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Khosraviani V, Ip EJ, Li SA, Khosraviani A, Cariaga J, Caballero J, Lor K, Acree L, Echibe C, Barnett MJ. Changes in perceived stress and food or housing insecurity associated with COVID-19 in doctor of pharmacy students: A pre- and current- COVID-19 survey. Explor Res Clin Soc Pharm 2024; 13:100391. [PMID: 38174290 PMCID: PMC10762449 DOI: 10.1016/j.rcsop.2023.100391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/12/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background The novel coronavirus 2019 (COVID-19) pandemic impacted everyday life for most individuals, including students. Unique COVID-19 stressors among students may include virtual learning, mental stress, and being socially distanced from classmates. Studies examining the impact of COVID-19 on stress and lifestyle changes among pharmacy students are limited. Objective The primary purpose of this study was to compare stress and food or housing insecurity changes associated with COVID-19 in U.S. Doctor of Pharmacy (PharmD) students pre-COVID vs. during-COVID. Methods A 23-item survey was administered via Qualtrics® to multiple PharmD programs across the U.S. in pre-COVID-19 (spring 2019) and during-COVID-19 (spring 2021). Participants were recruited via e-mail. The survey included questions related to demographics, lifestyle (sleep, exercise, work hours, extracurricular activities), and food and housing insecurities. The survey also included a validated instrument to measure stress (Cohen-Perceived Stress Scale). Results from 2021 were compared to a similar national survey serendipitously administered prior to COVID-19 in Spring 2019. Results Pre- and COVID-19 analytical cohorts included 278 and 138 participants, respectively. While pre-COVID-19 students were slightly older (29.9 ± 4.7 vs. 27.7 ± 4.2, p ≤0.001), relative to COVID-19 students, other demographic factors were similar. No significant difference was observed in reported stress levels (PSS = 20.0 ± 6.3 vs. 19.7 ± 6.2, p = 0.610) between time periods. Significant differences in food (53.2% vs. 51.4%, p = 0.731) and housing (45.0% vs. 47.1%, p = 0.680) insecurity were also not seen. Conclusions These findings highlight that PharmD students' perceived stress and food and housing insecurities due to COVID-19 may have been minimal. Additional studies on pharmacy students should be conducted to validate these results. These results may help inform policymakers and stakeholders during the early stages of any future pandemics.
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Affiliation(s)
- Vista Khosraviani
- Department of Pharmacy Practice, University of the Pacific School Thomas J. Long School of Pharmacy, 751 Brookside Rd, Stockton, CA 95211, USA
| | - Eric J. Ip
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandy A. Li
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA 94592, USA
| | - Armon Khosraviani
- Department of Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Janessa Cariaga
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA 94592, USA
| | - Joshua Caballero
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 250 W. Green Street, Athens, GA 30602, USA
| | - Kajua Lor
- Department of Clinical Sciences, Medical College of Wisconsin Pharmacy School, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Lindsay Acree
- Department of Pharmacy Practice, University of Charleston School of Pharmacy, 2300 MacCorkle Ave SE, Charleston, WV 25396, USA
| | - Chinwe Echibe
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA 94592, USA
| | - Mitchell J. Barnett
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA 94592, USA
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Jalloh M, Stompanato J, Nguyen JQ, Barnett MJ, Ip EJ, Doroudgar S. Barber Motivation for Conducting Mental Health Screening and Receiving Mental Health Education in Barbershops That Primarily Serve African Americans: a Cross-sectional Study. J Racial Ethn Health Disparities 2023; 10:2417-2422. [PMID: 36190678 DOI: 10.1007/s40615-022-01420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 10/10/2022]
Affiliation(s)
- Mohamed Jalloh
- College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94592, USA.
| | - Jasmine Stompanato
- College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94592, USA
| | - John Q Nguyen
- College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94592, USA
| | - Mitchell J Barnett
- College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94592, USA
| | - Eric J Ip
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, USA
- Kaiser Permanente Mountain View Medical Offices, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Shadi Doroudgar
- College of Pharmacy, Touro University California, 1310 Club Drive, Vallejo, CA, 94592, USA
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3
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Barnett MJ, Lindfelt T, Doroudgar S, Chan E, Ip EJ. Pharmacy-faculty work-life balance and career satisfaction: Comparison of national survey results from 2012 and 2018. Exploratory Research in Clinical and Social Pharmacy 2022; 5:100112. [PMID: 35478528 PMCID: PMC9031084 DOI: 10.1016/j.rcsop.2022.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Changes in demographics and composition of pharmacy faculty, along with faculty perceived stress, work-life balance and career satisfaction have yet to be fully documented. Objective To compare recent results from a national survey of work-life balance and career satisfaction of United States (U.S.) pharmacy faculty with results obtained from a similar survey from 2012. Methods A 46-item anonymous survey administered via Qualtrics (Provo, UT) was sent to members of the American Association of Colleges of Pharmacy (AACP) in 2018. Information regarding demographics, stress, work-life balance, career satisfaction and intent to leave academia was collected. Although not part of the previous survey, participant information related to bullying and abuse in the pharmacy academic work was also gathered. While actual p-values are reported for all comparisons, a more conservative p-value of 0.01 was chosen a priori to indicate significance as multiple comparisons were made. Results A total of 1090 pharmacy faculty completed the survey, comparable to the number obtained in 2012 (n = 811). Overall response rates were similar for both years. The majority of pharmacy faculty in 2018 were female, white, married or with partner, worked in a pharmacy practice department and for a public institution. Notable differences between surveys included an increase in females, more associate professors and an increase in non-white faculty in 2018, relative to 2012. Stress, as measured by mean Perceived Stress Scale (PSS) scores was also significantly higher in 2018 (16.0 ± 6.6 vs. 13.5 ± 6.7, p < 0.01) relative to 2012. Faculty from 2018 were significantly less likely to report an intention to remain in academia (61.8% vs 86.3%, p < 0.01), relative to 2012. A sizable number of pharmacy faculty surveyed in 2018 also reported observing or experiencing hostility in the workplace, which included either bullying or verbal or physical abuse. Conclusions The makeup of pharmacy educators has evolved quickly over the last several years to comprise more female and associate professors who work within a pharmacy practice department. Also noteworthy is the significant increase in self-reported stress over the six-year timeframe. The direct implications of these findings are unknown but suggest that pharmacy academia is maturing in rank and changing to reflect the current pharmacy workforce (i.e., more females and additional clinical practice roles). Increases in responsibility likely accompany these maturing roles and may, along with other factors, contribute to the observed changes in the reported stress levels among faculty. Further research is called for regarding the reported hostility in pharmacy academic workplace and dovetails with concurrent work being done on citizenship and organizational citizenship behavior among pharmacy faculty. Findings of the study may aid pharmacy school administrators and stakeholders with plans to recruit, develop and retain faculty. Pharmacy faculty report frequent hostility and bullying in their workplace. Composition of pharmacy faculty is rapidly changing to include more females working in pharmacy practice departments. Pharmacy faculty report increased stress levels relative to a previous survey from 2012.
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Affiliation(s)
- Mitchell J. Barnett
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA 94592, United States of America
- Corresponding author.
| | - Tristan Lindfelt
- Epocrates Medical Information, athenahealth, Inc., 311 Arsenal Street, Watertown, MA 02472, United States of America
| | - Shadi Doroudgar
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA 94592, United States of America
- Stanford University, Department of Medicine-Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States of America
| | - Emily Chan
- Nebraska Medicine, Clarkson Family Medicine, University of Nebraska Medical Center, 988125 Nebraska Medical Center, Omaha, NE 68198, United States of America
| | - Eric J. Ip
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA 94592, United States of America
- Stanford University, Department of Medicine-Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States of America
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Baumgartner L, Israel H, Wong T, Sasaki-Hill D, Ip EJ, Barnett MJ. Performance on advanced pharmacy practice experiences after implementation of mock acute care patient simulations. Curr Pharm Teach Learn 2021; 13:1572-1577. [PMID: 34895665 DOI: 10.1016/j.cptl.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/09/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION We sought to compare student performance on acute care advanced pharmacy practice experiences (APPEs) pre- and post-incorporation of mock acute care patient simulations into the curriculum. METHODS A series of mock acute care APPE simulations (MACAS) were developed and incorporated into Touro University California College of Pharmacy curriculum for first- and second-year pharmacy students. Results for student performance on Acute Care I and Acute Care II APPEs were collected for students who received none, one year, or two years of the MACAS. Student admission characteristics and didactic academic performance (grade point average [GPA]) were also gathered. Student characteristics and APPE performance were compared across cohorts of students who received none, one year, and two years of MACAS. Multivariate models were created to measure the impact of the MACAS while controlling for student characteristics. RESULTS The final cohort included 394 students. In unadjusted analyses, students with one or two years of MACAS received significantly higher preceptor acute care APPE evaluations for communication, professionalism, and patient scores vs. students who received no MACAS. In multivariate models controlling for age, gender, and undergraduate GPA, one year of MACAS increased student acute care APPE communication, professionalism, and patient care scores, relative to no MACAS. Similar increases in acute care APPE scores were seen for students who received two years of MACAS. CONCLUSIONS MACAs significantly improved acute care APPE scores relative to students with no MACAS. This improvement in acute care APPEs occurred after students received a single year of MACAS.
