1
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Blood AJ, Chang LS, Colling C, Stern G, Gabovitch D, Feldman G, Adan A, Waterman F, Durden E, Hamersky C, Noone J, Aronson SJ, Liberatore P, Gaziano TA, Matta LS, Plutzky J, Cannon CP, Wexler DJ, Scirica BM. Methods, rationale, and design for a remote pharmacist and navigator-driven disease management program to improve guideline-directed medical therapy in patients with type 2 diabetes at elevated cardiovascular and/or kidney risk. Prim Care Diabetes 2024; 18:202-209. [PMID: 38302335 DOI: 10.1016/j.pcd.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
AIM Describe the rationale for and design of Diabetes Remote Intervention to improVe use of Evidence-based medications (DRIVE), a remote medication management program designed to initiate and titrate guideline-directed medical therapy (GDMT) in patients with type 2 diabetes (T2D) at elevated cardiovascular (CV) and/or kidney risk by leveraging non-physician providers. METHODS An electronic health record based algorithm is used to identify patients with T2D and either established atherosclerotic CV disease (ASCVD), high risk for ASCVD, chronic kidney disease, and/or heart failure within our health system. Patients are invited to participate and randomly assigned to either simultaneous education and medication management, or a period of education prior to medication management. Patient navigators (trained, non-licensed staff) are the primary points of contact while a pharmacist or nurse practitioner reviews and authorizes each medication initiation and titration under an institution-approved collaborative drug therapy management protocol with supervision from a cardiologist and/or endocrinologist. Patient engagement is managed through software to support communication, automation, workflow, and standardization. CONCLUSION We are testing a remote, navigator-driven, pharmacist-led, and physician-overseen management strategy to optimize GDMT for T2D as a population-level strategy to close the gap between guidelines and clinical practice for patients with T2D at elevated CV and/or kidney risk.
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Affiliation(s)
- Alexander J Blood
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Lee-Shing Chang
- Endocrinology Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Caitlin Colling
- Endocrinology Division, Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Gretchen Stern
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Gabovitch
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA
| | - Guinevere Feldman
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA
| | - Asma Adan
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Samuel J Aronson
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Personalized Medicine, Mass General Brigham, Cambridge, MA, USA
| | - Paul Liberatore
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Personalized Medicine, Mass General Brigham, Cambridge, MA, USA
| | - Thomas A Gaziano
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lina S Matta
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jorge Plutzky
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Christopher P Cannon
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Deborah J Wexler
- Endocrinology Division, Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Benjamin M Scirica
- Accelerator for Clinical Transformation, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Background: Primary immunodeficiency diseases (PIDD) consist of a heterogeneous group of disorders characterized by various aspects of immune dysregulation. Although the most universally recognized manifestation of PIDD is an increased susceptibility to infections, there is a growing body of evidence that patients with PIDD often have a higher incidence of lung disease, autoimmunity, autoinflammatory disorders, and malignancy. Objective: The purpose of this study was to better understand the noninfectious complications of PIDD by determining the comorbid disease prevalence across various age groups, genders, and immunoglobulin replacement types compared with the general population. Methods: A large U.S. insurance claims database was retrospectively analyzed for patients who had a diagnosis of PIDD and who had received intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG). The prevalences of 31 different comorbid conditions in the Elixhauser comorbidity index were compared among the 3125 patients in the PIDD population to > 37 million controls separated by gender and by 10-year age cohorts. Results: In the PIDD population, statistically significantly higher comorbid diagnoses included chronic obstructive pulmonary disease-asthma in 51.5%, rheumatoid disease in 14%, deficiency anemia in 11.8%, hypothyroidism in 21.2%, lymphoma in 16.7%, neurologic disorders in 9.7%, arrhythmias in 19.9%, electrolyte disorders in 23.6%, coagulopathies in 16.9%, and weight loss in 8.4%. Conclusion: PIDD that require immunoglobulin replacement are associated with an increased risk of numerous comorbid conditions that affect morbidity and mortality. Recognition and increased awareness of these noninfectious complications can allow for better monitoring, care coordination, targeted treatments, and improved prognosis.
