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Hu Y, Liang L, Liu S, Kung JY, Banh HL. Angiotensin-converting enzyme inhibitor induced cough compared with placebo, and other antihypertensives: A systematic review, and network meta-analysis. J Clin Hypertens (Greenwich) 2023; 25:661-688. [PMID: 37417783 PMCID: PMC10423763 DOI: 10.1111/jch.14695] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
Studies have shown that angiotensin converting enzyme inhibitors (ACEIs) are superior in primary and secondary prevention for cardiac mortality and morbidity to angiotensin receptor blocker (ARBs). One of the common side effects from ACEI is dry cough. The aims of this systematic review, and network meta-analysis are to rank the risk of cough induced by different ACEIs and between ACEI and placebo, ARB or calcium channel blockers (CCB). We performed a systematic review, and network meta-analysis of randomized controlled trials to rank the risk of cough induced by each ACEI and between ACEI and placebo, ARB or CCB. A total of 135 RCTs with 45,420 patients treated with eleven ACEIs were included in the analyses. The pooled estimated relative risk (RR) between ACEI and placebo was 2.21 (95% CI: 2.05-2.39). ACEI had more incidences of cough than ARB (RR 3.2; 95% CI: 2.91, 3.51), and pooled estimated of RR between ACEI and CCB was 5.30 (95% CI: 4.32-6.50) Moexipril ranked as number one for inducing cough (SUCRA 80.4%) and spirapril ranked the least (SUCRA 12.3%). The order for the rest of the ACEIs are as follows: ramipril (SUCRA 76.4%), fosinopril (SUCRA 72.5%), lisinopril (SUCRA 64.7%), benazepril (SUCRA 58.6%), quinapril (SUCRA 56.5%), perindopril (SUCRA 54.1%), enalapril (SUCRA 49.7%), trandolapril (SUCRA 44.6%) and, captopril (SUCRA 13.7%). All ACEI has the similar risk of developing a cough. ACEI should be avoided in patients who have risk of developing cough, and an ARB or CCB is an alternative based on the patient's comorbidity.
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Affiliation(s)
- Yiyun Hu
- Department of PharmacySecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Ling Liang
- Department of CardiologyThe Third Clinical Medical College, Fujian Medical UniversityFuzhouChina
- Department of CardiologyThe First Affiliated Hospital of Xiamen UniversityXiamenChina
| | - Shuang Liu
- Medical Affairs Management DepartmentSecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Janice Y. Kung
- University of Alberta, John W. Scott Health Sciences LibraryEdmontonCanada
| | - Hoan Linh Banh
- Faculty of Medicine and DentistryDepartment of Family MedicineUniversity of AlbertaEdmontonCanada
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Hu Y, Kung J, Galatis D, Banh HL. Short Acting Beta Agonist Use Associated with Increased Mortality and Morbidity in Asthma Patients: A Systematic Review and Meta-Analysis. J Pharm Pharm Sci 2022; 25:193-200. [PMID: 35662393 DOI: 10.18433/jpps32738] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Short acting b2 agonists are recommended to be used ≤ 2 canisters per year. It is suggested that overuse of b2 agonists will lead to increased morbidity and mortality. This study aimed to determine if overuse of b2 agonists result in increased morbidity and mortality. METHODS We performed a systematic review and meta-analysis of the literature to determine if overuse of b2 agonists cause increase mortality, ICU admissions, hospitalization, and exacerbation. RESULTS A total of 11,888 publications were identified and 4260 duplications were removed, resulting in 7268 abstracts that were screened and 7254 irrelevant studies that were excluded. Ultimately, 14 studies were included. The overall pooled estimated odds ratio (OR) for mortality was 0.83 (95% CI: 0.66, 1.05), 0.99 for ICU admission (95% CI: 0.80, 1.21), 1.22 for hospitalization (95% CI: 0.96, 1.31), and 0.99 for exacerbation (95% CI: 0.85, 1.15). CONCLUSION There is no statistical difference in mortality, ICU admission rate, hospitalization, or exacerbation with using b2 agonists.
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Affiliation(s)
- Yiyun Hu
- Second Xiangya Hospital of Central South University
| | - Janice Kung
- University of Alberta, John W. Scott Health Sciences Library
| | - Dimitri Galatis
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences
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Liang L, Kung JY, Mitchelmore B, Cave A, Banh HL. Comparative peripheral edema for dihydropyridines calcium channel blockers treatment: A systematic review and network meta-analysis. J Clin Hypertens (Greenwich) 2022; 24:536-554. [PMID: 35234349 PMCID: PMC9106091 DOI: 10.1111/jch.14436] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Dihydropyridine calcium channel blockers (DHPCCBs) are widely used to treat hypertension and chronic coronary artery disease. One common adverse effect of DHPCCBs is peripheral edema, particularly of the lower limbs. The side effect could lead to dose reduction or discontinuation of the medication. The combination of DHPCCBs and renin-angiotensin system blockers has shown to reduce the risk of DHPCCBs-associated peripheral edema compared with DHPCCBs monotherapy. We performed the current systematic review and network meta-analysis of randomized controlled trials (RCTs) to estimate the rate of peripheral edema with DHPCCBs as a class and with individual DHPCCBs and the ranking of the reduction of peripheral edema. The effects of renin-angiotensin system blockers on DHPCCBs network meta-analysis were created to analyze the ranking of the reduction of peripheral edema. A total of 3312 publications were identified and 71 studies with 56,283 patients were included. Nifedipine ranked highest in inducing peripheral edema (SUCRA 81.8%) and lacidipine (SUCRA 12.8%) ranked the least. All DHPCCBs except lacidipine resulted in higher relative risk (RR) of peripheral edema compared with placebo. Nifedipine plus angiotensin receptor blocker (SUCRA: 92.3%) did not mitigate peripheral edema and amlodipine plus angiotensin-converting enzyme inhibitors (SUCRA: 16%) reduced peripheral edema the most. Nifedipine ranked the highest and lacidipine ranked the lowest amongst DHPCCBs for developing peripheral edema when used for cardiovascular indications. The second or higher generation of DHPCCBs combination with ACEIs or ARBs or diuretics lowered the chance of peripheral edema development compared to single DHPCCB treatment.