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Affiliation(s)
- Laura Baumgartner
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America; Division of Primary Care and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305 United States of America.
| | - Heidi Israel
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America.
| | - Terri Wong
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America.
| | - Debbie Sasaki-Hill
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America.
| | - Eric J Ip
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America; Division of Primary Care and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305 United States of America.
| | - Mitchell J Barnett
- Touro University California College of Pharmacy, 1310 Club Dr., Mare Island, Vallejo, CA 94502, United States of America.
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Barnett MJ, Doroudgar S, Khosraviani V, Ip EJ. Multiple comparisons: To compare or not to compare, that is the question. Res Social Adm Pharm 2021; 18:2331-2334. [PMID: 34274218 DOI: 10.1016/j.sapharm.2021.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/08/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
Researchers attempt to minimize Type-I errors (concluding there is a relationship between variables, when there in fact, isn't one) in their experiments by exerting control over the p-value thresholds or alpha level. If a statistical test is conducted only once in a study, it is indeed possible for the researcher to maintain control, so that the likelihood of a Type-I error is equal to or less than the significance (p-value) level. When making multiple comparisons in a study, however, the likelihood of making a Type-I error can dramatically increase. When conducting multiple comparisons, researchers frequently attempt to control for the increased risk of Type-I errors by making adjustments to their alpha level or significance threshold level. The Bonferroni adjustment is the most common of these types of adjustment. However, these, often rigid adjustments, are not without risk and are often applied arbitrarily. The objective of this review is to provide a balanced commentary on the advantages and disadvantages of making adjustments when undertaking multiple comparisons. A summary discussion of familiar- and experiment-wise error is also presented. Lastly, advice on when researchers should consider making adjustments in p-value thresholds and when they should be avoided, is provided.
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Affiliation(s)
- Mitchell J Barnett
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA, 94592, USA; Iowa Public Health, Board of Pharmacy, Prescription Monitoring Program, 4688 400 SW 8th St E, Des Moines, IA 50309, USA.
| | - Shadi Doroudgar
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA, 94592, USA; Stanford University, Department of Medicine-Primary Care and Population Health, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Vista Khosraviani
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA, 94592, USA
| | - Eric J Ip
- Touro University California College of Pharmacy, Clinical Sciences Department, 1310 Club Drive, Mare Island, Vallejo, CA, 94592, USA; Stanford University, Department of Medicine-Primary Care and Population Health, 1265 Welch Road, Stanford, CA, 94305, USA
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6
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Herzik KA, Barnett MJ, Thanh DM, Doroudgar S, Ip EJ. Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization. J Am Geriatr Soc 2020; 68:2354-2358. [DOI: 10.1111/jgs.16723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kristen A. Herzik
- Department of Clinical Sciences Touro University California College of Pharmacy Vallejo California USA
- Department of Pharmacy Sharp Memorial Hospital San Diego California USA
- Department of Pharmacy Sharp Grossmont Hospital La Mesa California USA
| | - Mitchell J. Barnett
- Department of Clinical Sciences Touro University California College of Pharmacy Vallejo California USA
| | - Danielle M. Thanh
- Department of Clinical Sciences Touro University California College of Pharmacy Vallejo California USA
- Department of Pharmacy Stanford Health Care Stanford California USA
| | - Shadi Doroudgar
- Department of Clinical Sciences Touro University California College of Pharmacy Vallejo California USA
| | - Eric J. Ip
- Department of Clinical Sciences Touro University California College of Pharmacy Vallejo California USA
- Department of Medicine Stanford University School of Medicine Stanford California USA
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Steele I, Pope H, Ip EJ, Barnett MJ, Kanayama G. Is competitive body-building pathological? Survey of 984 male strength trainers. BMJ Open Sport Exerc Med 2020; 6:e000708. [PMID: 32419952 PMCID: PMC7223260 DOI: 10.1136/bmjsem-2019-000708] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives Hundreds of thousands, if not millions, of individuals worldwide engage in competitive body-building. Body-building often attracts derogatory characterisations such as as ‘bizarre’ or ‘narcissistic,’ or a ‘freak show’, seemingly implying that it is associated with pathology. Few studies have compared psychological features in competitive bodybuilders versus recreational strength trainers. Methods Using logistic regression with adjustment for age and race, we compared 96 competitive bodybuilders (‘competitors’) with 888 recreational strength trainers (‘recreationals’), assessed in a prior internet survey, regarding demographics; body image; use of anabolic–androgenic steroids (AAS), other appearance-enhancing and performance-enhancing drugs (APEDs), and classical drugs of abuse; history of psychiatric diagnoses; and history of childhood physical/sexual abuse. Results Competitors reported a higher lifetime prevalence of AAS (61 (63.5%) vs 356 (10.1%), p<0.001) and other APED use than recreationals but showed very few significant differences on other survey measures. AAS-using competitors were more likely than AAS-using recreationals to have disclosed their AAS use to a physician (31 (50.8%) vs 107 (30.0%), p=0.003). Both groups reported high levels of body image concerns but did not differ from one another (eg, ‘preoccupation with appearance’ caused significant reported distress or impairment in important areas of functioning for 18 (18.8%) competitors vs 132 (15.4%) recreationals, p=0.78). No significant differences were found on the prevalence of reported childhood physical abuse (9 (9.4%) vs 77 (8.8%), p=0.80) or sexual abuse (4 (4.2%) vs 39 (4.5%), p=0.83). Competitors reported a lower lifetime prevalence of marijuana use than recreationals (38 (39.6%) vs 514 (57.9%), p=0.001). Conclusion Aside from their APED use, competitive bodybuilders show few psychological differences from recreational strength trainers.
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Affiliation(s)
- Ian Steele
- Consultation-Liason Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Harrison Pope
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA
| | - Eric J Ip
- Clinical Sciences/College of Pharmacy, Touro University California, Vallejo, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mitchell J Barnett
- Clinical Sciences/College of Pharmacy, Touro University California, Vallejo, California, USA.,Iowa Board of Pharmacy, Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Gen Kanayama
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA
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Jalloh MA, Barnett MJ, Ip EJ. Men's Health-Related Magazines: A Retrospective Study of What They Recommend and the Evidence Addressing Their Recommendations. Am J Mens Health 2020; 14:1557988320936900. [PMID: 32589077 PMCID: PMC7322823 DOI: 10.1177/1557988320936900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022] Open
Abstract
Magazines have traditionally been an effective medium for delivering health media messages to large populations or specific groups. In this retrospective cross-sectional study, we evaluated nine issues from 2016 publications of American men’s health-related magazines (Men’s Health and Men’s Fitness) to evaluate their recommendations and determine their validity by examining corresponding evidence found in the peer-reviewed scientific literature. We extracted health recommendations (n = 161) from both magazines and independently searched and evaluated evidence addressing the recommendations. We could find at least a case study or higher quality evidence addressing only 42% of the 161 recommendations (80 recommendations from Men’s Health and 81 recommendations from Men’s Fitness). For recommendations from Men’s Health, evidence supported approximately 23% of the 80 recommendations, while evidence was unclear, nonexistent, or contradictory for approximately 77% of the recommendations. For recommendations from Men’s Fitness, evidence supported approximately 25% of the 81 recommendations, while evidence was unclear, nonexistent, or contradictory for approximately 75% of the recommendations. The majority of recommendations made in men’s health-related magazines appear to lack credible peer-reviewed evidence; therefore, patients should discuss such recommendations with health-care providers before implementing.