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Affiliation(s)
- Michelle Dilley
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Hannah Wangberg
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Joshua Noone
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina
| | - Bob Geng
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
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Gaynor N, Noone J, Monedero J, Murphy EE, O'Gorman DJ, Crown J, Collins DM. Abstract P4-06-19: The effect of relieving adenosine-mediated immunosuppression on trastuzumab-mediated antibody-dependent cell-mediated cytotoxicity (T-ADCC) against HER2+ breast cancer cell lines. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-06-19] [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
Abstract
Introduction: Trastuzumab (T) is a monoclonal antibody therapy used in the treatment of HER2+ breast cancer. T inhibits HER2 intracellular signalling and is capable of engaging the immune system through ADCC. Adenosine is an important negative regulator of the immune response through its interaction with the A2A receptor (A2AR, ADORA2A). Relieving adenosine-mediated immunosuppression by inhibiting A2AR may improve NK cell-mediated T-ADCC against HER2+ breast cancer cells. In addition, we have previously shown that SKBR3 cells resistant to the EGFR/HER2 tyrosine kinase inhibitor (TKI) lapatinib are less sensitive to T-ADCC and showed increased A2AR protein levels. This study examines the effects of inhibiting A2AR signalling on NK cell-mediated T-ADCC against treatment naïve HER2+ breast cancer cell lines HCC1954 and SKBR3 and lapatinib and afatinib (irreversible pan-HER-family TKI)-resistant sublines of HCC1954 and SKBR3.
Methods: HER2+ breast cancer cell lines SKBR3 and HCC1954 were exposed to afatinib (150nM) or lapatinib (1μM) for 6 months to generate TKI-resistant SKBR3-A and HCC1954-L cell lines. Acid-phosphatase-based proliferation assays were used to confirm resistance to TKI treatment. Western blotting was used to examine A2AR and HER2 protein levels in cell lines. NK cells were isolated from healthy volunteer whole blood by MACSxpress isolation kits. Immune cell-mediated cytotoxicity was determined at a 1:1 (NK cell: TC) ratio over 12 hours using a flow cytometry-based method. Direct cytotoxicity and T-ADCC were determined +/- A2AR agonist CGS21680 (1 μM) and/or A2AR antagonist preladenant (100 nM) for all cell lines. Experiments were carried out three times with three separate volunteer samples with representative results presented.
Results: HCC1954-L cells were 5.3-fold resistance to lapatinib (IC50 1.65 μM +/- 0.22 μM) vs. HCC1954 (IC50 0.31 μM +/- 0.15 μM). SKBR3-A cells were 33-fold resistant to afatinib (IC50 0.28 μM +/- 0.006 nM) vs. the parental SKBR3 cell line (IC50 0.009 μM +/- 0.006 μM). SKBR3 and HCC1954 expressed detectable protein levels of A2AR. A2AR and HER2 levels were not significantly changed between parental and resistant cell lines. Levels of direct cytotoxicity and T-ADCC elicited by NK cells were higher against SKBR3-A (p=0.002) and HCC1954-L cells (p=0.0004) than parental cell lines. The A2AR agonist CGS21680 alone had inconsistent effects on direct cytotoxicity and T-ADCC in all cell lines tested. The addition of A2AR antagonist preladenant to CGS21680, but not preladenant alone, increased T-ADCC against the parental HCC1954 cells by 12.7 +/- 3.4% and parental SKBR3 cells by 9.5 +/- 3.6%. T-ADCC levels in the targeted therapy-resistant HCC1954-L and SKBR3-A cell lines were not impacted by the CGS21680/preladenant combination.
Conclusions: A HER2-targeted therapy resistance phenotype is associated with increased T-ADCC in the models tested. Inhibition of activated A2AR can increase T-ADCC elicited by NK cells against treatment naïve HER2+ breast cancer cell lines but not TKI-resistant sublines. Further work is warranted to examine the impact of targeting A2AR in HER2+ breast cancer.
Citation Format: Gaynor N, Noone J, Monedero J, Murphy EE, O'Gorman DJ, Crown J, Collins DM. The effect of relieving adenosine-mediated immunosuppression on trastuzumab-mediated antibody-dependent cell-mediated cytotoxicity (T-ADCC) against HER2+ breast cancer cell lines [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-19.