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Affiliation(s)
- Ling Liang
- Department of CardiologyThe First Affiliated Hospital of Xiamen University, School of Medicin, Xiamen UniversityXiamenChina
- Department of Cardiologythe Third Clinical Medical College, Fujian Medical UniversityFuzhouChina
| | - Janice Y. Kung
- University of AlbertaJohn W. Scott Health Sciences LibraryEdmontonCanada
| | | | - Andrew Cave
- University of Alberta, Faculty of Medicine and DentistryDepartment of Family MedicineEdmontonCanada
| | - Hoan Linh Banh
- University of Alberta, Faculty of Medicine and DentistryDepartment of Family MedicineEdmontonCanada
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Hu Y, Kung J, Cave A, Banh HL. Effects of Vitamin D Serum Level on Morbidity and Mortality in Patients with COVID-19: A Systematic Review and Meta-Analysis. J Pharm Pharm Sci 2022; 25:84-92. [PMID: 35245430 DOI: 10.18433/jpps32590] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE It has been shown that low Vitamin D serum concentration is associated with increased pneumonia and viral respiratory infections. Vitamin D is readily available, inexpensive, and easy to administer to subjects infected with COVID-19. If effective in reducing the severity of COVID-19, it could be an important and feasible therapeutic intervention. METHODS We performed a systematic review and meta-analysis of the literature to determine the effects of Vitamin D serum concentration on mortality and morbidity in COVID-19 patients. The primary objectives were to determine if Vitamin D serum concentration decrease mortality, ICU admissions, ventilator support, and length of hospital stay in COVID-19 patients. RESULTS A total of 3572 publications were identified. Ultimately, 20 studies are included. A total of 12,806 patients aged between 42 to 81 years old were analyzed. The pooled estimated RR for mortality, ICU admission, ventilator support and length of hospital stay were 1.49 (95% CI: 1.34, 1.65), 0.87 (95% CI: 0.67, 1.14), 1.29 (95% CI: 0.79, 1.84), and 0.84 (95% CI -0.45, 2.13). CONCLUSION There is no statistical difference in mortality, ICU admission rate, ventilator support requirement, and length of hospital stay in COVID-19 patients with low and high Vitamin D serum concentration.
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Affiliation(s)
- Yiyun Hu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Janice Kung
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Mangin D, Lamarche L, Agarwal G, Banh HL, Dore Brown N, Cassels A, Colwill K, Dolovich L, Farrell B, Garrison S, Gillett J, Griffith LE, Holbrook A, Jurcic-Vrataric J, McCormack J, O’Reilly D, Raina P, Richardson J, Risdon C, Savelli M, Sherifali D, Siu H, Tarride JÉ, Trimble J, Ali A, Freeman K, Langevin J, Parascandalo J, Templeton JA, Dragos S, Borhan S, Thabane L. Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial. Trials 2021; 22:746. [PMID: 34702336 PMCID: PMC8549321 DOI: 10.1186/s13063-021-05685-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/05/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient's priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. METHODS We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. DISCUSSION Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient's goals and priorities for treatment. TRIAL REGISTRATION Clinical Trials.gov NCT02942927. First registered on October 24, 2016.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Hoan Linh Banh
- University of Alberta, 6-60 University Terrace, Edmonton, Alberta Canada
| | - Naomi Dore Brown
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Alan Cassels
- University of Victoria, 3800 Finnerty Road, Victoria, BC Canada
| | - Kiska Colwill
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
- University of Toronto, 144 College Street, Toronto, Ontario Canada
| | - Barbara Farrell
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario Canada
| | - Scott Garrison
- University of Alberta, 6-60 University Terrace, Edmonton, Alberta Canada
| | - James Gillett
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lauren E. Griffith
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Anne Holbrook
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jane Jurcic-Vrataric
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - James McCormack
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada
| | - Daria O’Reilly
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Parminder Raina
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Julie Richardson
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Mat Savelli
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Diana Sherifali
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jean-Éric Tarride
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Johanna Trimble
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada
| | - Abbas Ali
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Karla Freeman
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jessica Langevin
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jenna Parascandalo
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jeffrey A. Templeton
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Steven Dragos
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Sayem Borhan
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lehana Thabane
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
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Zhou Y, Xu P, Li H, Wang F, Yan H, Liang W, Xiang D, Zhang B, Banh HL. Population pharmacokinetics and exposure-response analysis of tigecycline in patients with hospital-acquired pneumonia. Br J Clin Pharmacol 2021; 87:2838-2846. [PMID: 33283892 DOI: 10.1111/bcp.14692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/19/2020] [Revised: 11/22/2020] [Accepted: 11/28/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Tigecycline has been widely used to treat hospital-acquired pneumonia (HAP) off-label since it is effective against a wide range of multidrug-resistant bacteria. However, no recommended dosage for this indication has been evaluated, resulting in possible inadequate treatment. AIMS The aims of this study are to establish the population pharmacokinetic (PPK) model of tigecycline in Chinese patients with HAP, as well as to evaluate the exposure-response relationship for the treatment of HAP with multidrug-resistant gram-negative bacteria. METHODS A PPK analysis of tigecycline was conducted on pooled data from 328 blood samples obtained from 89 patients with HAP. Tigecycline plasma concentrations were measured by a two-dimensional liquid chromatographic system and the data were analysed using Phoenix NLMETM software. Exposure-response analyses for efficacy were performed based on the data from 79 HAP patients with multidrug-resistant gram-negative infections. Classification and regression tree and logistic regression analyses were employed to identify which pharmacokinetic-pharmacodynamic (PK-PD) indices and magnitudes were the significant predictors of tigecycline efficacy. RESULTS A two-compartment model with zero-order absorption and first-order elimination adequately described the data. A larger body weight was associated with increased central volume of distribution and clearance (P < .005), and increased age, baseline creatinine concentration and aspertate aminotransferase were associated with decreased clearance (P < .005). The AUC0-12h × V/MIC ratio, APACHEII score and combined Pseudomonas aeruginosa infection are the strong predictors for tigecycline clinical response. Classification and regression tree analyses indicated that the combination of APACHEII score < 24 and AUC0-12h × V/MIC ratio ≥ 100 was associated with clinical success. CONCLUSIONS The proposed PPK model may serve as the basis for estimating tigecycline exposure for PK-PD analyses, and the PK-PD index and magnitude found in this study could be used for designing proper dosage regimens of tigecycline.
