Changes In Medication Regimens Research Articles

Nexus of Quality Use of Medicines, Pharmacists’ Activities, and the Emergency Department: A Narrative Review

Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as “choosing suitable medicines and using them safely and effectively”, remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED.

Assessing patient work system factors for medication management during transition of care among older adults: an observational study

ObjectiveTo develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults.Design,...

Long-term graft survival in a kidney transplant recipient with glioblastoma: Case report

Long-term immunosuppression after transplantation can increase the risk of cancer development in recipient patients. This case report describes the treatment approach for glioblastoma in a kidney transplant recipient after transplantation. The patient, a 61-year-old woman, received a living donor kidney transplant 24 years ago due to congenital nephrotic syndrome. The patient was on various immunosuppressive medications, including cyclosporine, prednisolone, and mycophenolate mofetil.After 16 years of follow-up, the patient presented with symptoms of brain tumor, leading to further tests. Subsequent examination revealed the presence of a tumor that had spread to frontal region within the brain.A surgical procedure was subsequently conducted to extract the tumor cells and alleviate the resulting pressure within the brain. Based on pathology results, it was determined that the patient had glioblastoma.Methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter was detected, indicating the potential response to chemotherapy. Chemotherapy was initiated, along with radiation therapy.After the diagnosis and surgery, the patient's medications for the kidney transplant were modified. Rapamycin replaced the previous medications, and the dose of mycophenolate mofetil and prednisolone was decreased. After 7 years, the patient's kidney is functioning well, with a creatinine level of 1.5, and brain imaging showed no abnormalities. After kidney transplantation, there is an increased risk of various cancers.Overall, this case report demonstrates a successful treatment approach for glioblastoma after kidney transplantation, emphasizing the need for close monitoring and individualized management in transplant recipients at risk for cancer development.Considering the current stability of the patient's condition after a change in medication regimen, patients who have been using the drug Cyclosporine for a long time should be included in future evaluations due to its carcinogenic properties.

Evaluation of left ventricular function and volume by two-dimensional echocardiography in a pediatric population: Correlation with cardiac magnetic resonance imaging.

Echocardiographic quantification of left ventricular (LV) volume and ejection fraction (EF) is widely used in the pediatric population. However, there is no consensus on the most accurate method of quantifying ventricular volumes and systolic function. The purpose of this study is to compare two commonly used echocardiographic methods for the evaluation of LV volume and quantification of EF, the five-sixth area-length (5/6 AL) and the modified biplane Simpson (BS), to cardiac magnetic resonance (CMR) imaging in children. CMR studies were paired with echocardiograms and retrospectively analyzed in children 18 years of age and younger. Studies performed more than 3 months between modalities, patients with congenital heart disease, and patients who had changes in medication regimen between corresponding CMR and echocardiograms were excluded. LV volumes and EF were calculated using the 5/6 AL and BS methods and compared to volumes and EF measured on corresponding CMR studies. Subgroup analyses were conducted based on LV function, pathology, and weight. We retrospectively analyzed 53 CMR and corresponding echocardiogram studies (23 studies for myocarditis and 30 studies for cardiomyopathy) in 46 patients. LVEF derived by both echocardiographic methods showed a good correlation to CMR (5/6 AL r = 0.85 and BS r = 0.82). However, both echocardiographic methods overestimated LVEF and underestimated LV volumes when compared to CMR. Left ventricular volumes and EF, as measured by echocardiography, correlate well with CMR measurements. Echocardiography underestimates LV systolic and diastolic volumes and overestimates LVEF. While echocardiography is a good surrogate for estimating LVEF, CMR should be considered in patients for whom accurate measurements are needed for critical clinical decision-making.