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Affiliation(s)
- N Gaynor
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - J Noone
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - J Monedero
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - EE Murphy
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - DJ O'Gorman
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - J Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
| | - DM Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland; School of Human Health and Performance, Dublin City University, Dublin, Ireland; St. Vincent's University Hospital, Dublin, Ireland
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Abstract
AIM The aim of this review was to identify the international evidence that is currently available on the economic value of self-care through responsible self-medication, in terms of the measures related to access to treatment, time, and productivity. METHODS A targeted literature search was conducted for 1990-2016, including data gathered from members of the World Self-Medication Industry and searches on PubMed, EBSCOHost, and Google Scholar. Specific searches of individual drug classes known to be switched to non-prescription status in this period were also conducted. RESULTS A total of 71 articles were identified, of which 17 (11 modeling studies, six retrospective analyses) were included in the review. Evidence from modeling studies and retrospective analyses of grouped data across a range of common conditions for which non-prescription medications are available in different countries/regions showed that the use of non-prescription products for the treatment of common conditions or for symptom management (e.g. allergies, chronic pain, migraine, vaginitis, gastrointestinal symptoms, or common cold symptoms) had considerable value to patients, payers, and employers alike in terms of cost savings and improved productivity. Potential benefits of self-medication were also identified in preventative healthcare strategies, such as those for cardiovascular health and osteoporosis. LIMITATIONS This review was limited by a targeted, but non-systematic approach to literature retrieval, as well as the inclusion of unpublished reports/white papers and patient self-reported data. CONCLUSIONS The evidence identified in this literature review shows that responsible, appropriate self-medication with non-prescription products can provide significant economic benefits for patients, employers, and healthcare systems worldwide.
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Affiliation(s)
- Joshua Noone
- a Precision Health Economics , Huntersville , NC , USA
| | - Christopher M Blanchette
- a Precision Health Economics , Huntersville , NC , USA
- b University of North Carolina , Charlotte , NC , USA
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Abstract
e18117 Background: Lung cancer is the leading cause of cancer death in the United States. It is estimated that 60% of lung cancer patients are afflicted with cancer-associated cachexia syndrome (CACS) and approximately 10% of these patients will die due to CACS. We examined the impact of CACS on survival among lung cancer elderly patients. Methods: We conducted a retrospective study using SEER-Medicare data. Patients were included if diagnosed with first primary lung cancer between January 1, 2005 and December 31, 2010, at least 66 years of age, and continuously enrolled in Medicare Parts A and B in the 12 months prior to diagnosis. We identified cachexia in lung cancer patients using ICD-9 codes. Descriptive statistics were used to identify population characteristics. Propensity score (1:1 nearest neighbor) matching was performed between cachectic and non-cachectic lung cancer patients to compare survival. Results: We identified 84,518 lung cancer patients. Of these, 2,536 (3%) developed CACS after lung cancer diagnosis. The most common comorbid conditions among cachectic and non-cachectic groups were chronic obstructive pulmonary disease (50% versus 45.62%), congestive heart failure (8.56% versus 13.38%), diabetes (7.41% versus 14.75%), peripheral vascular disease (3.82% versus 6.85%), and renal disease (3.63% versus 6.14%). Propensity score 1:1 matching for confounding bias and adjustment for immortal time bias resulted in a cohort of 3734 matched patients. Eighty-eight percent of patients in the cachectic group died during the follow-up period compared to 78% in the non-cachectic group. Median survival time among non-cachectic lung cancer patients was significantly longer than cachectic lung cancer patients (log-rank p < 0.0001). Specifically, median survival in non-cachectic patients was 201 days compared to 92 days among cachectic patients. Conclusions: The occurrence of CACS is independently associated with a significant decrease in survival among lung cancer elderly patients. The results of this study may be useful for identifying healthcare burden and planning treatment modalities for this population.