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Affiliation(s)
- Yangang Zhou
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Huande Li
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Feng Wang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Han Yan
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Wu Liang
- Changsha VALS Technology Co., Ltd, Changsha, China
| | - Daxiong Xiang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Bikui Zhang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hoan Linh Banh
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,Department of Family Medicine, University of Alberta, Edmonton, Canada
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7
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Liang L, Kung JY, Mitchelmore B, Gill J, Cave A, Banh HL. Angiotensin-Converting Enzyme Inhibitor Induced Cough in Chinese Patients: a Systematic Review and Meta-analysis. J Pharm Pharm Sci 2021; 24:137-147. [DOI: 10.18433/jpps31632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To determine the risk of angiotensin converting enzyme inhibitor (ACEI)-induced cough compared to non-ACEI cough among Chinese patients. Methods: A comprehensive search was conducted including randomized controlled trials, case-control studies and observational studies that compared ACEI treatment with control treatment in MEDLINE, EMBASE, CINAHL, Scopus, Google Scholar and ProQuest Dissertations & Theses Global. The studies which contained: Chinese population, ACEI, non-ACEI, and indications for the treatment of ACEI were included. The pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the relative risk of cough between ACEIs and non-ACEI drugs based on the events of reported cough in each study. Results: Eleven randomized controlled trials were included with a total of 1815 patients. The total number of cough events in ACEI treatment was 101 in 930 patients (11%) and 20 in 885 patients (2%) in the Non-ACEI treatment. The pooled RR was 5.16 (95% CI: 3.39-7.85) under fixed model. The discontinuation number of single ACEI treatment due to coughing side effect was 21 and the withdrawal rate was 4.13%. Only two patients discontinued non-ACEIs treatment due to the intolerable cough and the withdrawal rate was 0.34%. The overall RR of withdrawal related to cough was 7.06 (95% CI: 2.49-20.04). Conclusions: The pooled risk of the incidence of ACEI-induced cough was about five times higher than that of non-ACEI-induced cough in Chinese population. The risk of withdrawal events related to cough in the single ACEI treatment was seven times of that in the non-ACEI treatment.
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Xu P, Hu YY, Yuan HY, Xiang DX, Zhou YG, Cave AJ, Banh HL. The Impact of a Training Program on Clinical Pharmacists on Pharmacy Clinical Services in a Tertiary Hospital in Hunan China. J Multidiscip Healthc 2019; 12:975-980. [PMID: 31819471 PMCID: PMC6885557 DOI: 10.2147/jmdh.s228537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Prior to 2015, clinical consultation was the only clinical service provided by clinical pharmacists in Changsha Second Hospital. Between 2015 and 2017, a train-the-trainer program was implemented to train clinical pharmacists to provide pharmaceutical care and to conduct clinical research. The objective of the study is to examine the impact on the clinical services provided by pharmacists after the implementation of the train-the-trainer program. Patients and methods Between 2004 and 2014, all completed clinical consultation activities were tallied and summarized. The results from the tallied consultation activities were used as a baseline for clinical activities provided by pharmacists prior to the training. A structured training program was implemented between 2015 and 2017 to train clinical pharmacists to provide pharmaceutical care. After the implementation of the training program was completed, all clinical activities provided by pharmacists between January 2017 and December 2017 were documented in the clinical workload form. The clinical activities completed by each pharmacist were tallied and summarized. Results Between 2004 and 2014, a total of 6569 (average 657 per year) pharmacy consultations were requested and completed from a total of 44 departments. In 2017, a total of 15,078 hrs of clinical activities were logged. The pharmacists completed 3481 consultations in 2017 (an increase of 430%), averaging 316 consultations for each pharmacist and 271.8 hr per pharmacist. Over 2000 hrs (of the 15,078 hrs) were spent on direct patient care by the pharmacists. Conclusion This study shows that there was a 430% increase in clinical pharmacy consultation services provided by the clinical pharmacists after the implementation of the training program. This is directly related to the number of well-trained pharmacists available. After the implementation of the train-the-trainer program, the range of services as well as the number of clinical services and clinical hours spent on providing pharmaceutical care have significantly increased.
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Affiliation(s)
- Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yi Yun Hu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Hai Yan Yuan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Da Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yan Gang Zhou
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Andrew J Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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9
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Liang L, Hou X, Bainey KR, Zhang Y, Tymchak W, Qi Z, Li W, Banh HL. The association between hyperuricemia and coronary artery calcification development: A systematic review and meta-analysis. Clin Cardiol 2019; 42:1079-1086. [PMID: 31571239 PMCID: PMC6837029 DOI: 10.1002/clc.23266] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022] Open
Abstract
Hyperuricemia coincides with coronary artery calcification (CAC) development, but the role of serum uric acid (SUA) as a risk factor for CAC remains unclear. The objective of this study was to gain an insight into the association between SUA and CAC in adults by performing a meta-analysis. MEDLINE, EMBASE, the Cochrane Library, and EBSCO (CINAHL) were searched for relevant observational studies published until 2 June 2019. Studies were included only if they reported data on CAC presence (Agatston score > 0) or progression related to hyperuricemia in subclinical adult patients. The pooled estimates of crude and adjusted odds ratios (ORs) and 95% confidence interval (CI) were calculated to evaluate the association between CAC presence or progression and hyperuricemia. A total of 11 studies were identified involving 11 108 adults. The pooled OR based on the frequency of CAC presence showed that patients in the high SUA group had 1.806-fold risk for developing CAC (95% CI: 1.491-2.186) under the minimal threshold of hyperuricemia (more than 6 mg/dL or 357 μmoL/L). When SUA levels were analyzed as categorical variables, the pooled estimate of adjusted ORs was 1.48 (95% CI: 1.23-1.79) for CAC presence. Additionally, for each increase of 1 mg/dL of SUA level, the risk of CAC progression was increased by 31% (95% CI: 1.15-1.49) with an average follow-up duration ranged from 4.6 to 6.1 years. Hyperuricemia is closely associated with increased risk of CAC development and CAC progression in asymptomatic patients.
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Affiliation(s)
- Ling Liang
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Cardiology, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xianghua Hou
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Nephrology, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kevin R Bainey
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Yanlin Zhang
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Nephrology, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wayne Tymchak
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Zhongquan Qi
- Institute of Organ Transplantation, Xiamen University, Xiamen, China
| | - Weihua Li
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Cardiology, First Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hoan Linh Banh
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Zhou Y, Chen X, Xu P, Zhu Y, Wang K, Xiang D, Wang F, Banh HL. Clinical experience with tigecycline in the treatment of hospital-acquired pneumonia caused by multidrug resistant Acinetobacter baumannii. BMC Pharmacol Toxicol 2019; 20:19. [PMID: 31023357 PMCID: PMC6482491 DOI: 10.1186/s40360-019-0300-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/10/2019] [Indexed: 12/20/2022] Open
Abstract
Background Tigecycline, with broad in vitro antibacterial activity, has been widely used off-label for nosocomial pneumonia caused by multi-drug resistant Acinetobacter baumannii (MDRAB). However, many concerns have been raised about the efficacy of tigecycline treatment as the inconsistent results from previous clinical studies. Methods This retrospective study evaluated the outcome of adult patients with monomicrobial MDRAB nosocomial pneumonia treated with tigecycline between 2015 and 2017. Results. A total of 77 patients was eligible for this study, and the overall clinical success and 30-day survival rates were 70.03 and 70.13%, respectively, however, the microbiological eradication rate was relatively low (48%). Multivariate analysis indicated that shorter duration of tigecycline use associated with increased clinical failure, whereas higher CURB65 scores, mechanical ventilation and tigecycline resistant to MDRAB have significant association with 30-day mortality. Conclusions Our results suggest that tigecycline is one of the potential choices for the treatment of hospital-acquired pneumonia caused by MDRAB, especially with a MIC≤2 mg/L. In addition, a longer duration of tigecycline treatment may be required to insure better clinical outcomes.