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Affiliation(s)
- Mohamed A Jalloh
- Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Mitchell J Barnett
- Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Eric J Ip
- Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA.,Clinical Sciences, Department of Medicine (Division of Primary Care and Population Health), Stanford University School of Medicine, Vallejo, CA, USA
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Baumgartner L, Ip EJ, Sasaki-Hill D, Wong T, Israel H, Barnett MJ. Implementation of Mock Acute Care Advance Pharmacy Practice Experience Simulations and an Assessment Rubric. Am J Pharm Educ 2019; 83:7331. [PMID: 31871355 PMCID: PMC6920646 DOI: 10.5688/ajpe7331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/12/2018] [Accepted: 04/22/2019] [Indexed: 05/27/2023]
Abstract
Objective. To implement a mock acute care advanced pharmacy practice experience series into the didactic training of second-year pharmacy students and validate an accompanying assessment rubric. Methods. Three 90-minute acute care patient simulation laboratory sessions were developed with input from clinical specialists, preceptors, students, and faculty members. An accompanying student evaluation rubric was also developed. The assessment rubric was validated using pairs of preceptor raters to determine inter-rater reliability, along with predictive validity on advanced pharmacy practice experience (APPE) acute care scores. A student survey was also conducted. Results. The mock acute care APPEs were successfully implemented into the didactic curriculum. The assessment rubric had good inter-rater reliability and good predictive validity with acute care APPEs. Survey results indicated that students found the mock acute care APPE simulation laboratories useful. Conclusion. Other schools seeking to enhance their students' preparedness for and performance in acute care APPEs should consider implementing acute care APPE simulations in the didactic curriculum.
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Affiliation(s)
| | - Eric J Ip
- Touro University California College of Pharmacy Vallejo, California
| | | | - Terri Wong
- Touro University California College of Pharmacy Vallejo, California
| | - Heidi Israel
- Touro University California College of Pharmacy Vallejo, California
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Ip EJ, Doroudgar S, Shah-Manek B, Barnett MJ, Tenerowicz MJ, Ortanez M, Pope HG. The CASTRO study: Unsafe sexual behaviors and illicit drug use among gay and bisexual men who use anabolic steroids. Am J Addict 2019; 28:101-110. [PMID: 30724428 DOI: 10.1111/ajad.12865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/12/2018] [Accepted: 01/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The majority of anabolic androgenic steroid (AAS) studies have focused on the general male population. Approximately 15% of gay or bisexual men are seropositive for HIV and many AASs are administered via injection. Thus, AAS use among gay and bisexual men likely poses a greater risk of spreading infectious disease. Gay and bisexual men who use AAS were compared with non-users regarding self-reported seropositivity for HIV and hepatitis B and C, sexual behaviors and injection practices, illicit drug and alcohol use, and psychiatric disorders. METHODS The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey of 153 gay and bisexual men who exercise. Data collection occurred outside four gyms in the San Francisco Castro District. RESULTS The lifetime prevalence of AAS use among gay and bisexual men in the study was 21.6%. AAS users and non-users did not differ in self-reported seropositivity for HIV or hepatitis B and C, but AAS users reported higher rates of male-male condomless anal sex in the past year (84.8 vs 60.8%, p < .01) than non-users. More AAS users used ecstasy and methamphetamines (39.4 vs 16.7%, p < .01 and 18.2 vs 5.0%, p = .01, respectively) than non-users. DISCUSSION AND CONCLUSIONS Gay and bisexual men who used AAS were more likely to engage in unsafe sexual behaviors and use illicit drugs relative to non-users. Multiple factors place AAS users at higher risks for spreading infectious diseases. SCIENTIFIC SIGNIFICANT Our study suggests increased infectious disease risk among gay and bisexual men who use AAS. (Am J Addict 2019;XX:1-10).
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Affiliation(s)
- Eric J Ip
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.,Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.,Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Bijal Shah-Manek
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Mitchell J Barnett
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Michael J Tenerowicz
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Marvin Ortanez
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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11
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Ip EJ, Lindfelt TA, Tran AL, Do AP, Barnett MJ. Differences in Career Satisfaction, Work-life Balance, and Stress by Gender in a National Survey of Pharmacy Faculty. J Pharm Pract 2018; 33:415-419. [PMID: 30518289 DOI: 10.1177/0897190018815042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The percentage of women pharmacy students and pharmacy faculty has greatly increased over the last 40 years. However, it is not known whether gender differences exist in terms of career satisfaction, work-life balance, and stress in the pharmacy academia workplace. METHODS Results from a national web-based survey administered to American Association of Colleges of Pharmacy (AACP) members were utilized. Bivariate analyses were conducted to compare differences among faculty according to gender (men vs women). A series of multivariate models controlling for demographic and other faculty and school-level factors were created to explore the impact of gender on satisfaction with current position, satisfaction with work-life balance, and perceived stress. RESULTS Among the 802 survey respondents, 457 (57.0%) women were more likely to be younger, hold a lower academic rank, and be in a pharmacy practice department, relative to 345 (43.0%) men. In adjusted results, men pharmacy faculty were more likely to report being extremely satisfied with their current job, more likely to report being extremely satisfied with their work-life balance, and score lower on a standardized stress measure relative to women. CONCLUSION While primarily descriptive, the results suggest women pharmacy faculty in the United States are less satisfied with their current academic position, less satisfied with their current work-life balance, and have higher stress levels compared to men even after controlling for age, academic rank, and department (along with other factors). Further research is needed to explore and address causes of the observed gender-related differences among pharmacy faculty.
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Affiliation(s)
- Eric J Ip
- College of Pharmacy, Touro University California, Vallejo, CA, USA
| | | | - Annie L Tran
- College of Pharmacy, Touro University California, Vallejo, CA, USA
| | - Amanda P Do
- College of Pharmacy, Touro University California, Vallejo, CA, USA
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12
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Lindfelt T, Ip EJ, Gomez A, Barnett MJ. The impact of work-life balance on intention to stay in academia: Results from a national survey of pharmacy faculty. Res Social Adm Pharm 2018; 14:387-390. [DOI: 10.1016/j.sapharm.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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Abstract
Membrane integrity fluorescent staining is used routinely to evaluate islet viability. Results are used as one of the determining factors in islet product release criteria, and are used to assess the efficacy of different culture conditions. Recently, it has been observed that there is variation in the viability staining of freshly isolated islets based on which viability assay is used. This investigation compares three membrane integrity stains for the viability assessment of isolated human islets. Fluorescein diacetate/propidium iodide (FDA/PI), the current standard method for assessing islet viability, demonstrates intense extracellular fluorescence, reducing the differential staining of intact islets. We further evaluated SYTO-13/ethidium bromide (SYTO/EB) and calcein AM/ethidium homodimer (C/EthD) as alternative viability assays, and found considerable variation between FDA/PI and either SYTO/EB or C/EthD staining. Preparations of human islets were obtained from cadaveric pancreata after collagenase digestion, mechanical separation, and purification by continuous Ficoll gradient centrifugation. For each preparation, two replicate samples of 50 islets were counted for each stain, and the percent viability calculated. The results for SYTO/EB and C/EthD were nearly identical [57.6 ± 7.3% and 57.9 ± 7.2%, respectively (mean ± SEM), N = 11]. FDA/PI-stained islets, however, showed consistently elevated values when compared to SYTO/EB. Accurate assessment of islet viability remains a critical determinant of islet product release. The discrepancies found between FDA/PI scoring and visual quality, compared with alternative stains, suggests that the FDA/PI stain may not be the optimal approach to assess islet viability.
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Affiliation(s)
- M J Barnett
- Clinical Islet Program, University of Alberta, Edmonton, Canada
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14
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Lindfelt TA, Ip EJ, Barnett MJ. Survey of career satisfaction, lifestyle, and stress levels among pharmacy school faculty. Am J Health Syst Pharm 2015; 72:1573-8. [DOI: 10.2146/ajhp140654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Eric J. Ip
- Touro University California College of Pharmacy, Vallejo
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15
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Barnett MJ, Ganesan TS, Waxman JH, Richards MA, Smith BF, Rohatiner AZ, Dhaliwal HS, Slevin ML, Lister TA. Neurotoxicity of high-dose cytosine arabinoside. Prog Exp Tumor Res 2015; 29:177-88. [PMID: 3906761 DOI: 10.1159/000411637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Lor KB, Truong JT, Ip EJ, Barnett MJ. A randomized prospective study on outcomes of an empathy intervention among second-year student pharmacists. Am J Pharm Educ 2015; 79:18. [PMID: 25861099 PMCID: PMC4386739 DOI: 10.5688/ajpe79218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 04/16/2014] [Accepted: 07/13/2014] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To determine the impact of a single, 3-day intervention on empathy levels as measured by the validated Jefferson Scale of Empathy-Health Profession Students version (JSE-HPS). METHODS Forty second-year student pharmacists were recruited to participate in a non-blinded prospective study. Subjects were randomized to an intervention group (n=20) or control group (n=20) and completed the JSE-HPS at baseline, 7 days postintervention, and 90 days postintervention. The intervention group consisted of a 3-day simulation, each day including a designated activity with loss of dominant hand usage, vision, and speech. RESULTS The 3-day simulation increased empathy levels in the intervention group compared to the control group 7 days postintervention (p=0.035). However, there were no effects on empathy levels 90 days postintervention (p=0.38). CONCLUSION Empathy scores increased but were not sustained in the long-term with a 3-day empathy intervention.