Anti-Hypertensive Drugs Special References with Their Classification of Calcium Channel Blocker

Objective: Determine the distribution and longitudinal changes in antihypertensive medication regimens in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: We used antihypertensive medication data collected by pill bottle review at each visit to categorize antihypertensive regimens by medication class. Free text string variables of medication names were independently reviewed by two clinical pharmacists to create standardized generic medication names and classes. Results: Figure 1 illustrates longitudinal changes in class combinations and number of drugs at the randomization, 6, 12, and 18-month visits. Fifty-six percent of participants modified their initial regimen by the 6-month visits; 43% of participants made additional modifications to their regimens from the 6-month to the 18-month visit. The most common initial regimens, and least likely regimens to be changed over time, were combinations with an ACEI/ARB and diuretics ± other classes (42% of initial regimens). Participants in the intensive arm added a mean (standard deviation) of 0.6 (0.9) medications to their initial regimens in the first 18-months compared to -0.1 (0.9) in the standard arm. Conclusion: Intensive blood pressure treatment requires more medication complexity in terms of class and dose. Further study of distinct regimens may reveal if certain class and dose combinations provide better SBP control, safety, or patient satisfaction.

A multicenter retrospective study of patients treated in the thalamus with responsive neurostimulation.

For drug resistant epilepsy patients who are either not candidates for resective surgery or have already failed resective surgery, neuromodulation is a promising option. Neuromodulatory approaches include responsive neurostimulation (RNS), deep brain stimulation (DBS), and vagal nerve stimulation (VNS). Thalamocortical circuits are involved in both generalized and focal onset seizures. This paper explores the use of RNS in the centromedian nucleus of the thalamus (CMN) and in the anterior thalamic nucleus (ANT) of patients with drug resistant epilepsy. This is a retrospective multicenter study from seven different epilepsy centers in the United States. Patients that had unilateral or bilateral thalamic RNS leads implanted in the CMN or ANT for at least 6 months were included. Primary objectives were to describe the implant location and determine changes in the frequency of disabling seizures at 6 months, 1 year, 2 years, and > 2 years. Secondary objectives included documenting seizure free periods, anti-seizure medication regimen changes, stimulation side effects, and serious adverse events. In addition, the global clinical impression scale was completed. Twelve patients had at least one lead placed in the CMN, and 13 had at least one lead placed in the ANT. The median baseline seizure frequency was 15 per month. Overall, the median seizure reduction was 33% at 6 months, 55% at 1 year, 65% at 2 years, and 74% at >2 years. Seizure free intervals of at least 3 months occurred in nine patients. Most patients (60%, 15/25) did not have a change in anti-seizure medications post RNS placement. Two serious adverse events were recorded, one related to RNS implantation. Lastly, overall functioning seemed to improve with 88% showing improvement on the global clinical impression scale. Meaningful seizure reduction was observed in patients who suffer from drug resistant epilepsy with unilateral or bilateral RNS in either the ANT or CMN of the thalamus. Most patients remained on their pre-operative anti-seizure medication regimen. The device was well tolerated with few side effects. There were rare serious adverse events. Most patients showed an improvement in global clinical impression scores.

Deep brain stimulation and intrathecal/intraventricular baclofen for glutaric aciduria type 1: A scoping review, individual patient data analysis, and clinical trials review.

Glutaric aciduria type 1 (GA1) is an autosomal recessive disease frequently leading to dystonia. Deep brain stimulation (DBS), intrathecal baclofen (ITB), and intraventricular baclofen (IVB) are the current interventional treatment options for refractory dystonia. We performed a scoping review, individual patient data (IPD) analysis, and clinical trials review to summarize the existing literature on these interventions in this population, characterize outcomes, and suggest directions for future investigation. PubMed, Embase, and Scopus were searched following PRISMA guidelines. IPD were extracted from studies providing IPD for GA1 patients. ClinicalTrials.gov was reviewed. Of 139 articles, 7 studies with 10 patients were included. In study-level data, 2/4 (50.0%) DBS studies found no improvement in dystonia and 3/3 (100%) on baclofen found decreased dystonia and enteral medication regimen. In the IPD analysis, four studies with 5 patients (2 IVB, 2 DBS, 1 ITB) were included. The average percent reduction in dystonia was 29.9% ± 32.5% (median:18%, IQR:18%-29.2%). Function improved in 4 (80.0%) patients. All patients with reported changes in enteral dystonia-related medication regimen (3/3, 100%) reported reduction in medication usage. No patients (0%) had perioperative complications. Mean follow-up length was 14.8 ± 12.2 months. No interventional clinical trials were found. ITB, IVB, and DBS represent present neuromodulatory approaches for the treatment of GA1. ITB and IVB reduce dystonia, while DBS has a heterogeneous effect. ITB and IVB improved function and reduced enteral medication regimens. These findings must be viewed with caution considering limited data and a serious risk of bias. Further large-scale studies are necessary to determine indications for ITB, IVB, and DBS and elucidate treatment algorithms.