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Affiliation(s)
- Yangang Zhou
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China
| | - Xumin Chen
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China
| | - Ping Xu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China. .,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China.
| | - Yan Zhu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China
| | - Kuangguo Wang
- The Traditional Chinese Medicine hospital of Longhui, Changsha, Hunan, People's Republic of China
| | - Daxiong Xiang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China
| | - Feng Wang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China
| | - Hoan Linh Banh
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.,Institute of Clinical Pharmacy, Central South University, Changsha, People's Republic of China.,Department of Family Medicine, University of Alberta, Edmonton, Canada
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Wang Q, Jiang ZP, Yu EQ, Zeng J, Zhu Y, Cai HL, Yan M, Xiang DX, Zhao XL, Xu P, Jiao Z, Banh HL. Population pharmacokinetic and pharmacogenetics of imatinib in Chinese patients with chronic myeloid leukemia. Pharmacogenomics 2019; 20:251-260. [PMID: 30767712 DOI: 10.2217/pgs-2018-0139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to establish a population pharmacokinetic (PPK) model in Chinese patients with chronic myeloid leukemia, and to quantify the effects of pharmacogenetics on pharmacokinetic parameters of imatinib. Methods: A total of 229 plasma concentrations from 170 patients were analyzed. Nonlinear mixed effect model was used to establish the PPK model. Results: A one-compartment model with first-order absorption and first-order elimination adequately describes imatinib pharmacokinetics. Actual bodyweight shows slight effect on the estimated apparent clearance (CL/F) of imatinib in this study population. The final PPK model is: Ka (1/h) = 0.329; CL/F (l/h) = 9.25 × (actual bodyweight/70)0.228; V/F(l) = 222. Conclusion: Actual bodyweight has a slight effect on CL/F. Demographics, physiopathology and pharmacogenetics covariates have no significant effects on imatinib pharmacokinetics.
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Affiliation(s)
- Qing Wang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Zhi-Ping Jiang
- Laboratory of Clinical Pharmacology, Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Er-Qian Yu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, PR China
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China
| | - Jing Zeng
- Department of Education & Research, Ningbo Medical Center, Li Huili Eastern Hospital, Ningbo, Zhejiang 315000, PR China
| | - Yan Zhu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Hua-Lin Cai
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Miao Yan
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Da-Xiong Xiang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Xie-Lan Zhao
- Laboratory of Clinical Pharmacology, Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Ping Xu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
| | - Zheng Jiao
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Hoan Linh Banh
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, PR China
- Faculty of Medicine & Dentistry/Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB T6G 2T4, Canada
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12
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Tang D, Song BL, Yan M, Zou JJ, Zhang M, Zhou HY, Wang F, Xiao YW, Xu P, Zhang BK, Chen XJ, Xiang DX, Linh Banh H. Identifying factors affecting the pharmacokinetics of voriconazole in patients with liver dysfunction: A population pharmacokinetic approach. Basic Clin Pharmacol Toxicol 2019; 125:34-43. [PMID: 30715804 DOI: 10.1111/bcpt.13208] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/09/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Voriconazole is a broad-spectrum antifungal agent commonly used to treat invasive fungal infections. Voriconazole has significant intraindividual and interindividual pharmacokinetics variability in different patient populations. Pharmacokinetic data of voriconazole in patients with liver dysfunction were limited. The aims of this study were to evaluate the population pharmacokinetics of voriconazole in patients with liver dysfunction and to identify the factors that affect voriconazole pharmacokinetics. A total of 166 samples taken from 57 patients with liver dysfunction were included in the study. A one-compartment pharmacokinetic model with first-order absorption and elimination was used to describe the data. Voriconazole clearance (CL) was 0.58 L/h, the volume of distribution (Vd ) was 134 L, and oral bioavailability (F) was 80.8%. This study showed that platelet count was significantly associated with voriconazole pharmacokinetic parameters. CYP2C19 polymorphisms had no effect on voriconazole pharmacokinetic parameters. Voriconazole CL was significantly decreased in patients with liver dysfunction. This study provides useful pharmacokinetics information for patients with liver dysfunction while highlighting the value of therapeutic drug monitoring in adjusting doses.
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Affiliation(s)
- Dan Tang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Bai-Li Song
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Miao Yan
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Jian-Jun Zou
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Min Zhang
- Department of Infectious Diseases, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hua-Ying Zhou
- Department of Infectious Diseases, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Wang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Yi-Wen Xiao
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Bi-Kui Zhang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xi-Jing Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Da-Xiong Xiang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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13
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Yan M, Wu ZF, Tang D, Wang F, Xiao YW, Xu P, Zhang BK, Liu YP, Xiang DX, Banh HL. The impact of proton pump inhibitors on the pharmacokinetics of voriconazole in vitro and in vivo. Biomed Pharmacother 2018; 108:60-64. [PMID: 30216801 DOI: 10.1016/j.biopha.2018.08.121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 06/27/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022] Open
Abstract
Voriconazole (VRC) and proton pump inhibitors (PPIs) have similar metabolic pathways. The objectives of the study are to evaluate the impact of PPIs on the pharmacokinetics of VRC. Human liver microsomes model was applied to assess the inhibitory effects of PPIs on the metabolism of VRC in vitro. A retrospective study was also carried out to explore the relationship between the plasma VRC trough concentrations and PPIs uses. Patients were divided into six groups: control (n = 166), lansoprazole (LAN, n = 38), esomeprazole (ESO, n = 19), omeprazole (OME, n = 45), pantoprazole (PAN, n = 43), and ilaprazole (ILA, n = 38) groups. All five PPIs showed concentration-dependent inhibitory effects on the VRC metabolism in human liver microsomes, among which LAN, OME and ESO were three of the most potent inhibitors. Consistently, co-administered with LAN, OME and ESO significantly increased the plasma VRC trough levels (p < 0.05), whereas there was no significant association between VRC concentrations and PAN or ILA use. Interestingly, patients in the PPIs groups were more likely to reach the therapeutic VRC range of 1-5.5 μg/mL in steady state when compared with control patients (75-81% VS 69%). In conclusion, although all PPIs showed inhibitory effects on the VRC metabolism in vitro, only LAN, OME and ESO significantly increased VRC plasma concentrations. This study should be helpful for choice of the type of PPIs for patients administered with VRC.
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Affiliation(s)
- Miao Yan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Zhu-Feng Wu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Dan Tang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211100, China
| | - Feng Wang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Yi-Wen Xiao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Bi-Kui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Yi-Ping Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China
| | - Da-Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, Hunan 410011, China.