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Affiliation(s)
- Kajua B Lor
- Touro University California College of Pharmacy, Vallejo, California
| | - Julie T Truong
- Keck Graduate Institute School of Pharmacy, Claremont, California
| | - Eric J Ip
- Touro University California College of Pharmacy, Vallejo, California
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17
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Lash DB, Barnett MJ, Parekh N, Shieh A, Louie MC, Tang TTL. Perceived benefits and challenges of interprofessional education based on a multidisciplinary faculty member survey. Am J Pharm Educ 2014; 78:180. [PMID: 25657367 PMCID: PMC4315202 DOI: 10.5688/ajpe7810180] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/03/2014] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To identify differences among faculty members in various health professional training programs in perceived benefits and challenges of implementing interprofessional education (IPE). METHODS A 19-item survey using a 5-point Likert scale was administered to faculty members across different health disciplines at a west coast, multicollege university with osteopathic medicine, pharmacy, and physician assistant programs. RESULTS Sixty-two of 103 surveys (60.2%) were included in the study. Faculty members generally agreed that there were benefits of IPE on patient outcomes and that implementing IPE was feasible. However, group differences existed in belief that IPE improves care efficiency (p=0.001) and promotes team-based learning (p=0.001). Program divergence was also seen in frequency of stressing importance of IPE (p=0.009), preference for more IPE opportunities (p=0.041), and support (p=0.002) within respective college for IPE. CONCLUSIONS Despite consensus among faculty members from 3 disciplines that IPE is invaluable to their curricula and training of health care students, important program level differences existed that would likely need to be addressed in advance IPE initiatives.
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Affiliation(s)
- David Benjamin Lash
- Touro University California College of Pharmacy, Vallejo, CA
- Co-primary author
| | - Mitchell J. Barnett
- Touro University California College of Pharmacy, Vallejo, CA
- Co-primary author
| | - Nirali Parekh
- Touro University California College of Pharmacy, Vallejo, CA
| | - Anita Shieh
- Touro University California College of Pharmacy, Vallejo, CA
| | - Maggie C. Louie
- Touro University California College of Pharmacy, Vallejo, CA
- Dominican University of California, San Rafael, CA
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18
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Seftel MD, Barnett MJ, Couban S, Leber B, Storring J, Assaily W, Fuerth B, Christofides A, Schuh AC. A Canadian consensus on the management of newly diagnosed and relapsed acute promyelocytic leukemia in adults. ACTA ACUST UNITED AC 2014; 21:234-50. [PMID: 25302032 DOI: 10.3747/co.21.2183] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of all-trans-retinoic acid (atra) and anthracyclines (with or without cytarabine) in the treatment of acute promyelocytic leukemia (apl) has dramatically changed the management and outcome of the disease over the past few decades. The addition of arsenic trioxide (ato) in the relapsed setting-and, more recently, in reduced-chemotherapy or chemotherapy-free approaches in the first-line setting-continues to improve treatment outcomes by reducing some of the toxicities associated with anthracycline-based approaches. Despite those successes, a high rate of early death from complications of coagulopathy remains the primary cause of treatment failure before treatment begins. In addition to that pressing issue, clarity is needed about the use of ato in the first-line setting and the role of hematopoietic stem-cell transplantation (hsct) in the relapsed setting. The aim for the present consensus was to provide guidance to health care professionals about strategies to reduce the early death rate, information on the indications for hsct and on the use of ato in induction and consolidation in low-to-intermediate-risk and high-risk apl patients.
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Affiliation(s)
| | - M J Barnett
- University of British Columbia, Vancouver, BC
| | - S Couban
- Dalhousie University, Halifax, NS
| | - B Leber
- McMaster University, Hamilton, ON
| | - J Storring
- McGill University Health Centre, Montreal, QC
| | | | | | | | - A C Schuh
- Princess Margaret Hospital, Toronto, ON
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19
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Knapp KK, Shah B, Barnett MJ, Taylor TN, Miller L. Provider status and the need for additional qualified residency opportunities—Response to Kudla. J Am Pharm Assoc (2003) 2014; 54:216-6. [DOI: 10.1331/japha.2014.13230] [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: 11/23/2022]
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20
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Truong JT, Barnett MJ, Tang TTL, Ip EJ, Teeters JL, Knapp KK. Factors impacting self-perceived readiness for residency training: results of a national survey of postgraduate year 1 residents. J Pharm Pract 2014; 28:112-8. [PMID: 24674909 DOI: 10.1177/0897190014527318] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the factors impacting postgraduate year 1 (PGY1) residents' self-perceived readiness for residency. METHODS A total of 1801 residents who matched in American Society of Health-System Pharmacists (ASHP)-accredited PGY1 programs were e-mailed individualized invitations to take an online survey. The survey collected self-ratings of readiness for residency training competencies including time management and organization, foundational knowledge, clinical practice, project management, and communication. KEY FINDINGS Data from 556 completed surveys were analyzed. Residents agreed they were ready to perform activities requiring time management and organization (median = 4, mean = 4.08), foundational knowledge (median = 4, mean = 3.83), clinical practice (median = 4, mean = 3.67), and communication (median = 4, mean = 4.05). Residents who completed at least 1 academic advance pharmacy practice experience (APPE), 5 clinical APPEs, or held a bachelors degree felt more confident than their counterparts in regard to project management (P < .001, <.001, and .01, respectively). CONCLUSION PGY1 residents generally felt prepared for time management and organization, foundational knowledge, and communication residency training competencies. This was significant for those who completed 1 or more academic APPEs, 5 or more clinical rotations, or a bachelors degree. Study results may assist pharmacy schools in preparing students for residency training, prospective resident applicants in becoming more competitive candidates for residency programs, and residency program directors in resident selection.
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Affiliation(s)
- Julie T Truong
- Department of Clinical and Administrative Sciences, Keck Graduate Institute School of Pharmacy, Claremont, CA, USA
| | | | - Terrill T-L Tang
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Eric J Ip
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Janet L Teeters
- Department of Accreditation Services, American Society of Health-System Pharmacists, Bethesda, MD, USA
| | - Katherine K Knapp
- Department of Social, Behavioral, and Administrative Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
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21
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Abstract
The traditional approach to allogeneic hematopoietic stem cell transplantation involves the administration of myeloablative preparative regimens. This form of conditioning is associated with a relatively high incidence of regimen-related toxicity. As a result, candidates for allogeneic stem cell transplantation may be excluded owing to advanced age or co-morbid medical illness. Recently, so-called "non-myeloablative" regimens have been introduced, where less intense conditioning therapy is used in an attempt to reduce regimen-related toxicity. In addition, non-myeloablative transplantation takes advantage of the graft-versus-tumour effect that is characteristic of allogeneic stem cell transplantation. We review the background, available clinical data, and future directions in non-myeloablative stem cell transplantation, and focus on its potential use in the treatment of lymphoid malignancies.
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Affiliation(s)
- M D Seftel
- Leukemia/Bone Marrow Transplantation Program of British Columbia, British Columbia Cancer Agency, Vancouver Hospital and Health Sciences Center, University of British Columbia, Canada.
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22
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Abstract
OBJECTIVE To describe the relationship between state-level Aggregate Demand Index (ADI) data and market factors reflecting both supply and demand: unemployment rates, pharmacy graduates, community pharmacy prescription growth rates, and Medicare Part D. DESIGN Cross-sectional time series analysis using state-level data. SETTING U.S. labor market for pharmacists, from 2001 to 2010. INTERVENTION Model ADI data for states (dependent variable) against five independent variables: previous year ADI, unemployment rates, pharmacy graduates, prescription growth rates, and Medicare Part D. MAIN OUTCOME MEASURES Significance and predictive ability of the model, sign of the variables studied, and R2. RESULTS In the two-way (state and time) fixed-effects model, all variables were significant and R2 was 0.79. Contributions to state-level ADIs were, in rank order, previous year ADI, unemployment rates, pharmacy graduates, and prescription growth rates. The model predicted 2010 ADI values for 44 of 51 states within ±10%. The model depicts the independent contributions of each variable for the short (∼1 year) and longer term. Although the nature of ADI data precludes quantitative predictions about the pharmacist job market, the model results show marketplace directions (up or down) and comparative impacts. CONCLUSION The model demonstrated that unemployment rates, pharmacy graduates, prescription growth rates, and Medicare Part D contributed significantly to state-level ADIs between 2001 and 2010. The relationships uncovered should be monitored and reexamined as new data emerge in order to anticipate the directions of the pharmacist job market.
