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Jugl S, Winterstein AG. Ectopic Pregnancy Risk and Levonorgestrel-Releasing Intrauterine Systems. JAMA 2023; 330:378. [PMID: 37490092 DOI: 10.1001/jama.2023.8888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Sebastian Jugl
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
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Sajdeya R, Mardini MT, Tighe PJ, Ison RL, Bai C, Jugl S, Hanzhi G, Zandbiglari K, Adiba FI, Winterstein AG, Pearson TA, Cook RL, Rouhizadeh M. Developing and validating a natural language processing algorithm to extract preoperative cannabis use status documentation from unstructured narrative clinical notes. J Am Med Inform Assoc 2023; 30:1418-1428. [PMID: 37178155 PMCID: PMC10354766 DOI: 10.1093/jamia/ocad080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE This study aimed to develop a natural language processing algorithm (NLP) using machine learning (ML) techniques to identify and classify documentation of preoperative cannabis use status. MATERIALS AND METHODS We developed and applied a keyword search strategy to identify documentation of preoperative cannabis use status in clinical documentation within 60 days of surgery. We manually reviewed matching notes to classify each documentation into 8 different categories based on context, time, and certainty of cannabis use documentation. We applied 2 conventional ML and 3 deep learning models against manual annotation. We externally validated our model using the MIMIC-III dataset. RESULTS The tested classifiers achieved classification results close to human performance with up to 93% and 94% precision and 95% recall of preoperative cannabis use status documentation. External validation showed consistent results with up to 94% precision and recall. DISCUSSION Our NLP model successfully replicated human annotation of preoperative cannabis use documentation, providing a baseline framework for identifying and classifying documentation of cannabis use. We add to NLP methods applied in healthcare for clinical concept extraction and classification, mainly concerning social determinants of health and substance use. Our systematically developed lexicon provides a comprehensive knowledge-based resource covering a wide range of cannabis-related concepts for future NLP applications. CONCLUSION We demonstrated that documentation of preoperative cannabis use status could be accurately identified using an NLP algorithm. This approach can be employed to identify comparison groups based on cannabis exposure for growing research efforts aiming to guide cannabis-related clinical practices and policies.
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Affiliation(s)
- Ruba Sajdeya
- Department of Epidemiology, College of Public Health & Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mamoun T Mardini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick J Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ronald L Ison
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Chen Bai
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sebastian Jugl
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Gao Hanzhi
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Kimia Zandbiglari
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Farzana I Adiba
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Thomas A Pearson
- Department of Epidemiology, College of Public Health & Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health & Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Masoud Rouhizadeh
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Sajdeya R, Fechtel HJ, Spandau G, Goodin AJ, Brown JD, Jugl S, Smolinski NE, Winterstein AG, Cook RL, Wang Y. Protocol of a Combined Cohort and Cross-Sectional Study of Persons Receiving Medical Cannabis in Florida, USA: The Medical Marijuana and Me (M 3) Study. Med Cannabis Cannabinoids 2023; 6:46-57. [PMID: 37261066 PMCID: PMC10228286 DOI: 10.1159/000530052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/01/2023] [Indexed: 06/02/2023] Open
Abstract
Significant knowledge gaps regarding the effectiveness and safety of medical cannabis (MC) create clinical challenges for MC physicians, making treatment recommendations and patients choosing treatment among the growing number of options offered in dispensaries. Additionally, data describing the characteristics of people who use MC and the products and doses they receive are lacking. The Medical Marijuana and Me (M3) Study was designed to collect patient-centered data from MC users. We aim to describe preferred MC use patterns that patients report as "most effective" for specific health conditions and symptoms, identify user characteristics associated with such use patterns, characterize adverse effects, including cannabis use disorder, identify products and patient characteristics associated with adverse effects, describe concurrent prescription medication use, and identify concomitant medication use with potential drug-MC interaction risk. Among MC initiators, we also aim to quantify MC use persistence and identify reasons for discontinuation, assess MC utilization pattern trajectories over time, describe outcome trajectories of primary reasons for MC use and determine factors associated with different trajectories, track changes in concomitant substance and medication use after MC initiation, and identify factors associated with such changes. M3 is a combined study comprised of: (1) a prospective cohort of MC initiators completing surveys at enrollment, 3 months, and 9 months after MC initiation and (2) a cross-sectional study of current MC users. A multidisciplinary committee including researchers, physicians, pharmacists, patients, and dispensary personnel designed and planned study protocols, established study measures, and created survey questionnaires. M3 will recruit 1,000-1,200 participants aged ≥18 years, with ∼50% new and ∼50% current MC patients from MC clinics across Florida, USA. Study enrollment started in May 2022 and will continue until the target number of patients is achieved. Survey domains include sociodemographic characteristics, physical and mental health, cannabis use history, reasons for MC use and discontinuation, MC products and use patterns, concurrent use of prescription medications and other substances, and side effects. Data collected in the M3 Study will be available for interested researchers affiliated with the Consortium for Medical Marijuana Clinical Outcomes Research. The M3 Study and Databank will be the largest cohort of current and new MC users in Florida, USA, which will provide data to support MC-related health research necessary to inform policy and clinical practice and ultimately improve patient outcomes.