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Xu P, Xiang DX, Cave AJ, Banh HL. Impacts from the implementation of a Novel Clinical Pharmacist Training Program in Changsha, Hunan Province, China. Fam Med Community Health 2018. [DOI: 10.15212/fmch.2017.0142] [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: 11/18/2022] Open
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15
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Zhu Y, Xu P, Wang Q, Luo JQ, Xiao YW, Li YY, Zhou YG, Cave A, Banh HL. Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief. J Pharm Pharm Sci 2018; 21:19-26. [DOI: 10.18433/j3sh21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose: The objective of this study was to determine: 1) the incidence and the risk factors of diclofenac/acetaminophen combination as a single agent induced Acute Kidney Injury (AKI) in postoperative pain relief 2) the average cost and length of hospital stay for patients in AKI group and non-AKI group. Methods: All patients with no prior history of chronic kidney disease (CKD) and normal serum creatinine [44~130 μmol /l] who received diclofenac and acetaminophen combination as a single agent intramuscularly (IM) between January and December 2015 in The Second Xiangya Hospital, Changsha, Hunan, China were included in this retrospective own-control study. Baseline serum creatinine (SCr) and SCr during NSAID use were collected. AKI is defined as an increased of Scr over 1.5 times the baseline. Multivariate analyses were performed with a logistic regression model to assess the significant risk factors of AKI. Results: A total of 821 patients were included in the study with 63 [7.7%] patients had diclofenac/acetaminophen combination single agent induced AKI. Multivariate analysis confirmed that using diclofenac/acetaminophen combination after surgeries within 24 h were significantly associated with AKI [odds ratio, OR, 2.173; 95% CI, 1.113-4.243; P=0.023]. The average cost and length of hospitalization in AKI group was 1.87 times [p=0.000] and 1.2 times [p=0.043] comparison than non-AKI group, respectively. Conclusions: The incidence of diclofenac/acetaminophen combination single agent induced AKI in postoperative pain relief was 7.7%. Patients with hypertension or liver cirrhosis was more likely to develop AKI and using diclofenac/acetaminophen combination after surgeries within 24 h was significant risk factors for AKI. AKI prolonged the cost and length of hospitalization. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.
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16
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Luo JQ, Ren H, Banh HL, Liu MZ, Xu P, Fang PF, Xiang DX. The Associations between Apolipoprotein E Gene Epsilon2/Epsilon3/Epsilon4 Polymorphisms and the Risk of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus. Front Physiol 2017; 8:1031. [PMID: 29311965 PMCID: PMC5732920 DOI: 10.3389/fphys.2017.01031] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
Background and Objective: Apolipoprotein E (APOE) plays important roles in lipoprotein metabolism and cardiovascular disease. Evidence suggests the APOE gene epsilon2/epsilon3/epsilon4 (ε2/ε3/ε4) polymorphisms might be associated with the susceptibility of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, no clear consensus has yet been established. Therefore, the aim of this meta-analysis is to provide a precise conclusion on the potential association between APOE ε2/ε3/ε4 polymorphisms and the risk of CAD in patients with T2DM based on case-control studies. Methods: Pubmed, Embase, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases were searched for all relevant studies prior to August 2017 in English and Chinese language. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were used to assess the strength of the relationships. The between-study heterogeneity was evaluated by Cochran's Q-test and the I2 index to adopt fixed- or random- effect models. Results: A total of 13 studies were eligible for inclusion. There was evidence for significant associations between APOE ε4 mutation and the risk of CAD in patients with T2DM (for ε3/ε4 vs. ε3/ε3: OR = 1.69, 95% CI = 1.38–2.08, P < 0.001; for ε4/ε4 vs. ε3/ε3: OR = 2.72, 95% CI = 1.61–4.60, P < 0.001; for ε4/ε4+ε3/ε4 vs. ε3/ε3: OR = 1.83, 95% CI = 1.52–2.22, P < 0.001; for ε4 allele vs. ε3 allele: OR = 1.64, 95% CI = 1.40–1.94, P < 0.001). In contrast, no significant associations were found in genetic model of APOE ε2 mutation (for ε2/ε2 vs. ε3/ε3: OR = 1.67, 95% CI = 0.90–3.09, P = 0.104; for ε2/ε3 vs. ε3/ε3: OR = 1.18, 95% CI = 0.93–1.51, P = 0.175; for ε2/ε2+ε2/ε3 vs. ε3/ε3: OR = 1.26, 95% CI = 0.88–1.82, P = 0.212; for ε2 allele vs. ε3 allele: OR = 1.34, 95% CI = 0.98–1.84, P = 0.07). Conclusions: The APOE gene ε4 mutation is associated with an increased risk of CAD in patients with T2DM, while the ε2 variation has null association with this disease.
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Affiliation(s)
- Jian-Quan Luo
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Huan Ren
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mou-Ze Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ping-Fei Fang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Da-Xiong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
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Wang Q, Chen S, Zhou YG, Xu P, Liu YP, Cai HL, Chen H, Luo Z, Banh HL. Association Between Vancomycin Blood Brain Barrier Penetration and Clinical Response in Postsurgical Meningitis. J Pharm Pharm Sci 2017; 20:161-167. [PMID: 28719362 DOI: 10.18433/j3493f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This study investigated the association between vancomycin blood brain barrier penetration and clinical response in patients with postsurgical meningitis. METHODS Adult patients with postsurgical meningitis were recruited. Eligible patients received vancomycin 500 mg every 6 h for at least 5 days. On day 3 or 4, cerebrospinal fluid (CSF) and simultaneous serum samples were obtained to determine CSF minimum concentrations (Cmin), serum Cmin and CSF to serum Cmin ratio. RESULTS Twenty-two patients (14 men and 8 women; mean age of 52.6± 12.1 years) were recruited. The vancomycin Cmin was 3.63 ± 1.64 mg/L in CSF and 13.38 ± 5.36 mg/L in serum, with the CSF to serum Cmin ratio of 0.291 ± 0.118. The Cmin in serum and in CSF showed a significant correlation (p=0.005, r =0.575). The vancomycin CSF Cmin had a significant correlation with the decline of white blood cell counts (WBCs) in CSF (p=0.003, r =0.609). CSF Cmin, serum Cmin and CSF to serum Cmin ratio all showed no significant correlation with clinical response (p=0.335, 0.100, 0.679, respectively). CONCLUSIONS There was a positive correlation between serum Cmin and CSF Cmin. However, only CSF Cmin is positively correlated with WBCs improvement in CSF. All other parameters such as serum Cmin, CSF Cmin and CSF to serum Cmin ratio had no correlation with clinical response. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.