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Affiliation(s)
- Shweta Shah
- University of North Carolina at Charlotte, Charlotte, NC
| | - Joshua Noone
- University of North Carolina at Charlotte, Charlotte, NC
| | | | - Susan T Arthur
- University of North Carolina at Charlotte, Charlotte, NC
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6
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. Healthcare cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. Treatment patterns associated with pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. The prevalence of non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Fernandez A, Howse E, Rubio-Valera M, Thorncraft K, Noone J, Luu X, Veness B, Leech M, Llewellyn G, Salvador-Carulla L. Setting-based interventions to promote mental health at the university: a systematic review. Int J Public Health 2016; 61:797-807. [DOI: 10.1007/s00038-016-0846-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/12/2015] [Accepted: 06/09/2016] [Indexed: 10/21/2022] Open
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10
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Blanchette C, Noone J, Roy D, Van Doren B, Zacherle E, Runken M, Howden R. Natural Progression of Alpha-1 Antitrypsin Deficiency Among Hospitalized COPD Patients in the US. Chest 2015. [DOI: 10.1378/chest.2281578] [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: 11/01/2022] Open
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Volper BD, Huynh RT, Arthur KA, Noone J, Gordon BD, Zacherle EW, Munoz E, Sørensen MA, Svensson RB, Broderick TL, Magnusson SP, Howden R, Hale TM, Carroll CC. Influence of acute and chronic streptozotocin-induced diabetes on the rat tendon extracellular matrix and mechanical properties. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1135-43. [PMID: 26310937 DOI: 10.1152/ajpregu.00189.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/24/2015] [Indexed: 12/29/2022]
Abstract
Diabetes is a major risk factor for tendinopathy, and tendon abnormalities are common in diabetic patients. The purpose of the present study was to evaluate the effect of streptozotocin (60 mg/kg)-induced diabetes and insulin therapy on tendon mechanical and cellular properties. Sprague-Dawley rats (n = 40) were divided into the following four groups: nondiabetic (control), 1 wk of diabetes (acute), 10 wk of diabetes (chronic), and 10 wk of diabetes with insulin treatment (insulin). After 10 wk, Achilles tendon and tail fascicle mechanical properties were similar between groups (P > 0.05). Cell density in the Achilles tendon was greater in the chronic group compared with the control and acute groups (control group: 7.8 ± 0.5 cells/100 μm(2), acute group: 8.3 ± 0.4 cells/100 μm(2), chronic group: 10.9 ± 0.9 cells/100 μm(2), and insulin group: 9.2 ± 0.8 cells/100 μm(2), P < 0.05). The density of proliferating cells in the Achilles tendon was greater in the chronic group compared with all other groups (control group: 0.025 ± 0.009 cells/100 μm(2), acute group: 0.019 ± 0.005 cells/100 μm(2), chronic group: 0.067 ± 0.015, and insulin group: 0.004 ± 0.004 cells/100 μm(2), P < 0.05). Patellar tendon collagen content was ∼32% greater in the chronic and acute groups compared with the control or insulin groups (control group: 681 ± 63 μg collagen/mg dry wt, acute group: 938 ± 21 μg collagen/mg dry wt, chronic: 951 ± 52 μg collagen/mg dry wt, and insulin group: 596 ± 84 μg collagen/mg dry wt, P < 0.05). In contrast, patellar tendon hydroxylysyl pyridinoline cross linking and collagen fibril organization were unchanged by diabetes or insulin (P > 0.05). Our findings suggest that 10 wk of streptozotocin-induced diabetes does not alter rat tendon mechanical properties even with an increase in collagen content. Future studies could attempt to further address the mechanisms contributing to the increase in tendon problems noted in diabetic patients, especially since our data suggest that hyperglycemia per se does not alter tendon mechanical properties.