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Affiliation(s)
- Ruba Sajdeya
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Hannah J. Fechtel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Gabriel Spandau
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Agricultural Education and Communication, College of Agricultural and Life Sciences, University of Florida, Gainesville, Florida, USA
| | - Amie J. Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Joshua D. Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Sebastian Jugl
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Nicole E. Smolinski
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, Gainesville, Florida, USA
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Jugl S, Goodin AJ, Brown JD. Climbing the Evidence Pyramid: Dosing Considerations for Medical Cannabis in the Management of Chronic Pain. Med Cannabis Cannabinoids 2023; 6:41-45. [PMID: 37124080 PMCID: PMC10134049 DOI: 10.1159/000530251] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Sebastian Jugl
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Amie J. Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Joshua D. Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
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Sajdeya R, Jugl S, Cook R, Brown JD, Goodin A. Clinical Considerations for Cannabis Use and Cardiovascular Health. Med Cannabis Cannabinoids 2022; 5:120-127. [PMID: 36467784 PMCID: PMC9710318 DOI: 10.1159/000526731] [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] [Received: 06/14/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ruba Sajdeya
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Sebastian Jugl
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida, USA
| | - Robert Cook
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Joshua D. Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, Florida, USA
- *Amie Goodin,
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Jean-Jacques J, Cook R, Winterstein AG, Goodin A, Brown JD, Jugl S, Wang Y. Priorities for Medical Marijuana Research from the Perspective of Physicians, Dispensary Owners/Staff, and Patients: A Survey Study. Med Cannabis Cannabinoids 2021; 4:107-113. [DOI: 10.1159/000518105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> More patients are turning to medical marijuana as an alternative treatment, yet there are apparent knowledge gaps on the risk benefit of medical marijuana for a variety of indications. This study aimed to determine the priorities for medical marijuana research from the perspective of multiple stakeholders including patients, clinicians, and industry representatives. <b><i>Methods:</i></b> An anonymous survey was administered to attendees of the 2019 American Medical Marijuana Physicians Association annual meeting in Orlando, Florida. Respondents completed the survey on paper or smartphone via Qualtrics. The survey included questions on demographics and medical marijuana research priorities under the following broad categories: clinical conditions, safety issues, marijuana types, populations, and others. <b><i>Results:</i></b> Forty-six participants (56.5% female, mean age = 51.6 ± 14.1) responded to the survey. A majority were medical marijuana qualified physicians in Florida (56.5%), 30.5% other physicians or clinicians, and 21.7% medical marijuana patients (multiple choices allowed). The top conditions prioritized for research by this group were chronic pain, cancer, and anxiety, and the top priority safety issues were dosing/product choice, complications from smoking/vaping, and drug interactions. Regarding marijuana types, the group prioritized research on THC/CBD ratios, different modes of consumption, and terpenes. <b><i>Conclusions:</i></b> Findings from this survey indicate that medical marijuana stakeholders perceived a broad range of research topics as priorities. More research is needed to advance the evidence in these areas and provide guidance to patients, physicians, and the medical marijuana industry.
