 12 163 rivaroxaban users). The crude incidence of recurrent venous thromboembolism was three per 100 person-years in the apixaban group and seven per 100 person-years in the rivaroxaban group. The incidence of major bleeding was three per 100 person-years in the apixaban group and six per 100 person-years in the rivaroxaban group. In multivariable Cox regression models, the use of apixaban compared with rivaroxaban was associated with decreased risk of recurrent venous thromboembolism (HR 0·37 [95% CI 0·24-0·55]; p<0·0001) and major bleeding events (0·54 [0·37-0·82]; p=0·0031). INTERPRETATION Based on our findings, apixaban seems to be more effective than rivaroxaban in preventing the development of recurrent venous thromboembolism and major bleeding events. Our data might give some assurance to clinicians that apixaban can be an effective and safe therapeutic option for treatment of patients with venous thromboembolism. FUNDING None.
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Affiliation(s)
- Ghadeer K Dawwas
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
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Abstract
The inclusion of pharmacists on care teams has been shown to improve clinical and economic health outcomes. However, a significant barrier to the widespread incorporation of pharmacists into care teams is the ability to financially support the salary of the pharmacist. A mechanism to improve the ability of pharmacists to generate clinical revenue already exists in the form of incident-to billing, although there remains considerable uncertainty regarding the criteria for incident-to billing and specifically how pharmacists can use this model to capture revenue for clinical services. In this article, we discuss incident-to billing criteria as it pertains to outpatient clinics, common misconceptions related to incident-to billing, and how clinical pharmacists may use this mechanism to generate revenue for the clinical services they provide. DISCLOSURES: This work was not supported by any funding source. The authors have no relevant conflicts of interest to disclose.
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Affiliation(s)
- Eric Dietrich
- 1 University of Florida College of Pharmacy, Gainesville
| | - John G Gums
- 1 University of Florida College of Pharmacy, Gainesville
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Dietrich E, Davis K. Antibiotic use in patients hospitalized with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2018; 75:1268-1269. [DOI: 10.2146/ajhp180178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eric Dietrich
- University of Florida College of Pharmacy Gainesville, FL
| | - Kyle Davis
- Wake Forest Baptist Medical Center Winston-Salem, NC
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30
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Pissavini M, Tricaud C, Wiener G, Lauer A, Contier M, Kolbe L, Trullás Cabanas C, Boyer F, Nollent V, Meredith E, Dietrich E, Matts PJ. Validation of an in vitro sun protection factor (SPF) method in blinded ring-testing. Int J Cosmet Sci 2018; 40:263-268. [PMID: 29676800 DOI: 10.1111/ics.12459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/10/2018] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The objective of this work was to investigate the utility of a new in vitro SPF test method in blinded ring-testing, against new ISO acceptance criteria. METHODS Twenty four blinded, commercial, emulsion-type, primary sunscreen products, covering the full range of labelled SPF in Europe (SPF6 - 50+), were tested by three test institutes using the current ISO24444:2010 In Vivo SPF Test Method and simultaneously by three separate test laboratories using a new candidate in vitro SPF test method, developed under the leadership of Cosmetics Europe (CE). The resulting relationship between in vitro SPF and in vivo SPF values was then compared with acceptance criteria developed recently by the International Standards (ISO) TC217/WG7 Sun Protection Test Methods Working Group. RESULTS Analysis of the mean inter-laboratory in vitro and mean inter-institute in vivo SPF values revealed a strong correlation between in vitro and in vivo values, with a Pearson correlation coefficient of r2 = 0.88 (P < 0.0001), a slope of 1.01 and a non-significant intercept (-1.48; P = 0.62). When these data were compared to the new ISO WG7 acceptance criteria, method bias was found to be extremely low and over 95% of the coupled data lay within the model 'funnel' (defined by upper and lower confidence intervals). CONCLUSION In conclusion, the results of blinded ring testing and comparison to new ISO WG7 acceptance criteria indicate that a new in vitro SPF test method meets (and exceeds) these minimum criteria and is an interesting candidate for possible deployment as an industry test methodology.