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Affiliation(s)
- Brent D Volper
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona; Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona
| | - Richard T Huynh
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona; Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona
| | - Kathryn A Arthur
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Joshua Noone
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Benjamin D Gordon
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Emily W Zacherle
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Eduardo Munoz
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Mikkel A Sørensen
- Musculoskeletal Rehabilitation Research Unit and Institute of Sports Medicine, Copenhagen Bispebjerg Hospital Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; and
| | - René B Svensson
- Musculoskeletal Rehabilitation Research Unit and Institute of Sports Medicine, Copenhagen Bispebjerg Hospital Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; and
| | - Tom L Broderick
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - S Peter Magnusson
- Musculoskeletal Rehabilitation Research Unit and Institute of Sports Medicine, Copenhagen Bispebjerg Hospital Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; and
| | - Reuben Howden
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Taben M Hale
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona
| | - Chad C Carroll
- Department of Physiology, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona;
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Noone J, Critchley E, Cullingham P, Coulthard P, Saksena A. The implications of substance misuse for intravenous conscious sedation practice. Br Dent J 2015; 218:227-30. [PMID: 25720886 DOI: 10.1038/sj.bdj.2015.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Abstract
Substance misuse is a major health concern in the United Kingdom, as the consequences for individuals are significant and may include multisystem organ damage. It is important for the dentist to know which patients are misusing substances as some pharmacological agents routinely used in dental practice may be contraindicated. The dentist should be aware of the range of clinical presentations that may arise from substance misuse and when suspected, a thorough drug history must be obtained. Patients may require special consideration and further investigations when planning elective procedures, particularly under intravenous conscious sedation. Therefore, management within a specialist centre and liaison with other health professionals may be indicated to ensure treatment is provided safely.
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Affiliation(s)
- J Noone
- Dental Core Trainee Year 2 in Oral and Maxillofacial Surgery, University of Manchester
| | - E Critchley
- Dental Core Trainee Year 2 in Oral and Maxillofacial Surgery, University of Manchester
| | - P Cullingham
- Specialty Registrar Oral Surgery, University of Manchester
| | - P Coulthard
- Head of School of Dentistry and Professor of Oral and Maxillofacial Surgery, University of Manchester
| | - A Saksena
- Consultant in Oral Surgery, University Dental Hospital of Manchester
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13
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Blanchette CM, Nunes AP, Lin ND, Mortimer KM, Noone J, Tangirala K, Johnston S, Gutierrez B. Adherence to risk evaluation and mitigation strategies (REMS) requirements for monthly testing of liver function. Drugs Context 2015; 4:dic-4-212272. [PMID: 25709706 PMCID: PMC4335780 DOI: 10.7573/dic.212272] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/29/2014] [Accepted: 12/08/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Risk evaluation and mitigation strategies (REMS), as mandated by the US Food and Drug Administration (FDA) for medications with the potential for harm, are increasingly incorporating rigid protocols for patient evaluation, but little is known about compliance with these programs. Despite the inherent limitations, data on administrative claims may provide an opportunity to investigate adherence to these programs. Methods: We assessed adherence to liver function test (LFT) requirements included in the REMS program for bosentan through use of administrative claims. Patients observed in the Optum Research Database who were initiators of bosentan from November 20, 2001 to March 31, 2013 were included. Adherence to LFTs was calculated using pharmacy claims for bosentan dispensation and medical claims for laboratory services, and was assessed at the time of drug initiation and within specified time intervals throughout follow-up. Results: Of 742 patients, 523 (70.5%) had ≥1 qualifying LFT. Among patients with ≥12 dispensations, claims for LFTs at individual dispensations were 53.2–64.0%. Median proportion of dispensations with ≥1 LFT was 0.8 among patients with ≥6 (interquartile range, 0.7–1.0) or ≥12 (0.7–0.9) dispensations. Adherence was 90–100% for 33.3% of all initiators, whereas 29.3% of initiators were non-adherent (defined as <50% of on-therapy LFTs). Conclusions: Analyses of administrative claims suggest that the REMS program for bosentan may not have adequately guaranteed adherence to the program’s monthly monitoring of LFTs. Such investigations of existing REMS programs may provide insight on how to accomplish more successful evaluation of REMS.