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Sarayani A, Jugl S, Winterstein AG. Letter by Sarayani et al Regarding Article, "Association Between Immune Checkpoint Inhibitors With Cardiovascular Events and Atherosclerotic Plaque". Circulation 2021; 143:e1031-e1032. [PMID: 34152796 DOI: 10.1161/circulationaha.120.052678] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amir Sarayani
- Center for Drug Evaluation and Safety and Department of Pharmaceutical Outcome and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Sebastian Jugl
- Center for Drug Evaluation and Safety and Department of Pharmaceutical Outcome and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Almut G Winterstein
- Center for Drug Evaluation and Safety and Department of Pharmaceutical Outcome and Policy, College of Pharmacy, University of Florida, Gainesville
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Jugl S, Sajdeya R, Morris EJ, Goodin AJ, Brown JD. Much Ado about Dosing: The Needs and Challenges of Defining a Standardized Cannabis Unit. Med Cannabis Cannabinoids 2021; 4:121-124. [PMID: 35224432 PMCID: PMC8832202 DOI: 10.1159/000517154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 08/27/2023] Open
Affiliation(s)
- Sebastian Jugl
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Ruba Sajdeya
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie J. Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Joshua D. Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA
- Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Sajdeya R, Shavers A, Jean-Jacques J, Costales B, Jugl S, Crump C, Wang Y, Manfio L, Pipitone RN, Rosenthal MS, Winterstein AG, Cook RL. Practice Patterns and Training Needs Among Physicians Certifying Patients for Medical Marijuana in Florida. J Prim Care Community Health 2021; 12:21501327211042790. [PMID: 34452585 PMCID: PMC8404623 DOI: 10.1177/21501327211042790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little is known about the clinical training or practice experiences among physicians who certify patients for medical marijuana. The objective of this study was to determine information sources, factors influencing recommendations, clinical practices in patient assessment, communications, and recommendations, and priority areas for additional training among physicians who certify patients for medical marijuana. METHODS A cross-sectional state-wide anonymous survey of registered medical marijuana physicians in Florida between June and October 2020 was administered. Numerical responses were quantified using counts and percentages. The frequencies for "often" and "always" responses were aggregated when appropriate. RESULTS Among 116 respondents, the mean (standard deviation) age was 57 (12) years old, and 70% were male. The most frequently used information sources were research articles (n = 102, 95%), followed by online sources (n = 99, 93%), and discussions with other providers and dispensary staff (n = 84, 90%). Safety concerns were most influential in patient recommendations (n = 39, 39%), followed by specific conditions (n = 30, 30%) and patient preferences (n = 26, 30%). Ninety-three physicians (92%) reported they "often" or "always" perform a patient physical exam. Eighty-four (77%) physicians provided specific administration route recommendations. Half (n = 56) "often" or "always" provided specific recommendations for Δ-9-tetrahydrocannabinol: cannabidiol ratios, while 69 (62%) "often" or "always" provided specific dose recommendations. Online learning/training modules were the most preferred future training mode, with 88 (84%) physicians "likely" or "very likely" to participate. The top 3 desired topics for future training were marijuana-drug interactions (n = 84, 72%), management of specific medical conditions or symptoms (n = 83, 72%), and strategies to reduce opioids or other drugs use (n = 78, 67%). CONCLUSIONS This survey of over 100 medical marijuana physicians indicates that their clinical practices rely on a blend of research and anecdotal information sources. While physicians report clinical factors as influential during patient recommendation, patient assessment practices and treatment regimen recommendations vary substantially and rely on experimental approaches. More research is needed to inform evidence-based practice and training, especially considering details on drug interactions, risk-benefit of treatment for specific clinical conditions, and strategies to reduce opioid use.