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Affiliation(s)
- Qing Wang
- The Second Xiangya Hospital of Central South University, Department of Pharmacy/Institute of Clinical Pharmacy, Changsha, Hunan, P.R. China
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Affiliation(s)
- Hoan Linh Banh
- Department of Family Medicine/Faculty of Medicine and Dentistry (Banh, Cave), University of Alberta
| | - Elaheh Ahmadi
- Department of Family Medicine/Faculty of Medicine and Dentistry (Banh, Cave), University of Alberta
| | - Andrew Cave
- Department of Family Medicine/Faculty of Medicine and Dentistry (Banh, Cave), University of Alberta
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Ross D, Schipper S, Westbury C, Linh Banh H, Loeffler K, Allan GM, Ross S. Examining Critical Thinking Skills in Family Medicine Residents. Fam Med 2016; 48:121-126. [PMID: 26950783] [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: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. METHODS This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). RESULTS For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). CONCLUSIONS Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.
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Affiliation(s)
- David Ross
- Department of Family Medicine, University of Alberta
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Abstract
Purpose: Summarize available information regarding clinical impact of citalopram on the QTc interval. Methods: A literature search was conducted in Pubmed, EMBASE, and Cochrane databases using the MeSH term “long QT syndrome” and key word “citalopram” on July 11, 2014. Results: Thirty-one studies were evaluated with 4 included in this review. Studies were excluded if they reported acute overdoses of citalopram or did not report on patient-specific risk factors for long QT syndrome (eg, hypokalemia, bradycardia, and increased age). The majority of the available data is derived from case reports. A number of confounders complicate the determination of a causal link between QTc prolongation and citalopram. Of the 4 studies included for review, none identified significant QTc prolongation in patients taking citalopram 20 to 60 mg daily without the patients having one or more patient-specific risk factors for prolonged QTc. Conclusion: There is insufficient evidence to establish a causal link between citalopram 20 to 60 mg orally daily and increased risk of TdP. Further research is required to determine the clinical impact and association between citalopram 20 to 60 mg daily and QTc prolongation.
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Affiliation(s)
| | - Andrew J. Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Renée St-Jean
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Kaye Edmonton Clinic, Edmonton, Alberta, Canada
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Banh HL, Chow S, Li S, Letassy N, Cox C, Cave A. Pharmacy students screening for pre-diabetes/diabetes with a validated questionnaire in community pharmacies during their experiential rotation in Alberta, Canada. SAGE Open Med 2015; 3:2050312115585040. [PMID: 26770784 PMCID: PMC4679240 DOI: 10.1177/2050312115585040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/09/2015] [Indexed: 01/16/2023] Open
Abstract
Purpose: Type 2 diabetes is a major condition impacting morbidity, mortality, and health care costs in Canada. Pharmacists are very accessible and are in an ideal position to promote public health education. The primary goal of this study was to incorporate public health promotion and education into a community pharmacy experiential education rotation for fourth year pharmacy students to screen for the risk of pre-diabetes/diabetes in adults. A secondary goal was to determine the frequency of common risk factors for pre-diabetes/diabetes in adults in the community setting. Method: Fourth year pharmacy students were invited to recruit all adults 25 years or older attending community pharmacies to complete a pre-diabetes/diabetes risk assessment questionnaire. If the participants were at risk, the participants were provided education about risk reduction for developing pre-diabetes/diabetes. Results: A total of 340 participants completed a risk assessment questionnaire. Over 90% of people approached agreed to complete a risk assessment questionnaire. The common risk factors were overweight (154/45%), hypertension (102/30%), taking medications for hypertension (102/30%), and having symptoms of diabetes (111/33%). The ethnic minorities have 2.56 (confidence interval = 1.48–44.1) times greater odds of having a family history of diabetes compared to non-minority subjects. Conclusion: Pharmacy students are able to screen community-based patients for pre-diabetes/diabetes risks. The most common risk factors presented were overweight, hypertension, and taking medications for hypertension.
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Affiliation(s)
- Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sheldon Chow
- London Health Sciences Centre, London, ON, Canada
| | - Shuai Li
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Nancy Letassy
- Department of Pharmacy Practice, College of Pharmacy, University of Oklahoma, Oklahoma City, Oklahoma
| | - Cheryl Cox
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andrew Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Chan V, Cave AJ, Banh HL. Self-reported osteoporosis prevention in inhaled corticosteroid users in community pharmacy setting. SAGE Open Med 2015; 3:2050312115586912. [PMID: 26770786 PMCID: PMC4679234 DOI: 10.1177/2050312115586912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/22/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The use of inhaled corticosteroids is the standard maintenance therapy in asthma therapy and as adjunct therapy in moderate to severe chronic obstructive pulmonary disease. A dose-related increase in fracture risk is associated with inhaled corticosteroid use; there is an inverse relationship between bone mineral density and duration and cumulative dose of inhaled corticosteroid. Adequate intake of calcium and vitamin D are cornerstones of osteoporosis prevention. The objectives are to assess whether the proportion of patients receiving inhaled corticosteroids are taking calcium and vitamin D; the association between long-term inhaled corticosteroid use and abnormal bone mineral density or fractures; and how many qualified patients received bone mineral density scans. METHODS Patients who filled a prescription for inhaled corticosteroids at selected community pharmacies across Alberta were recruited for a survey of their osteoporosis prevention activities. RESULTS A total of 256 patients from 12 community pharmacies were included. The average age was 60 ± 17.4 years with 65% female. There were 21%, 51%, and 28% of patients on high, medium, and low dose inhaled corticosteroids, respectively. Only 17% of patients >50 years old received recommended calcium and vitamin D supplementation and 87 (73%) of the qualified patients received bone mineral density scan. CONCLUSION Osteoporosis prevention in inhaled corticosteroid users is currently poorly addressed. More promotion is needed to raise pharmacist awareness of the risks of inhaled corticosteroids.
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Affiliation(s)
- Valerie Chan
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew J Cave
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hoan Linh Banh
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Sadowski CA, Cor K, Cave A, Banh HL. Administration Technique and Acceptance of Inhaler Devices in Patients With Asthma or COPD. Ann Pharmacother 2015; 49:639-48. [PMID: 25814632 DOI: 10.1177/1060028015579097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Correct technique and patient acceptance of inhalation devices for lung disease influence successful long-term management. Patient ability to use the proper technique may differ depending on the device as well as patient factors. OBJECTIVES The objectives of our study are to measure self-reported level of acceptability of inhaler devices in community settings and compare correct use of inhaler devices using a novel scale for measuring appropriate inhaler technique. METHODS This prospective observational study enrolled patients from 3 different practice sites with asthma and/or chronic obstructive pulmonary disease (COPD) who were using an inhaler device. In addition to describing the samples' overall acceptability and correct use scores for the different inhalers, acceptability and correct use scores were compared based on patient characteristics. RESULTS A total of 161 patients completed the study. The results show that acceptability was lowest for the pressurized metered dose inhaler (pMDI) with a spacer (S); effective use was best demonstrated with pMDI and poorest with pMDI-S. Older patients were found to be more accepting of the HandiHaler device than younger patients. Patients reporting taking more inhaled drugs were found to be more accepting of the pMDI-S than those taking fewer drugs. Finally, patients reporting taking more inhaled drugs demonstrated less-effective use of the HandiHaler device than patients taking fewer drugs. CONCLUSION Pulmonary disease duration does not ensure improved use for all inhalers; patients taking more drugs demonstrate less-effective use for some devices. Assessment of patient acceptance and factors that predict the ability to use a device should be considered to individualize therapy.