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Affiliation(s)
| | | | | | | | - Joshua Noone
- University of North Carolina, Charlotte, NC, USA
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14
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Noone J, Blanchette CM, Roy D, Van DB, Arthur S. Cachexia in the Us Health Care System. Value Health 2014; 17:A389. [PMID: 27200894 DOI: 10.1016/j.jval.2014.08.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Noone
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - C M Blanchette
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - D Roy
- University of North Carolina, Charlotte, Charlotte, NC, USA
| | - Doren B Van
- University of North Carolina, Charlotte, Charlotte, NC, USA
| | - S Arthur
- University of North Carolina at Charlotte, Charlotte, NC, USA
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15
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Noone J. Cultural perspectives on contraception: a literature review. Clin Excell Nurse Pract 2000; 4:336-40. [PMID: 11858315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The incorporation of transcultural nursing concepts has become an integral component of holistic nursing practice. However, to deliver culturally appropriate nursing care, knowledge of cross-cultural health beliefs and practices is necessary. This article reviews cultural perspectives on contraception based on a literature review of qualitative and quantitative health care research studies related to the topics of culture and contraception. The purpose of this literature review is to provide a knowledge foundation for health care providers who provide contraceptive counseling. Implications for practice, as well as recommendations for future research, are developed.
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Affiliation(s)
- J Noone
- Kauai Community College, Lihue, Hawaii, USA.
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16
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Noone J, Warren J, Brittain M. Information overload: opportunities and challenges for the GP's desktop. Stud Health Technol Inform 1999; 52 Pt 2:1287-91. [PMID: 10384667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Recent developments in health data networks, the health sector and information systems, have created an overload of information available to the General Practitioner. The implementation of viable Health Data Networks within hospitals and subsequent connection to the GP's desktop PC enables increased access to patient records, decision-support and communication with experts around the world To address the high usage of expensive health services and lengthy waiting lists health services around the world are embracing programs such as Community, Coordinated, Shared and Managed care. This focus on coordination of care and increased emphasis on evidenced-based medicine is greatly enhanced through the advent of viable health data networks. Other resources such as databases, best-practice guidelines, the web, email, telemedicine and a range of commercial programs that provide further services has created an overload of resources available to the GP. Current human-computer interface guidelines are not adequate for prescribing design solutions to deal with the information overload facing GPs. The challenge for the near future is to present the vast array of information sources to the GP in an acceptable and useable information system interface. Part of the solution may revolve around the development of standards for Electronic Health Record systems for GPs, as is being done currently in Australia; but we suspect that less mainstream interface technologies will be required to exploit the wealth of available healthcare information.
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Affiliation(s)
- J Noone
- Health Informatics Research Group, School of Computer and Information Science, University of South Australia, Australia.
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Noone J, Longe S. Bell's palsy in the primary care setting: a case study. Clin Excell Nurse Pract 1998; 2:206-11. [PMID: 10455563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Bell's palsy is an acute unilateral paralysis of the facial muscles innervated by the seventh cranial nerve. Although the etiology of Bell's palsy is unknown, it is thought to result from edema, entrapment, or inflammation of the seventh cranial nerve. A history of recent viral infection--especially herpes simplex--diabetes mellitus, pregnancy, or hypertension are all common risk factors that may precede the onset. This article reviews assessment findings, differential diagnoses, and the treatment of Bell's palsy, which is considered a diagnosis of exclusion. A 10-day course of oral corticosteroids is the recommended therapy for lessening its course and severity in some populations. Recent research recommends the addition of acyclovir for 10 days, suggesting a herpetic viral etiology. Close follow-up is imperative to prevent corneal injury and to monitor worsening of symptoms. Although most patients recover within 1 to 6 months, incomplete recovery may be seen in severe or recurrent cases. Indications for referral are discussed. A case study is presented to illustrate the findings in this interesting disease.
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Affiliation(s)
- J Noone
- Kauai Community College, Hawaii, USA
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Noone J. Diagnosis and treatment of leptospirosis in the primary care setting. Nurse Pract 1998; 23:62-4, 66, 68 passim. [PMID: 9614681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Leptospirosis is an infectious illness that usually develops 1 to 2 weeks after indirect or direct exposure to the urine of infected animals. Infection occurs through open cuts, absorption through intact mucous membranes, and drinking contaminated water. The typical presentation is a flulike syndrome of sudden onset that tends to resolve within 2 weeks. A mild immunologic phase usually presents as an aseptic meningitis. A more severe immunologic phase (Well's syndrome) can result in jaundice, renal failure, adult respiratory distress syndrome, disseminated intravascular coagulation, and death. Laboratory tests take too long to replace clinical diagnosis, which is imperative so that antibiotic therapy can begin before the fourth day of illness. Although leptospirosis is more common in tropical climates, detection in the continental United States is increasing. Early, accurate detection and treatment in the primary care setting are vital for limiting life-threatening complications.