PD37-05 USE OF CONTRAST ENHANCED ULTRASONOGRAPHY WITH URODYNAMICS: A COMPARISON STUDY TO FLUOROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD37-05 USE OF CONTRAST ENHANCED ULTRASONOGRAPHY WITH URODYNAMICS: A COMPARISON STUDY TO FLUOROSCOPY Emmett H. Kennady, Sean T. Corbett, Susan Leroy, Kathryn Morgan, Reza Daugherty, Nicole Kapral, and Nora G. Kern Emmett H. KennadyEmmett H. Kennady More articles by this author , Sean T. CorbettSean T. Corbett More articles by this author , Susan LeroySusan Leroy More articles by this author , Kathryn MorganKathryn Morgan More articles by this author , Reza DaughertyReza Daugherty More articles by this author , Nicole KapralNicole Kapral More articles by this author , and Nora G. KernNora G. Kern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (CeVUS) has been in use to evaluate for genitourinary anomalies but has not been known to be used in conjunction with UDS. We evaluated the ability, quality of using CeVUS UDS and compared the results with fluoro UDS. METHODS: Children ages 0-18 were enrolled for CeVUS UDS who previously underwent fluoro UDS. Demographic data, imaging data for CeVUS and fluoro UDS, time in between studies, and clinical data between studies were recorded. Changes in clinical status between the 2 studies included changes in catheterization, urine leakage between, anticholinergic medications, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar’s Chi-Squared and Wilcoxon matched-pairs signed rank test. RESULTS: 53 children were recruited with none declining the study. Table 1 contains demographics and clinical changes between studies. Median time between studies was 1.3 years (IQR 0.9 - 2.9). 53 CeVUS UDS studies were completed with adequate data; none were aborted due to technical reasons. In 4 cases, the bladder neck could not be visualized accurately due to non-mixing and layering of the microbubble contrast against urine (Table 1). Benefits to CeVUS included ability to visualize the exact moment the bladder neck opened. There were no significant differences in bladder shape, presence of vesicoureteral reflux, bladder neck or urethral changes in the cohort at differing time points. Following exclusion of patients with significant changes in medication regimen, catheterization, neuro procedures, hydronephrosis, and UTIs that could lead to changes in UDS imaging findings, a subgroup analysis of 25 patients demonstrated no significant differences in parameters between the 2 studies. CONCLUSIONS: CeVUS can be used adequately in conjunction with urodynamics. Slight limitations to CeVUS include more granular imaging for bladder shape compared to fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with CeVUS. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e987 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emmett H. Kennady More articles by this author Sean T. Corbett More articles by this author Susan Leroy More articles by this author Kathryn Morgan More articles by this author Reza Daugherty More articles by this author Nicole Kapral More articles by this author Nora G. Kern More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors related to barriers and medication adherence in patients with type 2 diabetes mellitus: a cross-sectional study.

Evidence has shown that 50% of patients, including type 2 diabetes mellitus (DM), are non-adherent to the prescribed antidiabetic medication regimen. Some barriers lead to nonadherence in people with DM type 2. The study aimed to identify factors related to adherence in patient with DM and to assess the correlation between barriers to adherence type 2 DM patients. The cross-sectional study was conducted in 63 primary healthcare centers in Surabaya, Indonesia. Patients with DM type 2 were recruited between April and September 2019 using convenient sampling technique. Ethics approval was obtained (80/EA/KEPK/2019). A total of 266 patients with type 2 DM participated in this study. Of the respondents, 201 (75.2%) were female. Unwanted drug effects, changes in medication regimens, and refilling the prescription when the drugs run out were most reported factors that affected adherence. Spearman correlations and linear regression tests were used to examine the relationship between barriers to medication adherence, and education with medication adherence. A significant difference was observed between the level of education and adherence (p = 0.031). The results showed an association between barriers to medication and adherence to medication (r = 0.304; p < 0.001) which was confirmed in regression analysis (R = 0.309, R square = 0.095, p <0.001). Barriers to adherence are common and affect adherence to therapy. It is essential to expand the roles of health care professionals in the community to include counseling, barrier-monitoring, education, and problem-solving to improve patient medication adherence.