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Affiliation(s)
- M Pissavini
- Coty-Lancaster SAM, 2, rue de la Lujerneta, Monaco City, 98000, Monaco
| | - C Tricaud
- L'Oréal, 188 rue Paul Hochart, Chevilly Larue, 94550, France
| | - G Wiener
- Edgewell Personal Care, Ormond Beach, FL, 32174, USA
| | - A Lauer
- Chanel PB, 135 avenue Charles de Gaulle, Neuilly sur Seine, 92200, France
| | - M Contier
- LVMH Recherche Parfums et Cosmétiques, 185 avenue de Verdun, Saint Jean de Braye, 45800, France
| | - L Kolbe
- Beiersdorf AG, Unnastrasse 48, Hamburg, 20245, Germany
| | | | - F Boyer
- Pierre Fabre Dermo Cosmetique, Hôtel Dieu, 2 Rue Viguerie BP3071, Toulouse cedex 3, 31 025, France
| | - V Nollent
- Johnson & Johnson Consume Inc, 1 rue Camille Desmoulins, Issy les Moulineaux, 92130, France
| | - E Meredith
- CTPA, Sackville House, 40 Piccadilly, London, W1J 0DR, UK
| | - E Dietrich
- Cosmetics Europe - The Personal Care Association, Avenue Herrmann-Debroux 40, Brussels, B-1160, Belgium
| | - P J Matts
- Greater London Innovation Centre, Procter & Gamble, Egham, UK
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31
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Eggers MJ, Doyle JT, Lefthand MJ, Young SL, Moore-Nall AL, Kindness L, Medicine RO, Ford TE, Dietrich E, Parker AE, Hoover JH, Camper AK. Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana. Int J Environ Res Public Health 2018; 15:E76. [PMID: 29304032 PMCID: PMC5800175 DOI: 10.3390/ijerph15010076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 12/19/2022]
Abstract
An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families' financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.
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Affiliation(s)
- Margaret J Eggers
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - John T Doyle
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- Crow Water Quality Project, P.O. Box 370, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Myra J Lefthand
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Sara L Young
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Anita L Moore-Nall
- Department of Earth Sciences, Montana State University, P.O. Box 173480, Bozeman, MT 59717, USA.
| | - Larry Kindness
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
| | - Roberta Other Medicine
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- Environmental Health Department, Crow/Northern Cheyenne Indian Health Service Hospital,Crow Agency, MT 59022, USA.
| | - Timothy E Ford
- School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant Street,Amherst, MA 01003, USA.
| | - Eric Dietrich
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
| | - Albert E Parker
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Department of Mathematical Sciences, Montana State University, P.O. Box 173980,Bozeman, MT 59717, USA.
| | - Joseph H Hoover
- Health Sciences Center, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Anne K Camper
- Center for Biofilm Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
- Crow Environmental Health Steering Committee, Little Big Horn College, Crow Agency, MT 59022, USA.
- College of Engineering, Montana State University, P.O. Box 173980, Bozeman, MT 59717, USA.
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Pulver T, Dietrich E, Door A, Doss B, Harrison C, Downey G. Sandwich therapy for the treatment of stage IIIC endometrial carcinoma: A community-based experience. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carek PJ, Malaty J, Dietrich E, Lombardi J, Porter M, Blanc P, Samraj G. Addressing Hospital Readmissions: Impact of Weekly Review. Fam Med 2016; 48:638-641. [PMID: 27655198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The prevention of hospital readmissions has become an area for improvement for most health care organizations. Systematic reviews have been unable to identify a single intervention or bundle of interventions that reliably reduced risk of readmission in a generalizable manner. The aim of this quality improvement project was to examine the readmission rate to a family medicine residency program inpatient service following the implementation of a once per week session that reviewed patients who were readmitted during the prior week. METHODS The inpatient admissions and readmission to the family medicine inpatient service associated with a large academic health center were used for analysis. The impact of a regularly scheduled multidisciplinary team meeting that reviewed a list of patients was examined. Readmitted patients who were at high risk for readmission were specifically identified. Descriptive statistics were used to characterize and summarize the integral data obtained. The weekly readmission rate was presented using a control chart. RESULTS The readmission rate for the patients hospitalized after the intervention was 18.4%, compared to the readmission rate prior to the intervention (23.0%). While not a statistically different rate, a significant signal was noted. Demographic differences were noted in the group of patients considered to be high risk for readmission. CONCLUSIONS Regular rounds of an inpatient team that focuses on readmissions during the previous week reduced hospital readmissions. The impact of these sessions appears to be multifactorial.