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Affiliation(s)
- Thomas N Taylor
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
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23
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Ip EJ, Bui QV, Barnett MJ, Kazani A, Wright R, Serino MJ, Perry PJ. The effect of trazodone on standardized field sobriety tests. Pharmacotherapy 2013; 33:369-74. [PMID: 23450804 DOI: 10.1002/phar.1210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of a single dose of trazodone on the standardized field sobriety test (SFST). DESIGN A randomized, double-blinded, repeated-measures study. PARTICIPANTS Forty-five healthy adult subjects. SETTING University campus. MEASUREMENTS AND MAIN RESULTS The SFST consists of the horizontal gaze nystagmus, walk-and-turn, and one-leg stand tests. Subjects were administered a baseline SFST and at 2 hours after the administration of either trazodone 100 mg (30 subjects) or acetaminophen 650 mg (15 subjects). At 2 hours post drug administration, there were no statistical differences in failure rates between the trazodone and acetaminophen groups (53.3% vs 20.0%, p=0.054). However, the trazodone group exhibited more impairment clues within the individual tests of the SFST than the acetaminophen group. CONCLUSIONS A one-time dose of trazodone 100 mg does not result in an increased SFST failure rate at 2 hours postdosing compared to acetaminophen 650 mg. However, the number of individual impairment clues detected is increased with trazodone. Trazodone 100 mg may cause cognitive driving impairment.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, CA 94592, USA.
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24
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Ip EJ, Lu DH, Barnett MJ, Tenerowicz MJ, Vo JC, Perry PJ. Psychological and physical impact of anabolic-androgenic steroid dependence. Pharmacotherapy 2013; 32:910-9. [PMID: 23033230 DOI: 10.1002/j.1875-9114.2012.01123] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. DESIGN Subanalysis of data from the Anabolic 500, a cross-sectional survey. PARTICIPANTS One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009. MEASUREMENTS AND MAIN RESULTS Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users. CONCLUSION Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, Touro University California College of Pharmacy, Vallejo, California 94592, USA.
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25
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Mészáros K, Barnett MJ, Lenth RV, Knapp KK. Pharmacy school survey standards revisited. Am J Pharm Educ 2013; 77:3. [PMID: 23459404 PMCID: PMC3578335 DOI: 10.5688/ajpe7713] [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: 05/17/2012] [Accepted: 08/09/2012] [Indexed: 05/27/2023]
Abstract
In a series of 3 papers on survey practices published from 2008 to 2009, the editors of the American Journal of Pharmaceutical Education presented guidelines for reporting survey research, and these criteria are reflected in the Author Instructions provided on the Journal's Web site. This paper discusses the relevance of these criteria for publication of survey research regarding pharmacy colleges and schools. In addition, observations are offered about surveying of small "universes" like that comprised of US colleges and schools of pharmacy. The reason for revisiting this issue is the authors' concern that, despite the best of intentions, overly constraining publication standards might discourage research on US colleges and schools of pharmacy at a time when the interest in the growth of colleges and schools, curricular content, clinical education, competence at graduation, and other areas is historically high. In the best traditions of academia, the authors share these observations with the community of pharmacy educators in the hope that the publication standards for survey research about US pharmacy schools will encourage investigators to collect and disseminate valuable information.
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Affiliation(s)
- Károly Mészáros
- College of Pharmacy, Touro University California, Vallejo, CA 94592, USA.
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Abstract
Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 ± 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a "recreational exerciser" (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 ± 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it "easy" to acquire their insulin. Strategies aimed to prevent insulin misuse are needed.
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Affiliation(s)
- Eric J Ip
- Touro University College of Pharmacy, Vallejo, CA 94592, USA.
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Ip EJ, Lu DH, Barnett MJ, Tenerowicz MJ, Vo JC, Perry PJ. Psychological and Physical Impact of Anabolic-Androgenic Steroid Dependence. Pharmacotherapy 2012. [DOI: 10.1002/phar.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Eric J. Ip
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
| | - Debbie H. Lu
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
| | - Mitchell J. Barnett
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
| | - Michael J. Tenerowicz
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
| | - Justin C. Vo
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
| | - Paul J. Perry
- Department of Pharmacy Practice; Touro University California College of Pharmacy; Vallejo; California
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Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 2012; 31:757-66. [PMID: 21923602 DOI: 10.1592/phco.31.8.757] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To contrast the characteristics of two groups of men who participated in strength-training exercise-those who reported anabolicandrogenic steroid (AAS) use versus those who reported no AAS use. DESIGN Analysis of data from the Anabolic 500, a cross-sectional survey. PARTICIPANTS Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009. MEASUREMENTS AND MAIN RESULTS Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005). CONCLUSION Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, Touro University College of Pharmacy, Vallejo, California 94592, USA.
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Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The Touro 500: An In-depth Analysis of 506 Steroid Users and 771 Non-Steroid Users. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402365.24715.02] [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: 11/21/2022]
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Knapp KK, Shah BM, Barnett MJ. The pharmacist Aggregate Demand Index to explain changing pharmacist demand over a ten-year period. Am J Pharm Educ 2010; 74:189. [PMID: 21436930 PMCID: PMC3058450 DOI: 10.5688/aj7410189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 06/08/2010] [Accepted: 09/15/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To describe Aggregate Demand Index (ADI) trends from 1999-2010; to compare ADI time trends to concurrent data for US unemployment levels, US entry-level pharmacy graduates, and US retail prescription growth rate; and to determine which variables were significant predictors of ADI. METHODS Annual ADI data (dependent variable) were analyzed against annual unemployment rates, annual number of pharmacy graduates, and annual prescription growth rate (independent variables). RESULTS ADI data trended toward lower demand levels for pharmacists since late 2006, paralleling the US economic downturn. National ADI data were most highly correlated with unemployment (p < 0.001), then graduates (p < 0.006), then prescription growth rate (p < 0.093). A hierarchical model with the 3 variables was significant (p = 0.019), but only unemployment was a significant ADI predictor. Unemployment and ADI also were significantly related at the regional, division, and state levels. CONCLUSIONS The ADI is strongly linked to US unemployment rates. The relationship suggests that an improving economy might coincide with increased pharmacist demand. Predictable increases in future graduates and other factors support revisiting the modeling process as new data accumulate.
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Seftel MD, Paulson K, Doocey R, Song K, Czaykowski P, Coppin C, Forrest D, Hogge D, Kollmansberger C, Smith CA, Shepherd JD, Toze CL, Murray N, Sutherland H, Nantel S, Nevill TJ, Barnett MJ. Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study. Bone Marrow Transplant 2010; 46:852-7. [PMID: 21042312 DOI: 10.1038/bmt.2010.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Failure of cisplatin-based chemotherapy in advanced germ cell tumour (GCT) is associated with a poor outcome. High-dose chemotherapy and auto-SCT is one therapeutic option, although the long-term outcome after this procedure is unclear. We conducted a multicentre cohort study of consecutive patients undergoing a single auto-SCT for GCT between January 1986 and December 2004. Of 71 subjects, median follow-up is 10.1 years. OS at 5 years is 44.7% (95% confidence interval (CI) 32.9-56.5%) and EFS is 43.5% (95% CI 31.4-55.1%). There were seven (10%) treatment-related deaths within 100 days of auto-SCT. Three (4.2%) patients developed secondary malignancies. Of 33 relapses, 31 occurred within 2 years of auto-SCT. Two very late relapses were noted 13 and 11 years after auto-SCT. In multivariate analysis, favourable outcome was associated with IGCCC (International Germ Cell Consensus Classification) good prognosis disease at diagnosis, primary gonadal disease and response to salvage chemotherapy. We conclude that auto-SCT results in successful outcome for a relatively large subgroup of patients with high-risk GCT. Late relapses may occur, a finding not previously reported.
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Affiliation(s)
- M D Seftel
- Section of Medical Oncology/Hematology, University of Manitoba, Canada.
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Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The touro 12-step: a systematic guide to optimizing survey research with online discussion boards. J Med Internet Res 2010; 12:e16. [PMID: 20507843 PMCID: PMC2956227 DOI: 10.2196/jmir.1314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 08/28/2009] [Accepted: 10/30/2009] [Indexed: 11/25/2022] Open
Abstract
The Internet, in particular discussion boards, can provide a unique opportunity for recruiting participants in online research surveys. Despite its outreach potential, there are significant barriers which can limit its success. Trust, participation, and visibility issues can all hinder the recruitment process; the Touro 12-Step was developed to address these potential hurdles. By following this step-by-step approach, researchers will be able to minimize these pitfalls and maximize their recruitment potential via online discussion boards.