Descriptive Longitudinal Analysis of Stereotypy and Corresponding Changes in Psychotropic Medication

ABSTRACT Introduction: Psychotropic medication is often prescribed to individuals with intellectual and developmental disabilities who engage in challenging and other behavior (e.g., aggression and stereotypy, respectively), but there is limited understanding of the effects of these medications on behavior. Objective: Within the context of a larger study that evaluated the effects of psychotropic medication regimen changes on the presentation of challenging behavior, this study describes the presentation of stereotypic behavior of three individuals diagnosed with autism spectrum disorder. Methods: Stereotypy was measured during weekly, one-hour, direct observations and during the control and ignore conditions of functional analyses of challenging behavior (which were conducted following changes in psychotropic medication regimens). Results: Patterns of stereotypy varied over time, but not significantly, and at times seemed to coincide with medication changes. Discussion: Our results suggest stereotypy persists throughout adulthood; however, additional research is needed.

Pharmacist Collaborative Care in Heart Failure Management in Kirkuk City- Iraq

Background: In spite of advances toward the treatment of heart failure (HF), the number of hospital readmissions, and their associated health care costs are very high, and anticipated to rise exceptionally over the next decade that put an expanded load on the healthcare system. Drug-related problems (DRPs) is among the leading cause of hospital readmission. DRPs occur frequently upon discharge due to changes in medication regimen or suboptimal discharge instructions given to patients. Which can cause harm to patients. A need was therefore identified to update systems of care for HF. Recent policy is an increasing focus on delivering of intensive pharmaceutical care for these patients with the aim of reducing hospital admissions. Objective: To clarify the role of clinical pharmacist (CP) in the care of patients with HF in reducing rehospitalization, discrepancies, improving adherence and health related quality of life (QOL). Methods: A prospective, randomized, controlled intervention study was conducted on 100 patients with chronic HF were recruited from the Cardiac Clinic and Internal Medical Ward, at Azadi Teaching Hospital in Kirkuk City from March to August 2019. Patients have been randomized to two groups (50 patients per each) standard care (control) or standard care plus a follow-up program (intervention) that includes medication review and interview. Intervention participants are scheduled for a 30-min appointment with the clinical pharmacist, following their standard follow-up appointments at the Cardiac Clinic, patients in the intervention group were seen individually two times (baseline and follow-up) or as required over six weeks, at the Cardiac Clinic. An intervention agenda was set to check and manage any problems with prescribing and adherence. Additional information supplied on the discharge medication related to dose adjustments and discontinued medication. The data were analyzed using Statistical Package for the Social Sciences (SPSS) V.22, chi-square (X2) test, and t-test, and the significance level was < 0.05. Results: Ninety- three out of 100 patients were completed the study distributed between intervention and control group (47, 46) patients respectively. Both groups were nearly similar in term of age, gender, education level and smoking. After 6 weeks, there were statistically significant reductions in the following parameters of the intervention group; the total number of hospitalization (49 vs 23; P < 0.003), length of stay (LOS) (131 days’ vs 53 days; P < 0.002). Number of medication discrepancies, with a significant improvement in Patients' adherence (P value ≤ 0.01) and QOL. Regarding control group, no significant difference in the number of rehospitalization but the LOS there was a significant difference, a significant difference in one type of discrepancies, no improvement in adherence and QOL. Conclusions: The results of the current study revealed that pharmacists' contribution to providing medication care for patients with HF has a great impact on reducing the number of rehospitalization, LOS, medication discrepancies, and improving patient’s adherence and QOL, as well.