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Affiliation(s)
- Ruba Sajdeya
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Anna Shavers
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Jennifer Jean-Jacques
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Brianna Costales
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Sebastian Jugl
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Carly Crump
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Yan Wang
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Luran Manfio
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - R. Nathan Pipitone
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
- Florida Gulf Coast University, Fort Myers, FL, USA
| | - Martha S. Rosenthal
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
- Florida Gulf Coast University, Fort Myers, FL, USA
| | - Almut G. Winterstein
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
| | - Robert L. Cook
- University of Florida, Gainesville, FL, USA
- Consortium for Medical Marijuana Clinical Outcomes Research, FL, USA
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Jugl S, Keshwani S, Adkins L, Heldermon CD, Winterstein A, Goodin A. A systematic review of evidence for cannabis and cannabinoids as adjuvant therapy in palliative and supportive oncology care. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12091 Background: Medical cannabis use is increasing significantly in the United States as states reduce restrictions. However, ambiguity concerning the evidence for medical cannabis efficacy and safety, especially in the field of oncology, is persistent. Clinicians therefore face challenges in examining benefits and risks of medical cannabis as adjuvant treatment for cancer patients. This study identifies and evaluates the most recent available evidence for the efficacy of cannabis and cannabinoids as adjuvant in supportive and/or palliative use in patients with cancer. Methods: Electronic databases searched included PubMed, Embase, Web of Science, and Cochrane Library to identify studies published following the latest available systematic review, between July 2016 through October 2019. Studies conducted outside the United States, studies not evaluating cannabis or cannabinoids in Oncology care, and preclinical studies were excluded. Findings were organized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework. Lastly, qualitative synthesis was used to generate summary statements about the role of cannabis and cannabinoids as adjuvant in supportive and/or palliative cancer care. Results: We screened 2,267 articles and included 96 studies in our qualitative synthesis. Among those were 2 RCT’s (1 completed), 6 Systematic reviews with Meta-analysis, 4 Systematic reviews without Meta-analysis, 71 other types of reviews and 13 observational studies. The most frequently reported outcomes assessed were efficacy of cannabis and cannabinoids for: pain (40 of 96; 17 indicating improvement), nausea and vomiting (26 of 96; 20 indicating improvement), cachexia (22 of 96; 2 indicating improvement), and utilization patterns of cannabis and/or cannabinoids among cancer patients (8 of 96). Conclusions: Latest available prevalence estimates indicate that a significant proportion of patients in the United States with cancer use cannabis and/or cannabinoids (18.3-40.0%). There is substantial evidence for the effectiveness of cannabis and cannabinoids in treating cancer-related pain; specifically, oromucosal THC/CBD spray. There is conclusive evidence for the effectiveness of cannabis and cannabinoids in relieving chemotherapy-induced nausea and vomiting; specifically, oral THC. There is inconclusive evidence regarding the effectiveness of cannabis and cannabinoids in treating cancer-related cachexia.
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Affiliation(s)
- Sebastian Jugl
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida; Center for Drug Evaluation and Safety (CoDES), Gainesville, FL
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida; Center for Drug Evaluation and Safety (CoDES), Gainesville, FL
| | - Lauren Adkins
- Health Science Center Library, University of Florida, Gainesville, FL
| | | | - Almut Winterstein
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida; Center for Drug Evaluation and Safety (CoDES), Gainesvillle, FL
| | - Amie Goodin
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida; Center for Drug Evaluation and Safety (CoDES), Gainesville, FL
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Nagaraja N, Jugl S, Brown JD, Simpkins AN, Wilson CA, Yuzefovich Khanna A, Youn TS, Kelly AG. Abstract WP245: Demographics, Risk Factors and Outcomes of Stroke in Young Adults Aged 18-45 Years in Comparison With Those Older Than 45 Years. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The prevalence of stroke in young adults have increased with the prevalence of cerebrovascular risk factors in this population. The objective of this study was to compare stroke prevalence in age groups 18-45 years versus more than 45 years by demographics, risk factors, and outcome.
Methods:
We analyzed the National Inpatient Sample Database from the Healthcare Cost and Utilization Project for the years 2008-14. Patients with stroke were identified based on discharge DRG codes 61-66 for acute ischemic stroke with use of thrombolytic therapy, intracranial hemorrhage or cerebral infarction. Demographics, risk factors from comorbid condition codes, and outcomes were analyzed.