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Affiliation(s)
| | - Ken Cor
- University of Alberta, Edmonton, AB, Canada
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Korownyk C, Kolber MR, McCormack J, Lam V, Overbo K, Cotton C, Finley C, Turgeon RD, Garrison S, Lindblad AJ, Banh HL, Campbell-Scherer D, Vandermeer B, Allan GM. Televised medical talk shows--what they recommend and the evidence to support their recommendations: a prospective observational study. BMJ 2014; 349:g7346. [PMID: 25520234 PMCID: PMC4269523 DOI: 10.1136/bmj.g7346] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the quality of health recommendations and claims made on popular medical talk shows. DESIGN Prospective observational study. SETTING Mainstream television media. SOURCES Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors). INTERVENTIONS Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show. MAIN OUTCOMES MEASURES Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made. RESULTS We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations. CONCLUSIONS Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows. Additional details of methods used and changes made to study protocol.
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Affiliation(s)
- Christina Korownyk
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Michael R Kolber
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - James McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3
| | - Vanessa Lam
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2R7
| | - Kate Overbo
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2R7
| | - Candra Cotton
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Caitlin Finley
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Adrienne J Lindblad
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Hoan Linh Banh
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, Canada T6G 1C9
| | - G Michael Allan
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, Canada T6G 2T4
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Banh HL, Cor K. Evaluation of an injection training and certification program for pharmacy students. Am J Pharm Educ 2014; 78:82. [PMID: 24850944 PMCID: PMC4028591 DOI: 10.5688/ajpe78482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/27/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate an injection training and certification program for third-year (P3) pharmacy students, and to measure the impact of students' administration of immunizations at an influenza clinic on their knowledge, skills, and competence in immunization. DESIGN A repeated measures design was used to assess students' injection skills across the injection training and certification program and the influenza clinic. A repeated measures design was also used to evaluate students' self-reported knowledge, experience, and confidence. ASSESSMENT Postcertification and during influenza clinic comparisons showed significant improvement in students' knowledge, experience, and confidence after taking part in the influenza clinic. University staff members and students indicated in a survey that they were satisfied with the clinic services provided by pharmacy students. CONCLUSION The injection training and certification program and the university influenza clinic were effective in enhancing and fostering student skills development.
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Affiliation(s)
- Hoan Linh Banh
- Faculty of Medicine and Dentistry/Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ken Cor
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Affiliation(s)
- James McCormack
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver V6T1Z3, BC Canada.
| | - Hoan Linh Banh
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - G Micheal Allan
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Turgeon RD, Banh HL, Korownyk C. Is diabetes a coronary artery disease equivalent? Can Fam Physician 2013; 59:1306. [PMID: 24336544 PMCID: PMC3860928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Allan GM, Banh HL, Ference J. Use of ASA after warfarin for unprovoked VTE. Can Fam Physician 2013; 59:1075. [PMID: 24130282 PMCID: PMC3796973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Cheung W, Tam K, Cheung P, Banh HL. Satisfaction with student pharmacists administering vaccinations in the University of Alberta annual influenza campaign. Can Pharm J (Ott) 2013; 146:227-32. [PMID: 23940480 DOI: 10.1177/1715163513492628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate University of Alberta staff and students' acceptance of and satisfaction with receiving influenza vaccinations from student pharmacists during the university's annual influenza campaign. MATERIAL AND METHODS A patient survey was created to collect patient demographics, influenza history and feedback on the services provided by pharmacy students and to measure willingness to receive vaccinations from a pharmacist in a community pharmacy. The 13-question survey was distributed to patients who received an influenza vaccination from a student pharmacist during the influenza campaign. KEY FINDINGS A total of 1555 staff and students completed the satisfaction survey. Almost all (n = 1533, 99%) survey participants were satisfied or very satisfied with the service provided by student pharmacists. A total of 1437 (92%) participants agreed or strongly agreed that based on this experience, they would be willing to receive vaccinations from a pharmacist in a community pharmacy and 1526 (98%) participants rated their overall experience at the flu clinic as very good or excellent. CONCLUSIONS Positive responses to the survey suggest that University of Alberta staff and students are satisfied with the service provided by student pharmacists. Their willingness to receive vaccines from a pharmacist in a community pharmacy highlighted public acceptance of the expanding role of pharmacists as immunizers.
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Affiliation(s)
- Wendy Cheung
- Faculty of Medicine and Dentistry, Department of Family Medicine, University of Alberta, Edmonton, Alberta
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Singal M, Banh HL, Allan GM. Daily multivitamins to reduce mortality, cardiovascular disease, and cancer. Can Fam Physician 2013; 59:847. [PMID: 23946027 PMCID: PMC3743696] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Mayank Singal
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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Richard G, Ojala V, Ojala A, Bowles SK, Banh HL. Monitoring programs for drugs with potential for abuse or misuse in Canada. Can Pharm J (Ott) 2013; 145:168-71. [PMID: 23509545 DOI: 10.3821/145.4.cpj168] [Citation(s) in RCA: 4] [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] [Indexed: 12/14/2022]
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Abstract
Delirium is a common manifestation of acute, reversible, brain dysfunction in critically ill patients. It is associated with increased morbidity and mortality in the intensive care unit (ICU). Detection and prevention of risk factors for delirium is critical. Daily assessment for delirium should be part of the treatment strategies. Although, non-pharmacologic treatment have been successful, often, pharmacologic intervention is necessary. Currently, there are no approved medications indicated for the treatment of ICU delirium. The objective of this review article is to provide a comprehensive overview of non-pharmacologic and pharmacologic options for the treatment of ICU delirium.
This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.