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Affiliation(s)
- Peter J Carek
- Department of Community Health and Family Medicine, University of Florida
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34
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Davis KA, Miyares MA, Dietrich E. Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence. Am J Health Syst Pharm 2016; 72:1623-9. [PMID: 26386103 DOI: 10.2146/ajhp140804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The safety and efficacy of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in the setting of secondary stroke prevention are reviewed. SUMMARY Antiplatelet therapy has been shown to reduce the risk of numerous vascular events, especially in the setting of secondary prevention. DAPT with aspirin and another antiplatelet agent such as clopidogrel, prasugrel, or ticagrelor has become the main stay of acute coronary syndrome (ACS) management. The underlying pathophysiologies of ACS, ischemic stroke, and transient ischemic attack (TIA) are similar. In the setting of ACS, DAPT has clearly been shown to improve outcomes over single antiplatelet therapy for up to 12 months after the ischemic event. However, the role for DAPT in the setting of ischemic stroke and TIA is less clear. The MATCH, CHARISMA, and SPS3 studies demonstrated that DAPT was associated with increased bleeding compared with single antiplatelet therapy without an appreciable reduction in ischemic events. Early initiation of DAPT proved beneficial in reducing future ischemic events in the FASTER and CHANCE trials; however, these trials did not provide enough evidence to recommend the routine use of DAPT in secondary stroke prevention, and current guidelines recommend against such therapy. DAPT with aspirin and clopidogrel appears to be effective only for patients with minor stroke or TIA when started within 24 hours of the ischemic event and continued for a maximum of 21 days. CONCLUSION Currently available evidence does not substantiate the widespread use of long-term aspirin with clopidogrel for the secondary prevention of ischemic stroke or TIA.
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Affiliation(s)
- Kyle A Davis
- Kyle A. Davis, Pharm.D., BCPS, is Clinical Hospital Pharmacist, Internal Medicine; and Marta A. Miyares, Pharm.D., BCPS (AQ-Cardiology), CACP, is Clinical Hospital Pharmacist, Internal Medicine, Jackson Memorial Hospital, Miami, FL. Eric Dietrich, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Community Health and Family Medicine, College of Medicine, and Clinical Assistant Professor, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville.
| | - Marta A Miyares
- Kyle A. Davis, Pharm.D., BCPS, is Clinical Hospital Pharmacist, Internal Medicine; and Marta A. Miyares, Pharm.D., BCPS (AQ-Cardiology), CACP, is Clinical Hospital Pharmacist, Internal Medicine, Jackson Memorial Hospital, Miami, FL. Eric Dietrich, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Community Health and Family Medicine, College of Medicine, and Clinical Assistant Professor, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville
| | - Eric Dietrich
- Kyle A. Davis, Pharm.D., BCPS, is Clinical Hospital Pharmacist, Internal Medicine; and Marta A. Miyares, Pharm.D., BCPS (AQ-Cardiology), CACP, is Clinical Hospital Pharmacist, Internal Medicine, Jackson Memorial Hospital, Miami, FL. Eric Dietrich, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Community Health and Family Medicine, College of Medicine, and Clinical Assistant Professor, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville
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35
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Davis K, Dietrich E. Extended use of clopidogrel and aspirin after ischemic stroke. Am J Health Syst Pharm 2016; 73:611-2. [DOI: 10.2146/ajhp150993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Eric Dietrich
- University of Florida Colleges of Medicine and Pharmacy Gainesville, FL
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36
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Davis K, Dietrich E. Ivabradine (Corlanor) for Heart Failure. Am Fam Physician 2016; 93:682-684. [PMID: 27175841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Kyle Davis
- Ochsner Medical Center, New Orleans, LA, USA
| | - Eric Dietrich
- University of Florida Colleges of Medicine and Pharmacy, Gainesville, FL, USA
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37
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Carris NW, Spinelli A, Pierini D, Taylor JR, Anderson KV, Sando K, Powell J, Rosenberg EI, Zumberg MS, Smith SM, Gums JG, Dietrich E. Feasibility of Extended-interval Follow-up for Patients Receiving Warfarin. Cardiovasc Ther 2016; 33:98-103. [PMID: 25786578 DOI: 10.1111/1755-5922.12115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS The 2012 American College of Chest Physician Evidence-Based Management of Anticoagulant Therapy guidelines suggest an international normalized ratio (INR) testing interval of up to 12 weeks, rather than every 4 weeks, for patients with consistently stable INRs while taking vitamin K antagonists. We aimed to examine the feasibility of extended-interval follow-up in a real-world setting. METHODS Patients receiving stable warfarin therapy for ≥ 12 weeks