150 Management of diabetes in pregnancy during the COVID-19 pandemic at a New York City hospital

To compare diabetic control and maternal and neonatal outcomes in pregnant women during the Coronavirus 2019 (COVID-19) pandemic to women managed one year prior. This was a retrospective cohort study of pregnant women with diabetes managed either during the COVID-19 pandemic or one year earlier. Twenty-two gestational and pregestational diabetic subjects were identified in a city hospital clinic during the peak of the pandemic in New York City (NYC) from March 15, 2020 until May 31, 2020. Fifty-seven pregnant diabetic subjects were identified who were managed at this clinic during the same timeframe in 2019. Demographics and maternal and neonatal outcomes were collected and compared. Diabetic control was compared by measuring change in hemoglobin A1c and diabetic medication regimen at time of delivery. Outcomes documented included mode of delivery, gestational age at delivery, postpartum hemorrhage, maternal infection, birth weight, shoulder dystocia, APGAR score <7, fetal acidosis, NICU admission, neonatal glucose level and neonatal demise. Secondary outcomes included number of virtual or in person visits, COVID-19 status, and gestational age at time of the diabetes diagnosis. Patients managed during the COVID-19 pandemic had significantly more telehealth visits and fewer in person visits compared to the year prior (p<0.001). However, no significant differences in maternal or neonatal outcomes or diabetic control were noted. There was no significant change in mode of delivery (p>0.999), shoulder dystocia (p=0.075), macrosomia (p>0.999), APGARs (p=0.671) or change in hemoglobin A1c during pregnancy (p=0.342). There were no significant differences in maternal or neonatal outcomes or diabetic control for subjects managed during the COVID-19 pandemic in a NYC hospital. A decreased number of in person visits, substituted with telehealth visits, had no apparent negative effect on outcomes or diabetic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Change in glucose-lowering medication regimens in individuals with type 2 diabetes mellitus during the COVID-19 pandemic in Germany.

To estimate the proportion of individuals with type 2 diabetes mellitus (T2DM) undergoing changes in glucose-lowering therapy in 2019 and 2020. Individuals with T2DM who had at least one consultation in one of 940 general (including diabetologist) practices in Germany between January and July 2019 (N = 79 268) and between January and July 2020 (N = 85 046) were included. Therapy changes were defined as the prescription of new glucose-lowering drugs, with or without the discontinuation of previous treatments (therapy switch and add-on therapy, respectively). The number of T2DM patients with at least one medication regimen change was calculated for the periods 1 January to 14 March in 2019 and 2020, and for the periods 15 March to 31 July in 2019 and 2020. March 2020 corresponded to the beginning of the lockdown in Germany. Overall, there was a decrease in the number of patients with at least one medication regimen change in the period 15 March to 31 July 2019 compared with 15 March to 31 July 2020 (dipeptidyl peptidase-4 inhibitors: -15%; sodium-glucose co-transporter-2 inhibitors: -3%; glucagon-like peptide-1 receptor agonists: 0%; other oral glucose-lowering drugs: -6%; and insulin: -21%). The coronavirus disease-2019 (COVID-2019) pandemic had a strong impact on glucose-lowering drug use in T2DM patients in Germany. More research is warranted to further investigate the treatment and management of T2DM individuals during the COVID-19 era in Germany and elsewhere.

Combining stimulants with antipsychotics for foster children and adolescents: Do prescribers adhere to guidelines?

ObjectiveConsistent with federal requirements for states to monitor psychotropic medication use in foster children and adolescents, we assessed prescribers’ adherence to best practice guidelines. Specifically, we identified the prevalence and patterns of combined use of stimulants and antipsychotics among a sample of foster children and adolescents that received additional non-pharmacological interventions from a state-funded team. A secondary purpose of this paper was to demonstrate a method for monitoring psychotropic medication use for this vulnerable population. MethodsUsing data from a state Medicaid database and a state-funded team, we tracked medication use among a sample of 128 foster children and adolescents aged 5–19 years with varying diagnoses who received behavioral and medication review services. We extracted data for children and adolescents who received the combination of stimulants and antipsychotics, and then we visually depicted the data to show changes in medication use before, during, and after our services. ResultsOut of the larger sample, twenty-one foster children and adolescents (16%) simultaneously received stimulants and antipsychotics. Visual depictions of data show that less than 50% received stimulants alone before combined use. In addition, participants experienced limited changes in medication regimens even after receiving non-pharmacological services. ConclusionsThese findings suggest that prescribers may not adhere to practice guidelines for use of stimulants and antipsychotics, even for clients who receive other services, and highlight the need for relevant stakeholders to monitor unsafe prescribing practices.