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Mar E, Barnett MJ, T-L Tang T, Sasaki-Hill D, Kuperberg JR, Knapp K. Impact of previous pharmacy work experience on pharmacy school academic performance. Am J Pharm Educ 2010; 74:42. [PMID: 20498735 PMCID: PMC2865408 DOI: 10.5688/aj740342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 06/22/2009] [Accepted: 09/07/2009] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To determine whether students' previous pharmacy-related work experience was associated with their pharmacy school performance (academic and clinical). METHODS The following measures of student academic performance were examined: pharmacy grade point average (GPA), scores on cumulative high-stakes examinations, and advanced pharmacy practice experience (APPE) grades. The quantity and type of pharmacy-related work experience each student performed prior to matriculation was solicited through a student survey instrument. Survey responses were correlated with academic measures, and demographic-based stratified analyses were conducted. RESULTS No significant difference in academic or clinical performance between those students with prior pharmacy experience and those without was identified. Subanalyses by work setting, position type, and substantial pharmacy work experience did not reveal any association with student performance. A relationship was found, however, between age and work experience, ie, older students tended to have more work experience than younger students. CONCLUSIONS Prior pharmacy work experience did not affect students' overall academic or clinical performance in pharmacy school. The lack of significant findings may have been due to the inherent practice limitations of nonpharmacist positions, changes in pharmacy education, and the limitations of survey responses.
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Affiliation(s)
- Ellena Mar
- Touro University College of Pharmacy, Vallejo, CA, USA
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Mészáros K, Barnett MJ, McDonald K, Wehring H, Evans DJ, Sasaki-Hill D, Goldsmith PC, Knapp KK. Progress examination for assessing students' readiness for advanced pharmacy practice experiences. Am J Pharm Educ 2009; 73:109. [PMID: 19885078 PMCID: PMC2769531 DOI: 10.5688/aj7306109] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [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: 12/03/2008] [Accepted: 02/06/2009] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To create a valid assessment tool to evaluate the readiness of pharmacy students for advanced pharmacy practice experiences (APPEs). DESIGN The Triple Jump Examination (TJE) was tailored to the 4-year, 2-plus-2 curriculum of the College. It consisted of (1) a written, case-based, closed-book examination, (2) a written, case-based open-book examination, and (3) an objective structured clinical examination (OSCE). The TJE was administered at the end of each 4 academic semesters. Progression of students to APPEs was dependent on achieving a preset minimum cumulative (weighted average) score in the 4 consecutive TJE examinations. ASSESSMENT The predictive utility of the examination was demonstrated by a strong correlation between the cumulative TJE scores and the preceptor grades in the first year (P3) of APPEs (r = 0.60, p > 0.0001). Reliability of the TJE was shown by strong correlations among the 4 successive TJE examinations. A survey probing the usefulness of TJE indicated acceptance by both students and faculty members. CONCLUSION The TJE program is an effective tool for the assessment of pharmacy students' readiness for the experiential years. In addition, the TJE provides guidance for students to achieve preparedness for APPE.
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Affiliation(s)
- Károly Mészáros
- College of Pharmacy, Touro University, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592, USA.
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Abou-Mourad YR, Lau BC, Barnett MJ, Forrest DL, Hogge DE, Nantel SH, Nevill TJ, Shepherd JD, Smith CA, Song KW, Sutherland HJ, Toze CL, Lavoie JC. Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens. Bone Marrow Transplant 2009; 45:295-302. [PMID: 19597425 DOI: 10.1038/bmt.2009.128] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed the late outcomes of 429 long-term survivors post allogeneic hematopoietic SCT (allo-HSCT) who received transplant in our center between 1981 and 2002, and were free of their primary disease for > or =2 years after allo-HSCT. Late recurrent primary malignancy was found in 58 (13.5%) patients and was the primary cause of late death. A total of 37 (8.6%) patients died of non-relapse causes at a median of 5.5 years (range, 2-15.6 years) post allo-HSCT. The major non-relapse causes of death were chronic GVHD (cGVHD), secondary malignancy and infection. The probabilities of OS and EFS were 85% (95% cumulative incidence (CI) (81-89%)) and 79% (95% CI (74-83%)) at 10 years, respectively. Long-term allo-HSCT survivors were evaluated for late complications (median follow-up, 8.6 years (range, 2.3-22.8 years)). cGVHD was diagnosed in 196 (53.1%) survivors. The endocrine and metabolic complications were hypogonadism in 134 (36.3%) patients, osteopenia/osteoporosis in 90 (24.4%), dyslipidemia in 33 (8.9%), hypothyroidism in 28 (7.6%) and diabetes in 28 (7.6%). Hypertension was diagnosed in 79 (21.4%), renal impairment in 70 (19.0%), depression in 40 (10.8%) and sexual dysfunction in 33 (8.9%) survivors. We conclude that in patients who receive allo-HSCT as treatment for hematological malignancy and who are free of their original disease 2 years post transplant, mortality is low and the probability of durable remission is high. Lifelong surveillance is recommended.
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Affiliation(s)
- Y R Abou-Mourad
- Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Gallagher G, Chhanabhai M, Song KW, Barnett MJ. Unusual presentation of precursor T-cell lymphoblastic lymphoma: involvement limited to breasts and skin. Leuk Lymphoma 2009; 48:428-30. [PMID: 17325911 DOI: 10.1080/10428190601059712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Greenwood MJ, Seftel MD, Richardson C, Barbaric D, Barnett MJ, Bruyere H, Forrest DL, Horsman DE, Smith C, Song K, Sutherland HJ, Toze CL, Nevill TJ, Nantel SH, Hogge DE. Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia. Leuk Lymphoma 2009; 47:1245-52. [PMID: 16923553 DOI: 10.1080/10428190600572673] [Citation(s) in RCA: 69] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute myeloid leukemia (AML) presenting with a high leukocyte count has been associated with an increase in induction mortality and poor results in a number of other survival measures. However, the level at which an elevated leukocyte count has prognostic significance in AML remains unclear. In this report on a series of 375 adult (non-M3) AML patients undergoing induction chemotherapy at a single institution, leukocyte count analyzed as a continuous variable is shown to be a better predictor of induction death (ID) and overall survival (OS) than a leukocyte count of > or = 100 x 10(9)/L, a value characteristically associated with "hyperleukocytosis" (HL). In this patient cohort, a presenting leukocyte count of > or = 30 x 10(9)/L had high sensitivity and specificity for predicting ID, and both performance status (PS) and leukocyte count more accurately predicted for ID than age. Considering these parameters in newly-diagnosed AML patients may facilitate the development of strategies for reducing induction mortality.
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Affiliation(s)
- M J Greenwood
- The Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology and Hematopathology, Vancouver General Hospital, BC Cancer Agency and the University of British Columbia, Vancouver, BC, Canada
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Barnett MJ, Frank J, Wehring H, Newland B, VonMuenster S, Kumbera P, Halterman T, Perry PJ. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009; 15:18-31. [PMID: 19125547 PMCID: PMC10438125 DOI: 10.18553/jmcp.2009.15.1.18] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time. OBJECTIVES To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization. METHODS Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated annually for medical care inflation. RESULTS From a database of nearly 100,000 MTM claims, a convenience sample of 50 plan sponsors was selected. After exclusion of claims with missing or potentially duplicate data, there were 76,148 claims for 23,798 patients from community pharmacy MTM providers in 47 states. Over the 7-year period from January 1, 2000, through December 31, 2006, the mean ([SD] median) pharmacy reimbursement was $8.44 ([$5.19] $7.00) per MTM service, and the mean ([SD] median) ECA was $93.78 ([$1,022.23] $5.00). During the 7-year period, pharmacist provided MTM interventions changed from primarily education and monitoring for new or changed prescription therapies to prescriber consultations regarding cost-efficacy management (Pearson chi-square P<0.001). Services also shifted from claims involving acute medications (e.g. penicillin antibiotics, macrolide antibiotics, and narcotic analgesics) to services involving chronic medications (e.g., lipid lowering agents, angiotensin-converting enzyme [ACE] inhibitors, and beta-blockers; P<0.001), resulting in significant changes in the therapeutic classes associated with MTM claims and an increase in the proportion of older patients served (P<0.001). These trends resulted in higher pharmacy reimbursements and greater ECA per claim over time (P<0.001). CONCLUSION MTM interventions over a 7-year period evolved from primarily the provision of patient education involving acute medications towards consultation-type services for chronic medications. These changes were associated with increases in reimbursement amounts and pharmacist-estimated cost savings. It is uncertain if this shift in service type is a result of clinical need, documentation requirements, or reimbursement opportunities.
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Affiliation(s)
- Mitchell J Barnett
- Touro University-California, College of Pharmacy, 1310 Johnson Ave, Vallejo, CA 94592, USA.