at baseline began extended-interval follow-up with visits occurring at 6 weeks, 14 weeks, and every 12 weeks thereafter to a maximum of 68 weeks or until they were no longer suitable for extended-interval follow-up. A single INR excursion >0.3 from goal was permitted if a reversible precipitating factor was identified and the INR was expected to return to goal without dose adjustment. The primary outcome was the proportion of patients completing all study follow-up visits. RESULTS Of 48 patients enrolled, 47 had evaluable data. The most common indication for anticoagulation was atrial fibrillation/flutter (53.2%). At baseline, mean prior warfarin treatment duration was 6.7 ± 6 years and median number of weeks on a stable regimen was 24 weeks (IQR, 19-37.5). Eleven patients (23%) completed all study follow-up visits, whereas 17 (36%) did not maintain a stable INR past the 14-week follow-up. CONCLUSION A large proportion of patients with previously stable (≥ 3 months) INRs were not able to maintain stable INRs during extended-interval follow-up. More research is needed to identify patient characteristics predictive of success with extended-interval follow-up prior to broad implementation.
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Affiliation(s)
- Nicholas W Carris
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Alisa Spinelli
- Department of Pharmacy Practice, Belmont University College of Pharmacy, Nashville, TN, USA
| | - Danielle Pierini
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - James R Taylor
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Katherine Vogel Anderson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Division of Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karen Sando
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Jason Powell
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Eric I Rosenberg
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Division of Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marc S Zumberg
- Division of Hematology/Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Steven M Smith
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - John G Gums
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Eric Dietrich
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Smith SM, Carris NW, Dietrich E, Gums JG, Uribe L, Coffey CS, Gums TH, Carter BL. Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension. ACTA ACUST UNITED AC 2016; 10:307-17. [PMID: 26852290 DOI: 10.1016/j.jash.2016.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now study. At baseline, 169 patients (27% of Collaboration Among Pharmacists and Physicians To Improve Outcomes Now patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic blood pressure was reduced by 7 mm Hg more with PPCM intervention than usual care (P = .036). Blood pressure control was 34.2% with PPCM versus 25.9% with usual care (adjusted odds ratio, 1.92; 95% confidence interval, 0.33-11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.
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Affiliation(s)
- Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA; Department of Family Medicine, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - John G Gums
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Christopher S Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tyler H Gums
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Abstract
In response to a change in posture from supine or sitting to standing, autonomic reflexes normally maintain blood pressure (BP) by selective increases in arteriovenous resistance and by increased cardiac output, ensuring continued perfusion of the central nervous system. In neurogenic orthostatic hypotension (NOH), inadequate vasoconstriction and cardiac output cause BP to drop excessively, resulting in inadequate perfusion, with predictable symptoms such as dizziness, lightheadedness and falls. The condition may represent a central failure of baroreceptor signals to modulate cardiovascular function, a peripheral failure of norepinephrine release from cardiovascular sympathetic nerve endings, or both. Symptomatic patients may benefit from both non-pharmacologic and pharmacologic interventions. Among the latter, two pressor agents have been approved by the US Food and Drug Administration: the sympathomimetic prodrug midodrine, approved in 1996 for symptomatic orthostatic hypotension, and the norepinephrine prodrug droxidopa, approved in 2014, which is indicated for the treatment of symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure (Parkinson's disease, multiple system atrophy and pure autonomic failure). A wide variety of off-label options also have been described (e.g. the synthetic mineralocorticoid fludrocortisone). Because pressor agents may promote supine hypertension, NOH management requires monitoring of supine BP and also lifestyle measures to minimize supine BP increases (e.g. head-of-bed elevation). However, NOH has been associated with cognitive impairment and increases a patient's risk of syncope and falls, with the potential for serious consequences. Hence, concerns about supine hypertension - for which the long-term prognosis in patients with NOH is yet to be established - must sometimes be balanced by the need to address a patient's immediate risks.