Results:
Out of a total of 3,624,243 adult patients with stroke hospitalized during the years 2008-14, 189103 (5.21%) hospitalizations were of patients aged 18-45 years. The ratio of stroke hospitalizations to overall hospitalizations increased from 154 to 185 per 10,000 hospitalizations from the year 2008 to 2014 with increase in stroke hospitalizations in both age groups. Stroke in young adults aged 18-45 years was more common in men, Blacks and Hispanics compared to those older than 45 years. Cerebrovascular risk factors were common in young adults with stroke and the prevalence of obesity, arterial malformation, tobacco use or alcohol abuse was higher in stroke patients aged 18-45 years compared to those older than 45 years (Table 1). There was up to 6% increase in the prevalence of cerebrovascular risk factors from 2008 to 2014. Young adults with stroke aged 18-45 years were more likely to be discharged home while older adults were more likely to be discharged to skilled nursing facility.
Conclusions:
There are gender and racial differences in stroke among adults aged 18-45 years compared to those older than 45 years age. Modifiable cerebrovascular risk factors are common in young adults with stroke. Most notably, both obesity and smoking were particularly higher in younger patients.
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Affiliation(s)
| | | | | | | | | | | | - Teddy S Youn
- Neurology, Univ of Florida College of Medicine, Gainesville, FL
| | - Adam G Kelly
- Univ of Florida College of Medicine, Gainesville, FL
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McInnes I, Nash P, Ritchlin C, Thom H, Kanters S, Palaka E, Gandhi K, Mpofu S, Jugl S. THU0437 Secukinumab for The Treatment of Psoriatic Arthritis: Comparative Effectiveness Results versus Licensed Biologics and Apremilast from A Network Meta-Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baeten D, Mease P, Strand V, McInnes I, Thom H, Kanters S, Palaka E, Gandhi K, Richards H, Jugl S. SAT0390 Secukinumab for The Treatment of Ankylosing Spondylitis: Comparative Effectiveness Results versus Currently Licensed Biologics from A Network Meta-Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maksymowych W, Strand V, Baeten D, Nash P, Thom H, Cure S, Palaka E, Gandhi K, Richards H, Jugl S. OP0114 Secukinumab for The Treatment of Ankylosing Spondylitis: Comparative Effectiveness Results versus Adalimumab Using A Matching-Adjusted Indirect Comparison. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2050] [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: 11/04/2022]
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Alten R, Strand V, Conaghan P, Deodhar A, Sullivan E, Blackburn S, Tian H, Gandhi K, Jugl S. THU0630 Treatment Failure, Treatment Switching and Health-Related Quality of Life in Patients with Ankylosing Spondylitis or Psoriatic Arthritis: Results from A Large Multinational Real-World Sample in Europe and The USA. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2129] [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: 11/04/2022]
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Gossec L, Kvien T, Conaghan P, Østergaard M, Cañete J, Gaillez C, Mpofu S, Davenport E, Jugl S. THU0442 Reduction in Fatigue in Patients with Active Psoriatic Arthritis Are Sustained over 2 Years: Long-Term Results of Two Phase 3 Studies with Secukinumab. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2052] [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: 11/03/2022]
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Conaghan P, Deodhar A, Strand V, Alten R, Sullivan E, Blackburn S, Tian H, Gandhi K, Jugl S. THU0411 Fatigue in Patients with Ankylosing Spondylitis and Low Vitality in Those with Psoriatic Arthritis: Results from A Large Real-World Survey in Europe and The USA. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2125] [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: 11/04/2022]
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Kvien T, Conaghan P, Deodhar A, Gossec L, Østergaard M, Cañete J, Gandhi K, Richards H, Williams N, Jugl S. SAT0421 Reduction in Fatigue in Patients with Active Ankylosing Spondylitis: Results of Two Phase 3 Studies of Secukinumab. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nash P, McInnes I, Mease P, Thom H, Cure S, Palaka E, Gandhi K, Mpofu S, Jugl S. THU0448 Secukinumab for The Treatment of Psoriatic Arthritis: Comparative Effectiveness Results versus Adalimumab Up To 48 Weeks Using A Matching-Adjusted Indirect Comparison. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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