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Ramadan KM, Connors JM, Al-Tourah AJ, Song KW, Gascoyne RD, Barnett MJ, Nevill TJ, Shepherd JD, Nantel SH, Sutherland HJ, Forrest DL, Hogge DE, Lavoie JC, Abou-Mourad YR, Chhanabhai M, Voss NJ, Brinkman RR, Smith CA, Toze CL. Allogeneic SCT for relapsed composite and transformed lymphoma using related and unrelated donors: long-term results. Bone Marrow Transplant 2008; 42:601-8. [DOI: 10.1038/bmt.2008.220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Halim TY, Song KW, Barnett MJ, Forrest DL, Hogge DE, Nantel SH, Nevill TJ, Shepherd JD, Smith CA, Sutherland HJ, Toze CL, Lavoie JC. Positive impact of selective outpatient management of high-risk acute myelogenous leukemia on the incidence of septicemia. Ann Oncol 2007; 18:1246-52. [PMID: 17442662 DOI: 10.1093/annonc/mdm112] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Curative intent chemotherapy for acute myelogenous leukemia (AML) leads to prolonged severe neutropenia, during which patients are highly susceptible to infection. Traditionally these high-risk patients were treated as inpatients. Our center recently implemented a selective ambulatory management policy for AML patients undergoing chemotherapy. MATERIALS AND METHODS A retrospective analysis was conducted to assess the occurrence of septicemia in AML patients treated over a 5 years period with curative intent chemotherapy. This review encompasses a change in policy from primarily inpatient care to selective outpatient management coupled with prophylactic antibiotic therapy. RESULTS A total of 294 patients, receiving 623 cycles of chemotherapy were identified. A significant decrease in septicemia was observed from the inpatient to outpatient cohort (22% to 13% P < 0.05), which correlated with the shift towards outpatient treatment of consolidation cycles. A shift from Gram-negative to Gram-positive organisms as the cause of septicemia was also detected in the outpatient cohort, likely due to the introduction of ciprofloxacin prophylaxis. No significant emerging resistance and no septicemia-related mortality were noted in the outpatient cohort. CONCLUSION The observed decrease in the incidence of septicemia in the ambulatory cohort adds supportive evidence to the feasibility of selective outpatient management of AML patients with respect to infectious complications.
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Affiliation(s)
- T Y Halim
- Department of Immunology and Microbiology, University of British Columbia, Vancouver, Canada
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Kaboli PJ, Shivapour DM, Henderson MS, Barnett MJ, Ishani A, Carter BL. Patient and Provider Perceptions of Hypertension Treatment: Do They Agree? J Clin Hypertens (Greenwich) 2007; 9:416-23. [PMID: 17541326 PMCID: PMC8109969 DOI: 10.1111/j.1524-6175.2007.06492.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of our study was to explore physician and patient attitudes regarding hypertension management. One hundred forty-five primary care providers and 189 patients with hypertension at 6 Veterans Administration clinics completed a hypertension survey. Fifty-one percent of patients were at their blood pressure goal, 58% were on guideline-concordant therapy, and 31% achieved both. Patients and providers agreed that physicians were a "very/extremely" useful source of information but differed in perceived value of pharmacists, educational material, advertising, and the Internet. They also agreed on the value of preventing cardiovascular events but differed in their perceptions of the importance of medication costs, side effects, and national guidelines. Blood pressure control and guideline-concordant therapy was higher than most prior reports, but with opportunity for improvement. Patients and providers differed in perceived value of various aspects of hypertension management; this information may help to determine trial design and quality improvement strategies in the future.
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Affiliation(s)
- Peter J Kaboli
- Center for Research in the Implementation of Innovative Strategies in Practice (CSIISP) at the Iowa City Veterans Affairs Healthcare Systems, Iowa City, IA 52246, USA.
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Song KW, Barnett MJ, Gascoyne RD, Chhanabhai M, Forrest DL, Hogge DE, Lavoie JC, Nantel SH, Nevill TJ, Shepherd JD, Smith CA, Sutherland HJ, Toze CL, Voss NJ, Connors JM. Primary therapy for adults with T-cell lymphoblastic lymphoma with hematopoietic stem-cell transplantation results in favorable outcomes. Ann Oncol 2006; 18:535-40. [PMID: 17158775 DOI: 10.1093/annonc/mdl426] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Controversy exists regarding the role of high-dose therapy followed by stem-cell transplant (SCT) in the treatment of T-cell lymphoblastic lymphoma (T-LBL). We conducted an intention-to-treat analysis of the strategy of SCT as definitive treatment of T-LBL. PATIENTS AND METHODS From July 1987 to March 2005, 34 adults with T-LBL were diagnosed and treated in British Columbia. Treatment, before planned SCT, consisted of a non-Hodgkin's lymphoma (NHL)/acute lymphoblastic leukemia hybrid chemotherapy protocol (28 patients) or a standard NHL chemotherapy regimen (six patients). RESULTS Median follow-up of the 23 surviving patients is 51 months (range 13-142 months). Twenty-nine proceeded to SCT (four allogeneic, 25 autologous). For all 34 patients, 4-year overall survival (OS) and event-free survival (EFS) are 72% and 68%, respectively. For patients proceeding to SCT, the 4-year OS and EFS are 79% and 73%, respectively. All patients who received allografts are alive without disease at 38-141 months since diagnosis. For patients who received autografts, the 4-year EFS is 69%. Bone marrow involvement was a significant prognostic factor predicting for a worse survival (P = 0.02). CONCLUSION A treatment strategy for adults with chemosensitive T-LBL that includes planned consolidation with SCT in first response produces favorable long-term outcome.
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Affiliation(s)
- K W Song
- The Leukemia/Bone Marrow Transplant Program of British Columbia, The Vancouver Hospital and Health Science Center, Division of Medical Oncology, British Columbia Cancer Agency and University of British Columbia, Canada.
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Perry PJ, Argo TR, Barnett MJ, Liesveld JL, Liskow B, Hernan JM, Trnka MG, Brabson MA. The Association of Alcohol-Induced Blackouts and Grayouts to Blood Alcohol Concentrations. J Forensic Sci 2006; 51:896-9. [PMID: 16882236 DOI: 10.1111/j.1556-4029.2006.00161.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The primary aim of this study was to investigate the association between measured blood alcohol concentration (BAC) and the presence and degree of amnesia (no amnesia, grayout, or blackout) in actively drinking subjects. A secondary aim was to determine potential factors other than BAC that contribute to the alcohol-induced memory loss. An interview questionnaire was administered to subjects regarding a recent alcohol associated arrest with a documented BAC greater than 0.08 g/dL for either public intoxication, driving under the influence, or under age drinking was administered. Demographic variables collected included drinking history, family history of alcoholism, presence of previous alcohol-related memory loss during a drinking episode, and drinking behavior during the episode. Memory of the drinking episode was evaluated to determine if either an alcohol-induced grayout (partial anterograde amnesia) or blackout (complete anterograde amnesia) occurred. Differences in (1) mean total number of drinks ingested before arrest, (2) gulping of drinks, and (3) BAC at arrest were found for those having blackouts compared with no amnesia; while differences in drinking more than planned were found between the no amnesia and grayout groups. A strong linear relationship between BAC and predicted probability of memory loss, particularly for blackouts was obvious. This finding clinically concludes that subjects with BAC of 310 g/dL or greater have a 0.50 or greater probability of having an alcoholic blackout.
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Affiliation(s)
- Paul J Perry
- Clinical and Administrative Pharmacy Division, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA.
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Ness J, Hoth A, Barnett MJ, Shorr RI, Kaboli PJ. Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. ACTA ACUST UNITED AC 2006; 4:42-51. [PMID: 16730620 DOI: 10.1016/j.amjopharm.2006.03.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of drugs with anticholinergic adverse effects is often deemed inappropriate in elderly (aged > or = 65 years) patients, yet studies continue to show extensive use in this population at high risk for adverse drug events (ADEs). The burden of drug-related anticholinergic symptoms in community-dwelling elderly patients has not been well described. OBJECTIVE The aim of this study was to assess the prevalence of anticholinergic symptoms, corresponding symptom burden, and anticholinergic-related ADEs in a sample of community-dwelling elderly veterans. METHODS This prospective cohort study was conducted at the primary care clinics at the Veterans Affairs Medical Center (VAMC), Iowa City, Iowa. The study sample included randomly selected patients with intact cognitive function attending the VAMC and prescribed > or = 5 scheduled medications. Data on current prescription and nonprescription drug use were elicited by a trained research assistant and a clinical pharmacist from patient interviews and electronic medical records. The prevalence and severity of 7 anticholinergic symptoms (dry mouth, constipation, blurred vision, confusion, urinary hesitation, dry eyes, and drowsiness) were assessed at baseline. The occurrence of ADEs at 12 weeks was compared between patients using anticholinergic drugs and those not using them. RESULTS A total of 532 patients were included (97.9% men; mean age, 74.3 years; 27.1% used at least 1 anticholinergic drug). Twenty-two anticholinergic drugs (16 prescription medications, 6 over-the-counter medications) were identified. The mean number of anticholinergic symptoms was significantly higher in the group using anticholinergic drugs (3.1 vs 2.5; P < 0.01). However, only 2 symptoms were statistically more prevalent in the group using anticholinergic drugs: dry mouth (57.6% vs 45.6%) and constipation (42.4% vs 29.4%) (both, P < 0.01). At 12 weeks, only 1 (0.8%) patient in the group using anticholinergic drugs reported an ADE considered related to an anticholinergic drug. CONCLUSIONS Anticholinergic drug use was common (27.1%) in these elderly veterans with intact cognitive function. The mean number of anticholinergic symptoms was significantly greater in this group, and the prevalences of dry mouth and constipation were significantly higher in the group using anticholinergic drugs (all, P < 0.01). Anticholinergic-related ADEs were rare (0.8%). Although anticholinergic drugs should generally be avoided in the elderly, individual risks and benefits for a patient should be considered.