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Affiliation(s)
- Louis Kuritzky
- a 1 Department of Community Health and Family Medicine, University of Florida , Gainesville, FL, USA
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Rogan S, Dietrich E, Wobmann A, Baur H. Effects of kinesio taping with fascia stimulatory bowls on neuromuscular activity of knee extensor synergists—a single case study. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dietrich E, Davis K. A Statin a Day to Keep the Doctor Away? Comparing Aspirin and Statins for Primary Prevention of Cardiovascular Disease. Ann Pharmacother 2014; 48:1238-1241. [PMID: 24958491 DOI: 10.1177/1060028014540609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For the primary prevention of cardiovascular (CV) disease, aspirin reduces the risk for major vascular events by approximately 15% to 20% with an absolute reduction of approximately 0.1%. Major bleeding occurs at an excess of approximately 2 cases per 1000 patient-years with aspirin therapy. For primary prevention, statin therapy has been shown to reduce the risk of CV events by approximately 30% to 40% with an absolute reduction of 1% to 2%. Rhabdomyolysis is rare, with an incidence of 3.4 cases per 100 000 patient-years. Compared with aspirin, statins have a more favorable risk-to-benefit profile for primary prevention.
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Affiliation(s)
- Eric Dietrich
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Kyle Davis
- Jackson Memorial Hospital, Miami, FL, USA
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Davis KA, Dietrich E. Davis and Dietrich's response to Abramson and colleagues' article on statins in low risk people. BMJ 2014; 348:g1795. [PMID: 24574491 DOI: 10.1136/bmj.g1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kyle A Davis
- Jackson Memorial Hospital, Miami, FL 33136-1096, USA
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43
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Abstract
Type 2 diabetes continues to be a challenging disease to manage. The addition of new agents with a positive risk–benefit ratio could potentially assist clinicians and patients in achieving adequate diabetes control. Canagliflozin, the first sodium-glucose cotransporter 2 inhibitor presently available on the market, offers a unique mechanism of action: it inhibits renal reabsorption of glucose, thereby increasing urinary glucose excretion. It reduces hemoglobin A1c by approximately 0.37%–1.16%; it also reduces the patient’s weight and systolic blood pressure and has a low risk for hypoglycemia. Adverse effects include an increased risk of urinary tract infections and genital mycotic infections. In this manuscript we review canagliflozin and its potential role in management of type 2 diabetes mellitus.
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Affiliation(s)
- Eric Dietrich
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, USA
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Dietrich E, Gums JG. Author's Reply. Ann Pharmacother 2013; 47:429. [DOI: 10.1345/aph.1r069c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Eric Dietrich
- Postdoctoral Fellow, Departments of Pharmacotherapy and Translational Research and Community Health and Family Medicine, Colleges of Pharmacy and Medicine, University of Florida
| | - John G Gums
- Professor of Pharmacy and Medicine, Associate Chair, Department of Pharmacotherapy and Translational Research, Director of Clinical Research, Department of Community Health and Family Medicine, University of Florida
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Abstract
Type 2 diabetes and obesity commonly occur together. Obesity contributes to insulin resistance, a main cause of type 2 diabetes. Modest weight loss reduces glucose, lipids, blood pressure, need for medications, and cardiovascular risk. A number of approaches can be used to achieve weight loss, including lifestyle modification, surgery, and medication. Lorcaserin, a novel antiobesity agent, affects central serotonin subtype 2A receptors, resulting in decreased food intake and increased satiety. It has been studied in obese patients with type 2 diabetes and results in an approximately 5.5 kg weight loss, on average, when used for one year. Headache, back pain, nasopharyngitis, and nausea were the most common adverse effects noted with lorcaserin. Hypoglycemia was more common in the lorcaserin groups in the clinical trials, but none of the episodes were categorized as severe. Based on the results of these studies, lorcaserin was approved at a dose of 10 mg twice daily in patients with a body mass index ≥30 kg/m(2) or ≥27 kg/m(2) with at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia, in addition to a reduced calorie diet and increased physical activity. Lorcaserin is effective for weight loss in obese patients with and without type 2 diabetes, although its specific role in the management of obesity is unclear at this time. This paper reviews the clinical trials of lorcaserin, its use from the patient perspective, and its potential role in the treatment of obesity.