Telehealth approach for amyotrophic lateral sclerosis patients: the experience during COVID-19 pandemic.

Specialized multidisciplinary ALS care has been shown to extend survival and improve patient's and caregiver's quality of life. During the COVID-19 pandemic, the management of patients suddenly changed and telemedicine has been proven to be as effective as outpatient care. We elaborate the experience with Telemedicine of a Tertiary ALS Center from an Italian geographical area with high infectious risk during the COVID-19 pandemic. 19 patients were evaluated in telemedicine by a multidisciplinary team including a neurologist (clinical evaluation, intercurrent events, and drug prescriptions); a dietician (diet and weight monitoring); a psychologist (psychological assessment and support); and a physiotherapist (physiotherapy treatment and device prescription). Telemedicine was performed using the online platform "IoMT Connected Care Platform (Ticuro Reply)." All patients reported a positive perception of talking face to face with healthcare professionals and were satisfied with how the team understood their problems. During video televisits, there was a change in the patient's medication regimen in 11/19; 2/19 required pneumological evaluation and started NIV; and 9/16 patients required prescription of devices. The mean monthly decline of ALSFRS-R before televisit was 0.88 (SD 1.17) and during televisit of 0.49 (SD 0.75). Bodyweight and daily caloric content remain stable. Reduction in HADS scores and stability in ALSAQ-40 were observed. Our study positively reproduced the multidisciplinary approach currently used with ALS patients, trying to stabilize the functional and metabolic status and improving the psychological one. Future directions include a personalized telemedicine program according to the patient's needs.

Longitudinal medication reconciliation at hospital admission, discharge and post-discharge.

Medication reconciliation (MR) is a widely recognised method to promote patient safety. However, its implementation is generally limited to an interaction at a single transition point. To examine the rates and types of changes implemented in patient's medication regimens when MR is performed longitudinally at hospital admission, discharge and post-discharge, and to assess the clinical impact. A prospective multicentre cohort study was conducted in two hospitals. Patients received MR at admission, discharge and within five days post-discharge at home. Data was collected on rates and types of changes implemented in their medication regimens, due to MR, at all three transition points. These changes entailed corrections of unintentional discrepancies, e.g., between patients' actual medication use and physician prescriptions, and optimisations of pharmacotherapy, e.g., adding laxatives when opioids are prescribed. Using a validated instrument, the clinical impact of all medication changes were scored. Data were analysed using descriptive statistics. In total, 197 patients with a median age of 73 years were included. In 86.3% of patients at least one change was implemented in the medication regimen due to longitudinal MR. At admission, discharge and post-discharge, changes in medication regimens were necessary in 66.5%, 62.9% and 52.8% of patients, respectively. At admission and post-discharge, mainly unintentional discrepancies were corrected, and at discharge mainly optimisations were implemented. Implemented medication changes, due to longitudinal MR, prevented potential harm in 161 patients (81.7%). Potentially serious medication errors were most often prevented at hospital discharge, and predominantly involved optimising antithrombotic agents. Changes in medication regimens were implemented in 86.3% of patients due to longitudinal MR at admission, discharge and post-discharge. The rates and types of medication changes vary over time. Hospital discharge is an important moment for optimising pharmacotherapy.

The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients.

The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall. Observational clinical study. Adults on ≥1 glaucoma medications examined between June 30, 2017 and August 2, 2017. in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen. 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression. A total of 118 patients enrolled: age 69.7±12.9 years (mean±SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4±1.0 vs. 2.7±0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate's degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002). AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.