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Affiliation(s)
- Jose Ness
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52246, USA
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Barnett MJ, Perry PJ, Langstaff JD, Kaboli PJ. Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs. J Manag Care Pharm 2006; 12:362-70. [PMID: 16792442 PMCID: PMC10438179 DOI: 10.18553/jmcp.2006.12.5.362] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. OBJECTIVE To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. METHODS A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. RESULTS Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P <0.001), and in each classification: always avoid (2% vs. 5%, P <0.001), rarely appropriate (8% vs. 13%, P<0.001), and some indications (15% vs. 17%, P <0.001). The rate of inappropriate drug use was lower in the VA compared with the private sector for males (21% vs. 24%, P <0.001) and females (28% vs. 32%, P <0.001). Differences were consistent when stratified by age. CONCLUSION Compared with private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.
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Affiliation(s)
- Mitchell J Barnett
- Health Services Research Specialist, Iowa City VAMC, Highway 1, Iowa City, IA 52246, USA.
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Abstract
OBJECTIVE To evaluate the use of typical and atypical antipsychotic medications and associated in-hospital mortality in a group of Veterans Administration (VA) patients with pneumonia. METHOD Our cohort consisted of 14,057 VA patients admitted for pneumonia in fiscal year (FY) 2003. Exposure to typical and atypical antipsychotics and other neuropsychiatric drugs was based on a prescription within 120 days preceding admission. Multivariate models determined the odds of mortality associated with each drug class and risk adjusted for comorbidity, admission source, demographic factors, and concurrent mental health conditions. The referent group for each analysis was pneumonia patients not receiving neuropsychiatric drugs. RESULTS In adjusted analyses, the odds of in-hospital mortality for VA patients admitted with pneumonia was higher for recent exposure to typical antipsychotics (OR = 1.51, 95% CI = 1.04-2.19; P = 0.03) when compared to patients not receiving neuropsychiatric medications. Patients exposed to atypical antipsychotics (OR = 1.20, 95% CI = 0.96-1.50, P = .10), tricyclic antidepressants (OR = 1.20, 95% CI = 0.44-1.55; P = 0.15), other antidepressants (OR = 1.07, 95% CI = 0.93-1.23; P = 0.37), or mood stabilizers (OR = 0.91, 95% CI = 0.73-1.14; P = 0.41) had no significant difference in in-hospital mortality. CONCLUSION In spite of recent safety concerns for atypical antipsychotics, we found no increased risk of mortality in acutely ill pneumonia patients. Rather, we found a higher adjusted mortality rate for patients taking typical antipsychotics. The contrasting mortality risks for patients taking typical and atypical antipsychotics may represent unmeasured severity of illness or comorbidity. Regardless, any antipsychotics should be used with caution and the efficacy and safety of alternative agents should be considered.
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Affiliation(s)
- Mitchell J Barnett
- The Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Administration Hospital, Iowa City, IA 52246, USA.
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48
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Abstract
STUDY OBJECTIVES To determine whether an association exists between health care resource use and beta-blocker therapy in patients with asthma or chronic obstructive pulmonary disease (COPD), and to determine whether any significant differences exist between type of beta-blocker agent administered and resource use. DESIGN Retrospective cohort study. DATA SOURCE Three Veterans Administration (VA) databases with information from hospitals and clinics in Iowa and Nebraska. Patients. A total of 8390 veterans with a diagnosis of asthma or COPD receiving treatment with a beta-blocker or another cardiovascular agent. MEASUREMENTS AND MAIN RESULTS Clinic visits and hospital admissions for asthma or COPD that occurred in 2000-2001 were identified using electronic administrative data files. Analyses were adjusted for comorbidity and patient demographics. Mean patient age was 67 years, and 97% of the patients were men. In unadjusted analyses, patients taking beta-blockers had more hospital admissions, similar inpatient length of stay (LOS), and fewer outpatient clinic visits for asthma or COPD. In adjusted analyses, however, no difference was noted in the odds of hospital admission or in LOS, and patients had fewer clinic visits related to asthma or COPD. The hazard ratio for hospital admission for asthma or COPD during the observation year was similar for patients taking and not taking beta-blockers, and no difference was noted with selective versus nonselective beta-blockers. However, the hospital admission rate was lower with atenolol than metoprolol. CONCLUSION Patients taking beta-blockers did not have more hospital admissions or clinic visits for their asthma or COPD than patients not taking these agents. When clinically indicated, beta-blockers-especially atenolol-should be considered for patients with asthma or COPD.
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Affiliation(s)
- Mitchell J Barnett
- Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Administration Medical Center, University of Iowa, Iowa City, Iowa 52246, USA
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Welke KF, Barnett MJ, Sarrazin MSV, Rosenthal GE. Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2005; 80:2114-9. [PMID: 16305854 DOI: 10.1016/j.athoracsur.2005.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 05/06/2005] [Accepted: 05/10/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND While prior research has found an inverse relationship between hospital volume and mortality after coronary artery bypass graft surgery (CABG), the use of volume as a proxy for quality and a means for selecting hospitals is controversial. The objective of this study is to quantify the relationship between hospital volume alone and CABG mortality. METHODS A retrospective cohort of 948,093 Medicare patients undergoing CABG in 870 US hospitals from 1996 to 2001 was categorized into quintiles, based on hospital CABG volume. Hospitals were also classified by volume criterion proposed by the Leapfrog Group. Logistic regression was used to adjust hospital mortality rates (in-hospital or within 30 days after CABG) for patient characteristics; discrimination of the volume categories was assessed by the c statistic. RESULTS The range in risk-adjusted mortality for hospitals within the quintiles was substantial: 1% to 17% at very low, 2% to 12% at low, 2% to 10% at medium, 2% to 9% at high, and 3% to 11% at very high volume hospitals. Moreover, volume alone was a poor discriminator of mortality (c statistic = 0.52). Similar variation in adjusted mortality was seen within the Leapfrog low-volume (1% to 17%) and high-volume groups (2% to 11%), and the Leapfrog criterion was a poor discriminator of mortality (c statistic = 0.51). Of the 660 low-volume Leapfrog hospitals, 253 (38%) had risk-adjusted mortality rates that were similar to or lower than the overall risk-adjusted mortality of high-volume hospitals (5.2%). CONCLUSIONS Volume alone, as a discriminator of mortality, is only slightly better than a coin flip (c statistic of 0.50).
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Affiliation(s)
- Karl F Welke
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
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50
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Toze CL, Galal A, Barnett MJ, Shepherd JD, Conneally EA, Hogge DE, Nantel SH, Nevill TJ, Sutherland HJ, Connors JM, Voss NJ, Kiss TL, Messner HA, Lavoie JC, Forrest DL, Song KW, Smith CA, Lipton J. Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease. Bone Marrow Transplant 2005; 36:825-30. [PMID: 16151430 DOI: 10.1038/sj.bmt.1705130] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n=20, 67%) or unrelated (n=10) donors, at the Princess Margaret Hospital (Toronto) (n=20) or the Leukemia/BMT Program of BC (Vancouver) (n=10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3-13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4-10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR=0.008, P=0.01) and chronic (RR=0.006, P=0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR=3.6, P=0.02) and decreased OS (RR of death=3.4, P=0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse.
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MESH Headings
- Adult
- Bone Marrow Transplantation/methods
- Disease-Free Survival
- Female
- Graft vs Host Disease/etiology
- Graft vs Host Disease/mortality
- Graft vs Leukemia Effect/radiation effects
- Histocompatibility Testing/methods
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Recurrence
- Remission Induction/methods
- Retrospective Studies
- Tissue Donors
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Whole-Body Irradiation/methods
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Affiliation(s)
- C L Toze
- Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Cancer Agency and University of BC, Vancouver, British Columbia, Canada.
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