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Affiliation(s)
- J Noone
- Kauai Community College, Lihue, Hawaii, USA
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Vonfrolio LG, Noone J. Understanding orthopedic emergencies. Nursing 1995; 25:32XX. [PMID: 7659340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Noone J. Acute pancreatitis: an Orem approach to nursing assessment and care. Crit Care Nurse 1995; 15:27-35; quiz 36-7. [PMID: 7628213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vonfrolio LG, Noone J. Self-test: recognizing signs of shock. Nursing 1995; 25:18, 21. [PMID: 7630545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vonfrolio LG, Noone J. Certification review: understanding cardiovascular disorders. Nursing 1995; 25:32NN. [PMID: 7630555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vonfrolio LG, Noone J. Understanding renal disorders. Nursing 1995; 25:32Z. [PMID: 7624078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vonfrolio LG, Noone J. Understanding GI disorders. Nursing 1995; 25:32TT. [PMID: 7708339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Vonfrolio LG, Noone J. Understanding the neurologic system. Nursing 1995; 25:32EE. [PMID: 7891906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Noone J. Identifying sinus arrest and exit block. Nursing 1994; 24:32Q-32R. [PMID: 8008275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
Table 2 provides an overview of the classifications of antiarrhythmic agents, their actions, and their uses against reentrant arrhythmias and those caused by enhanced automaticity. Table 3 reviews many of the differences between the two mechanisms of arrhythmias: enhanced automaticity and reentry. Clinical distinction will assist in the most appropriate choice of therapy for terminating cardiac arrhythmias.
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Weller DM, Noone J. Mechanisms of arrhythmias: enhanced automaticity and reentry. Crit Care Nurse 1989; 9:42-67. [PMID: 2680278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Table 2 provides an overview of the classifications of antiarrhythmic agents, their actions, and their uses against reentrant arrhythmias and those caused by enhanced automaticity. Table 3 reviews many of the differences between the two mechanisms of arrhythmias: enhanced automaticity and reentry. Clinical distinction will assist in the most appropriate choice of therapy for terminating cardiac arrhythmias.
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Gasparis L, Noone J. Gastrointestinal emergencies. Test your knowledge. Nursing 1989; 19:120-6. [PMID: 2717073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gasparis L, Noone J. Managing emergencies. Nursing 1989; 19:96-100. [PMID: 2927775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gasparis L, Noone J. Emergency interventions. Nursing 1989; 19:111-6. [PMID: 2911395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gasparis L, Noone J. Test your knowledge of neurologic emergencies. Nursing 1988; 18:72-5. [PMID: 3205465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Acquired Immune Deficiency Syndrome (AIDS) has made a wide impact not limited to those persons who have or are likely to contact it. A case history of a man with a near-delusional belief he had AIDS is presented to exemplify the individual issues that concern about AIDS may raise. Thorough exploration of the dynamic interplay of biological, psychological and social factors is recommended in each case before reassurance may be effective. Psychiatric consultation should assist in developing optimal intervention in each individual case.
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Affiliation(s)
- J McMillan
- University of British Columbia, Vancouver
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Noone J. Troubleshooting thermodilution pulmonary artery catheters. Crit Care Nurse 1988; 8:68-76. [PMID: 3269314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Gasparis L, Noone J. Test your skills: can you meet your patients' psychosocial needs? Nurs Life 1987; 7:42-3. [PMID: 3650738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Gasparis L, Noone J. Test yourself: can you meet your patients' psychosocial needs? Nurs Life 1987; 7:39-41. [PMID: 3647315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Gasparis L, Noone J. How well do you know the legal aspects of nursing? Nursing 1987; 17:43. [PMID: 3645402 DOI: 10.1097/00152193-198704000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Gasparis L, Noone J. Test your knowledge of nursing liability. Nurs Life 1986; 6:41-3. [PMID: 3640288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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