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Alexopoulos AS, Yancy WS, Edelman D, Coffman CJ, Jeffreys AS, Maciejewski ML, Voils CI, Sagalla N, Barton Bradley A, Dar M, Mayer SB, Crowley MJ. Clinical associations of an updated medication effect score for measuring diabetes treatment intensity. Chronic Illn 2021; 17:451-462. [PMID: 31653175 PMCID: PMC7182482 DOI: 10.1177/1742395319884096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effect score to account for newer agents and explored associations between medication effect score and patient-level clinical factors. METHODS Cross-sectional analysis of baseline data from a randomized controlled trial involving 263 Veterans with type 2 diabetes and hemoglobin A1c levels ≥8.0% (≥7.5% if under age 50). Medication effect score was calculated for all patients at baseline, alongside additional measures including demographics, comorbid illnesses, hemoglobin A1c, and self-reported psychosocial factors. We used multivariable regression to explore associations between baseline medication effect score and patient-level clinical factors. RESULTS Our sample had a mean age of 60.7 (SD = 8.2) years, was 89.4% male, and 57.4% non-White. Older age and younger onset of diabetes were associated with a higher medication effect score, as was higher body mass index. Higher medication effect score was significantly associated with medication nonadherence, although not with hemoglobin A1c, self-reported hypoglycemia, diabetes-related distress, or depression. DISCUSSION We observed several expected associations between an updated medication effect score and patient-level clinical factors. These associations support the medication effect score as an appropriate measure of diabetes regimen intensity in clinical and research contexts.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Diet and Fitness Center, Durham, NC, USA
| | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Nicole Sagalla
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - Anna Barton Bradley
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, VA, USA
| | - Moahad Dar
- Division of Endocrinology and Metabolism, East Carolina University, Greenville NC, USA.,Greenville Veterans Affairs Health Care Center, Greenville, NC, USA
| | - Stéphanie B Mayer
- Hunter Holmes McGuire Veterans Affairs Medical Center, Division of Endocrinology and Metabolism, Richmond, VA, USA.,Virginia Commonwealth University, Division of Endocrinology and Metabolism, Richmond, VA, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
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Forgerini M, Herdeiro MT, Galduróz JCF, Mastroianni PDC. Risk factors associated with drug therapy among elderly people with Alzheimer's disease: a cross-sectional study. SAO PAULO MED J 2020; 138:216-218. [PMID: 32578741 PMCID: PMC9671228 DOI: 10.1590/1516-3180.2019.0461.r2.19022020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving knowledge and establishing strategies and policies for better patient safety are worldwide priorities. OBJECTIVE To evaluate drug safety among elderly people with Alzheimer's disease (AD). DESIGN AND SETTING Cross-sectional study among elderly people within the National AD Assistance Protocol (PCDTDA/MS) who were living in the municipality of Araraquara, Brazil, in 2017. METHODS Through interviews conducted with relatives/caregivers of elderly people with diagnoses of AD, the following variables were evaluated: comorbidities, drug therapy used, use of potentially inappropriate medications for the elderly (PIMs), presence of potentially inappropriate interactions (PIIs) and medication regimen complexity index. Factors associated with AD severity were also evaluated. Multivariate and simple logistic regressions were applied. RESULTS 143 elderly people enrolled in PCDTDA/MS were analyzed. The majority were women (67.1%); assisted only through the public healthcare system (75.5%); polymedicated (57.4%); using at least one PIM (63.6%); presenting at least one PII (63.6%); and under drug therapy of low to medium complexity (92.2%). No semi-annual monitoring of the effectiveness of PCDTDA/MS drugs was identified. The proportion using AD drug therapy at daily doses differing from those recommended by the World Health Organization was 75.6%. However, these doses were not associated with drug risk. CONCLUSION The data from this study raise the hypothesis that use of polypharmacy might show a correlation with severity of AD. The drug safety risk may be associated with comorbidities of the metabolic syndrome, anxiety and off-label use of PIMs, such as risperidone and quetiapine, and benzodiazepines (i.e. clonazepam and flunitrazepam).