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Affiliation(s)
- James R Taylor
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
- Correspondence: James R Taylor University of Florida College of Pharmacy, PO Box 100486, Gainesville, FL 32610, USA, Tel +1 352 273 6239, Fax +1 352 273 6242, Email
| | - Eric Dietrich
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
| | - Jason Powell
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, Gainesville, FL, USA
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Abstract
Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, adverse events, dosing, and administration of intranasal fentanyl spray in the treatment of breakthrough cancer pain (BTCP) in adults. Data Sources: Relevant published data were identified using PubMed from inception to April 2012 using the search terms fentanyl nasal spray, intranasal fentanyl, intranasal fentanyl cancer pain, and fentanyl pectin cancer pain. Only articles evaluating the use of intranasal fentanyl spray for cancer pain were selected. Study Selection and Data Extraction: All articles evaluating the pharmacokinetics of intranasal fentanyl or the clinical efficacy of intranasal fentanyl spray for the treatment of BTCP were considered; references of selected articles were manually reviewed to identify further articles. The manufacturer of intranasal fentanyl spray was also contacted to obtain information. Data Synthesis: Intranasal fentanyl spray gained Food and Drug Administration approval for the treatment of BTCP in adults with cancer receiving stable BACKGROUND opioid therapy for chronic pain. In doses ranging from 100 to 800 μg/spray, intranasal fentanyl spray was found to be more effective than placebo and more effective than oral morphine or oral fentanyl formulations in reducing pain for up to 15–45 minutes; onset of analgesia was also improved with intranasal fentanyl spray. The most commonly observed adverse events included nausea, vomiting, vertigo, and dizziness. Conclusions: For the treatment of BTCP, intranasal fentanyl spray offers improved onset of analgesia compared to other oral therapies; this improved onset of analgesia may closely mimic the typical time course of a BTCP episode. Nasal administration may overcome problems such as nausea, vomiting, or xerostomia that may complicate oral administration of analgesics. Potential disadvantages include uncertainty in treating more than 4 BTCP episodes per 24 hours and a higher cost compared to generically available oral opioid analgesics.
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Affiliation(s)
- Eric Dietrich
- Departments of Pharmacotherapy and Translational Research and Community Health and Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL
| | - John G Gums
- Pharmacy and Medicine, Associate Chair, Department of Pharmacotherapy and Translational Research; Director of Clinical Research, Department of Community Health and Family Medicine, University of Florida
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Oudadesse H, Dietrich E, Gal YL, Pellen P, Bureau B, Mostafa AA, Cathelineau G. Apatite forming ability and cytocompatibility of pure and Zn-doped bioactive glasses. Biomed Mater 2011; 6:035006. [DOI: 10.1088/1748-6041/6/3/035006] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Höffken G, Lorenz J, Kern W, Welte T, Bauer T, Dalhoff K, Dietrich E, Ewig S, Gastmeier P, Grabein B, Halle E, Kolditz M, Marre R, Sitter H. Guidelines of the Paul-Ehrlich-Society of Chemotherapy, the German Respiratory Diseases Society, the German Infectious Diseases Society and of the Competence Network CAPNETZ for the Management of Lower Respiratory Tract Infections and Community-acquired Pneumonia. Pneumologie 2010; 64:149-54. [DOI: 10.1055/s-0029-1243910] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Höffken G, Lorenz J, Kern W, Welte T, Bauer T, Dalhoff K, Dietrich E, Ewig S, Gastmeier P, Grabein B, Halle E, Kolditz M, Marre R, Sitter H. [Guidelines for the epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults]. Dtsch Med Wochenschr 2010; 135:359-65. [PMID: 20166002 DOI: 10.1055/s-0030-1249171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- G Höffken
- Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.
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