MP66-17 CLINICAL EFFECTIVENESS OF BILATERAL ORCHIECTOMY IN REDUCING ANTI-ANDROGENS IN TRANSGENDER FEMALES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-17 CLINICAL EFFECTIVENESS OF BILATERAL ORCHIECTOMY IN REDUCING ANTI-ANDROGENS IN TRANSGENDER FEMALES Ross G. Everett*, Kaylee M. Luck, Bryce A. Toburen, and Jay I. Sandlow Ross G. Everett*Ross G. Everett* More articles by this author , Kaylee M. LuckKaylee M. Luck More articles by this author , Bryce A. ToburenBryce A. Toburen More articles by this author , and Jay I. SandlowJay I. Sandlow More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Androgen reducing medications are often given to suppress testosterone levels and reduce the dosage of exogenous estrogens in transwomen with gender dysphoria [GD]. However, these medications often carry adverse effects, particularly at higher doses. Bilateral orchiectomy [BO] is utilized as an alternative means of castration to reduce the magnitude of hormone medication in this population. However, few reports exist which report the actual changes in hormonal medication regimen that accompany BO. The objective of this study was to assess the impact of BO on the hormone regimen of patients with GD. METHODS: Retrospective chart review was used to identify patients with GD who underwent BO for GD at our institution between 2008-2018. Patients met criteria for BO as established by The World Professional Association for Transgender Health guidelines. Various parameters including medication regimen and hormone levels were compared before and after surgery. All data was analyzed in a standard statistical fashion. RESULTS: Nineteen patients underwent BO. Sixteen had pre-operative medication regimen information available. Median age at time of surgery was 46 years (range 30-65). All sixteen were on anti-androgen therapy [AAT] prior to surgery for a median duration of 42.5 months. Pre-operative and post-operative medication regimens were available for twelve patients. Of these, eleven (91.7%) were treated pre-operatively with spironolactone and one with bicalutamide (8.3%). Two (16.6%) patients were treated pre-operatively with finasteride. Post-operatively, ten patients (90.9%) were noted to have cessation of spironolactone and the one patient (100%) had discontinued bicalutamide. One of the two patients (50%) on finasteride had stopped the agent. Three (25%) had reduced their exogenous estrogen supplementation. Median time of follow-up available after surgery was 22 months. CONCLUSIONS: BO is an effective means of negating the need for ongoing androgen reducing medication for the majority of transgender female patients with 91.7% of patients stopping AAT post-operatively. Additionally, 25% reduced the amount of exogenous estrogen they used. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e990-e990 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross G. Everett* More articles by this author Kaylee M. Luck More articles by this author Bryce A. Toburen More articles by this author Jay I. Sandlow More articles by this author Expand All Advertisement PDF downloadLoading ...

2302 A Case of Hepatitis B Reactivation Resulting in Fulminant Hepatic Failure

INTRODUCTION: Patients with chronic HBV/HIV coinfection are at high risk of HBV chronicity and reactivation. Here we present a case of a patient who presented with acute liver failure secondary to hep B reactivation after adjustment of his HIV medication regimen. CASE DESCRIPTION/METHODS: A 56 year old male with HIV/HBV coinfection with undetectable viral loads was evaluated in the ED for new onset nausea and jaundice. Examination was significant for jaundice in the absence of any encephalopathy or other stigmata of chronic liver disease. Blood tests revealed INR 3, ALK-P 210, ALT 2186, AST 2934 and Bili T/D 25.6/17, platelet count 197K, Cr 1.98, and CD4 count 394. Liver US showed normal hepatic echotexture with patent vasculature. Serologic evaluation showed undetectable HIV viral load, negative Hep C PCR, positive HepBsAg, and highly positive hepatitis B DNA (&gt;1 billion copies). About 5 months prior to this acute presentation, he was switched from (Cobicistat, Elvitegravir, Emtricitabine, and Tenofovir) to another regimen that doesn’t include hepatitis B coverage (Atazanavir, Cobicistat , Rilpivirine, and Abacavir) due to concerns about Tenofovir contributing to his unexplained CKD. He was started on dual therapy with tenofovir and entecavir and was transferred to a nearby liver transplant center. His passed away after a short complicated hospital stay with acute liver failure and colonic pneumatosis. DISCUSSION: Our patient presented with acute fulminant liver failure after a brief period of inadvertent Hep B treatment interruption. Medical treatment was not helpful despite attempts at combination therapy with Tenfovovir and Entecavir (in contrast to Tenofovir monotherapy) despite the scarcity of data in this specific situation. There are case reports that demonstrated clinical improvement especially early treatment in the course; however progression to hepatic failure, liver transplantation, and death has also been widely reported despite therapy. This case serves as a reminder to all medical providers about the complexity of concomitant chronic HBV and HIV coinfection. Any medication regimen change in this patient population needs a multidisciplinary team based approach between HIV specialists and Hepatologists.

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study