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Affiliation(s)
- Marcela Forgerini
- Pharmacist and Doctoral Student, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
| | - Maria Teresa Herdeiro
- PhD. Pharmacist and Professor, Department of Medical Sciences, Universidade de Aveiro, Institute of Biomedicine (iBiMED), Aveiro, Portugal.
| | - José Carlos Fernandes Galduróz
- PhD. Adjunct Professor, Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Patrícia de Carvalho Mastroianni
- PhD. Pharmacist and Adjunct Professor, Department of Drugs and Medicines, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
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Zhao XL, Jin ZH, DI GL, Li L, Kong XH. Molecular characteristics, pathogenicity and medication regimen of Aeromonas hydrophila isolated from common carp (Cyprinus carpio L.). J Vet Med Sci 2019; 81:1769-1775. [PMID: 31406034 PMCID: PMC6943308 DOI: 10.1292/jvms.19-0025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aeromonas hydrophila causes disease in fish known as Motile
Aeromonas Septicemia (MAS), also named as bacterial hemorrhagic
septicemia. In this study, a pathogenic A. hydrophila strain was isolated
from common carp Cyprinus carpio L., which were suffering from severe
hemorrhagic septicemia. According to the phylogenetic analysis derived from 16S rDNA
sequence, the isolate formed a single branch in the A. hydrophila group,
named AhHN1. Artificial infection results indicated that AhHN1 showed strong pathogenicity
in C. carpio and the LD50 was 1.38 × 106 CFU/fish,
the clinical symptoms and pathological features of infected fish were similar to those
observed in natural infections. The antimicrobial susceptibility testing revealed that
AhHN1 resistance to more than 13 kinds of antimicrobial agents. However, the AhHN1 strain
exhibited an extremely sensitivity to enrofloxacin, the in vitro
activities of enrofloxacin were subsequently investigated and drug selection window (MSW)
was 0.0016–0.0125 µg/ml. Pharmacokinetics data showed
that plasma concentration of enrofloxacin was 0.0016, 0.0148 and 0.0282
µg/ml at 24 hr after orally administered with 2.5, 5
and 10 mg/kg enrofloxacin. Moreover, dosing once a day of 2.5, 5 and 10 mg/kg
enrofloxacin, which the relative protection ratio (RPS) was amounted to 33.3, 66.7, and
83.3%, respectively. Therefore, 5 mg/kg enrofloxacin was considered to be the rational
regimen for controlling AhHN1 infection in C. carpio in the countries
where the use of enrofloxacin is permitted in aquaculture. The aim of this study was to
establish a scientific medication regimen for the prevention and therapy of the
mutidrug-resistant A. hydrophila infection.
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Affiliation(s)
- Xian-Liang Zhao
- College of Life Sciences, Henan Normal University, Xinxiang, Henan 453007, China.,College of Fisheries, Henan Normal University, Xinxiang, Henan 453007, China
| | - Zhao-Hui Jin
- College of Fisheries, Henan Normal University, Xinxiang, Henan 453007, China
| | - Gui-Lan DI
- College of Fisheries, Henan Normal University, Xinxiang, Henan 453007, China
| | - Li Li
- College of Fisheries, Henan Normal University, Xinxiang, Henan 453007, China
| | - Xiang-Hui Kong
- College of Life Sciences, Henan Normal University, Xinxiang, Henan 453007, China
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Pazdernik M, Malek I, Koudelkova E, Sochman J, Kautzner J. Bone marrow suppression and associated consequences in patients after heart transplantation: A 6-year retrospective review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:372-7. [PMID: 26000773 DOI: 10.5507/bp.2015.022] [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] [Received: 12/02/2014] [Accepted: 04/22/2015] [Indexed: 11/23/2022] Open
Abstract