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Banh HL, Trevoy J, Pabst H, Beach J, Vethanayagam D. Persistent elevation of peripheral blood myeloid cell counts associated with omalizumab therapy. Am J Health Syst Pharm 2012; 69:302-6. [PMID: 22302255 DOI: 10.2146/ajhp110277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of persistent hematologic abnormalities in a patient receiving long-term omalizumab therapy for severe asthma is reported. SUMMARY During the course of her treatment at an asthma clinic, a 24-year-old woman was noted to have increased white blood cell counts, with elevated myeloid cell counts; the blood abnormalities were first documented more than 12 months previously. The woman had been taking omalizumab for more than 2 years and was also receiving immune globulin therapy for common variable immunodeficiency. Based on the results of bone marrow aspiration and biopsy, she was diagnosed as having mild neutrophilia, possibly related to past corticosteroid therapy, but there was no evidence of a malignancy, a hemophagocytic syndrome, or an infectious, myeloproliferative, or lymphoproliferative process. Pursuant to a multidisciplinary medication review, the use of omalizumab was identified as a potential factor in the myeloid cell elevations and discontinued. About 1 month after omalizumab therapy was halted, the patient's myeloid cell counts normalized. The temporal association of omalizumab use and blood abnormalities in this case, coupled with the lack of data on the drug's long-term hematologic effects, suggests a need for cautious use and close monitoring of omalizumab therapy, particularly in younger patients. CONCLUSION A patient with asthma and common variable immunodeficiency developed an elevation of peripheral blood myeloid cells that was first noticed 29 months after the initiation of monthly omalizumab injections. Omalizumab was discontinued, and the abnormality persisted for 1 month after the last dose. The patient's blood count results remained within normal limits 3 months after the last dose.
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Abstract
In Canada, asthma is the leading cause of admission in hospital. About of 80% of the death from asthma is preventable. Severe asthma is defined as a patient with persistent symptoms despite the use of adequate controller therapy, including multiple courses of oral glucocorticosteroids. However, about 10% of patients with severe asthma remain poorly controlled despite optimal treatment and these patients have the greatest morbidity and mortality. The management of refractory severe asthma remains extremely challenging. For patients with refractory severe asthma, the adjunct therapies recommended by national guidelines only included oral glucocorticosteroid and anti-IgE antibody (omalizumab) therapy. Currently, there is limited published literature on the unconventional treatments of refractory severe asthma. The objective of this review article is to provide an updated therapeutic overview of unconventional treatment options for refractory severe asthma.
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Affiliation(s)
- Hoan Linh Banh
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Abstract
PURPOSE OF REVIEW Intolerance of enteral feeding due to impaired gastrointestinal motility is common in critically ill patients. Strategies to prevent or treat gastrointestinal hypomotility include the use of prokinetic agents. Many currently employed prokinetic agents are associated with serious adverse drug reactions. The novel prokinetic agents - alvimopan, tegaserod, and dexloxiglumide - are reviewed. RECENT FINDINGS Alvimopan exerts mixed, but generally favorable, effects on restoration of gastrointestinal motility in patients with postoperative ileus. The observation of increased opioid requirements (without increased pain scores) and associated clinical ramifications requires further study. Tegaserod stimulates the peristaltic reflex and improves motility in multiple sites along the gastrointestinal tract. Its efficacy in improving gastrointestinal hypomotility in the critically ill population has not yet been determined. Furthermore, its use has been associated with the development of ischemic colitis and increased requirement for abdominal/pelvic surgery. Dexloxiglumide may be beneficial for improving gastric emptying in critically ill patients, especially those receiving lipid-enriched enteral feeds. SUMMARY Novel prokinetic agents show promise for management of gastrointestinal hypomotility in the critically ill population. However, further study is required before these agents can be recommended for use.
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Affiliation(s)
- Derek J Roberts
- Faculty of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Abstract
Studies have shown that early enteral nutrition in critically ill patients reduces the incidence of morbidity and death. Nonetheless, intolerance to gastric enteral nutrition is common in these patients as a result of gastroparesis. The use of prokinetic agents such as metoclopramide, domperidone, cisapride, and erythromycin can improve gastric emptying, but these agents are not without deleterious adverse effects. Tegaserod, a selective serotonin type 4 receptor partial agonist, was recently approved for treatment of women with irritable bowel syndrome. On the basis of tegaserod's mechanism of action, it was hypothesized that tegaserod may accelerate the return of gastric function in intensive care unit patients with gastroparesis. It would thus provide an additional agent for the management of gastroparesis with a more favorable safety profile. We present 3 case reports of the successful use of tegaserod in intensive care unit patients with impaired gastric motility. To our knowledge, the use of tegaserod in this setting has not been reported or studied previously.
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Affiliation(s)
- Hoan Linh Banh
- Department of Pharmacy, General Surgery, Queen Elizabeth II Health Sciences Centre, Nova Scotia, Canada.
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Abstract
The authors retrospectively assessed the relation between total and free serum concentrations and serum albumin in a sample of hospitalized patients to evaluate how well free serum concentrations can be estimated from total phenytoin serum concentrations. The authors also assessed the interpatient and intrapatient variability of the phenytoin free fraction. Paired serum samples of total and free phenytoin serum concentrations and serum albumin were obtained from 48 hospitalized patients (28 males, 20 females; mean age, 51 y; range, 13-90 y). Concomitant medications were recorded. Phenytoin free fraction and adjusted total phenytoin serum concentrations (adjusted for serum albumin) were calculated. One hundred sixty-three samples were obtained (mean, 3.4 samples per patient; range, 1-16 samples); 28 patients had more than one pair of samples obtained. Mean phenytoin free fraction was 15% +/- 7% (range, 4%-61%) for the 163 samples. The variability for the total, free, and free fractions were 65%, 75.9%, and 45.8%, respectively. There was significant variability in the phenytoin free fraction within individual patients who had more than one pair of serum concentrations obtained. The intraindividual coefficient of variation in phenytoin free fraction was 85% +/- 21.3% (range, 2%-94%). Despite strong overall correlation between the total phenytoin serum and free serum concentrations, there is excessive variability in phenytoin protein binding. Correction for serum albumin was not useful in this patient group. Because of significant interpatient and intrapatient variability in phenytoin serum concentrations, monitoring of total serum concentrations is unreliable and free phenytoin serum concentrations should be considered for monitoring in hospitalized patients.
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Affiliation(s)
- Hoan Linh Banh
- Department of Pharmacy, Queen Elizabeth Health Sciences Center, 1796 Summer Street, NHI-2417, Halifax, Nova Scotia, B3H 3A7 Canada.
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Abstract
A 65-year-old man with type IIa dyslipidemia who received flavored colestipol granules 2 scoops/day for 3 months developed asymptomatic hepatotoxicity. Several of his liver enzymes were elevated 10 times the upper limit of normal. One week after discontinuing colestipol, serum transaminases fell dramatically, with some returning to normal limits. Four weeks after colestipol was discontinued, all liver function tests were normal. Rechallenge was not attempted. Other potential causes of hepatocellular injury were evaluated. Bile acid-binding resins commonly are administered to treat type IIa dyslipidemia. Despite extensive use of the resins, significant elevations of transaminase levels are rare. Because the exact mechanism of bile acid resin-induced hepatotoxicity is unknown, high-risk patients may require liver function test monitoring and education on hepatotoxic side effects.
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Affiliation(s)
- S M Sirmans
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
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