AIMS To evaluate the incidence of bone marrow suppression and consequences of MMF dose adjustment in patients within the first year after heart transplantation. METHODS Group I (n=47) was treated with a regimen currently used in patients after heart transplantation (mycophenolatemofetil - MMF, valganciclovir - VGC and trimethoprim/sulfamethoxazole - TMP-SMX). Group II (n=47) received only MMF of potentially myelotoxic medications. The myelotoxic effect and need for dose modification were assessed. The incidence of rejections and infectious episodes associated with MMF adjustment were analyzed during the first 12 months in Group I. RESULTS There was a significantly greater proportion of patients with leukopenia (leukocyte count < 4 x 10^9/L) at 3 months after orthotopic heart transplantation in Group I compared with Group II (19.1% vs 2.1%; P = 0.02). The difference in lymphopenia (lymphocyte count < 0.8 x 10^9/L) at 3 months follow-up was highly significant (38.3 % vs 6.4 %; P = 0.0002). MMF was modified due to bone marrow suppression or severe infection in 63.8% patients in Group I and in only 8.5% of patients in Group II (P < 0.001). Reducing or stopping MMF was not associated with increased rejections. In Group I, at least 1 episode of higher degree cellular or humoral rejection occurred in 35% of patients with the standard MMF dosage compared with only 26% in patients with modified MMF (P = 0.0534). CONCLUSIONS Addition of VGC+TMP-SMX to current immunosuppressive medication regimen in patients after heart transplantation is associated with significant lymphocytopenia and leukopenia. Importantly, modification of immunosuppressive prophylaxis (reducing or stopping MMF) leads to normalization of blood count without increased incidence of rejections.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Eva Koudelkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Sochman
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Kraemer S, Minarzyk A, Eppendorfer S, Henneges C, Hundemer HP, Wilhelm S, Grunze H. Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study. BMC Psychiatry 2013; 13:193. [PMID: 23866017 PMCID: PMC3724595 DOI: 10.1186/1471-244x-13-193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 05/07/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational study assessed time on mood stabilizing medication and retention rates in patients with bipolar disorder (BD). METHODS In an 18-month, prospective, multicenter, non-interventional study conducted in Germany 761 outpatients (≥18 years) with BD and on maintenance therapy were documented. For analysis, patients were stratified by baseline medication: monotherapy olanzapine (OM, N = 186), lithium (LM, N = 152), anticonvulsants (N = 216), other mood stabilizing medication (OMS, N = 44); combination therapy olanzapine/lithium (N = 47), olanzapine/anticonvulsant (N = 68), other combinations (OC, N = 48). Continuation on medication was assessed as retention rates with 95% confidence intervals. Time to discontinuation and relapse-free time were calculated by Kaplan-Meier analysis. A relapse was defined as increase to CGI-BP >3, worsening of CGI-BP by ≥2 points, hospitalization or death related to BD. A Cox regression was calculated for the discontinuation of mood stabilizing therapy (reference: OM). Logistic regression models with stepwise forward selection were used to explore possible predictors of maintenance of treatment and relapse. RESULTS After 540 days (18 months), the overall retention rate of baseline medication was 87.7%, without notable differences between the cohorts. The overall mean time on mood stabilizing treatment was 444.7 days, with a range of 377.5 (OMS) to 481 (LM) by cohort. 74.0% of all patients were without relapse, with rates between the cohorts ranging from 58.4% (OC) to 80.2% (LM). CONCLUSIONS Retention rates exceeded controlled trial results in all treatment cohorts, in addition to other explanations possibly reflecting that the physicians were expertly adapting treatment regimens to the individual patient's disease characteristics and special needs.
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Affiliation(s)
- Susanne Kraemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Anette Minarzyk
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Steffen Eppendorfer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Carsten Henneges
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Hans-Peter Hundemer
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Stefan Wilhelm
- Lilly Deutschland GmbH, Medical Department, Werner-Reimers-Str. 2-4, 61352 Bad Homburg, Germany
| | - Heinz Grunze
- Newcastle University; Institute of Neuroscience, Newcastle, UK
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