Medication Regimens For Patients Research Articles

Impact of the addition of clinical pharmacy services to the cardiac catheterization laboratory.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Our cardiology pharmacy team recently expanded services to the cardiac catheterization laboratory (CCL) with the addition of a dedicated pharmacist; since that time, numerous process improvement initiatives have been implemented and medication review has been expanded. We conducted a single-center retrospective chart review. The primary outcome was the percentage of patients discharged from the CCL on appropriate guideline-directed medical therapy components after percutaneous coronary intervention (PCI) before and after integration of dedicated pharmacist services in the CCL. Secondary outcomes were assessed for all patients discharged from the CCL after implementation of a pharmacy presence and included the total number of pharmacist interventions at discharge, the number of prescriptions directed to our outpatient pharmacy, the number of medication reconciliations performed, the number of "protect your stent" educational sessions completed, and the number of clinically significant pharmacist interventions to the medication regimens of patients who underwent PCI. After a dedicated pharmacist was integrated to review CCL discharges, significantly more patients were discharged on high-intensity statin therapy (47.9% vs 78.0%; P < 0.0001) and fewer patients were discharged on omeprazole or esomeprazole prescribed concurrently with clopidogrel (18.7% vs 3.9%; P < 0.0001) following PCI. Of the patients who underwent PCI after addition of the pharmacist (n = 259), 23.9% (n = 66) had a clinically significant pharmacist intervention at discharge and 96.5% (n = 250) received protect your stent education. Of all discharges following pharmacist integration (n = 3,501), 13.6% (n = 477) had at least one pharmacist intervention, 771 prescriptions were sent to our outpatient pharmacy, and 66.4% (n = 2,325) of patients had a medication reconciliation completed. Addition of a dedicated pharmacist to the CCL was associated with increased rates of high-intensity statin prescribing and decreased use of esomeprazole and omeprazole with clopidogrel.

Does the Outcome of Graft Materials at Dental Implant Sites Differ Between Patients With Normal and Compromised Bone Health?

The objective of this paper was to assess the outcome of bone graft material at alveolar bone augmentation sites combined with dental implants in postmenopausal women with compromised bone health by evaluating cone beam computerized tomography (CBCT) scans at multiple time points.CBCT scans were analyzed on 55 postmenopausal women with compromised bone health status to determine the fate of alveolar bone augmentation. CBCT scans were taken immediately after surgery and 9 and 24 months postoperatively. The patient's medication regimens and durations were recorded, and the pixel intensity value (PIV) was measured and standardized using scoring criteria and visual assessment. Statistical analyses included 2-sample t tests for continuous variables and Fisher's exact tests for categorical variables.Among the normal patients, 73% received a grade 2 visual score, and 27% received a grade 1 visual score. After 24 months, 45% of patients received a grade 2 score, and 27% received a grade 3 score. In the osteoporotic group receiving medication, 77% of participants received a grade 1 visual score at the 9-month postoperative evaluation, while 23% received a grade 2 score. At the 24-month assessment, 55% of patients received a grade 1 score, 41% received a grade 2 score, and only 5% received a grade 3 score. Notably, although the graft material did not remodel into native bone, it was a scaffold for implants in controlled osteoporotic patients. The study's results show that the pixel intensity values of particulate graft materials are similar across the three different time points, suggesting that the graft material's pixel intensity value remains constant in postmenopausal women with osteoporosis. The study's limitations include a small sample size and a restricted 24-month follow-up period. This limited time frame may need to capture long-term changes or variations in graft materials adequately. Future research should include a larger sample size and have a longer follow-up duration to provide a more comprehensive understanding of the change in graft materials between patients with normal and compromised bone health.

The Optimization of Pharmacological and Non-pharmacological Interventions in a Case of Parkinson's Psychosis

Mr. L is a 64 y.o. male with a history of Parkinson's disease s/p bilateral DBS who initially presented to the emergency room from an assisted living facility for altered mental status and increased combativeness with staff. Patient was found to be experiencing symptoms of Parkinson's Psychosis and had uncontrol behavioral disturbance. Psychiatry was consulted for recommendations for agitation and hallucinations. Mr. L was hospitalized for over a year due to the need for higher level of care, inability to obtain guardianship, and inability to obtain subsequent placement. The patient's medication regimen was optimized with use of multiple medications including clozapine, lorazepam, and trazodone. Though medications showed some efficacy, Mr. L continued to display symptoms of agitation requiring use of restraints and emergency medication. Non-pharmacological interventions were recommended and included a combination of specific approaches to help address his needs such as techniques for medication adherence and increasing environment and social stimulation to decrease agitation and confusion. After initiating and distributing behavioral plan to patient's team, he required less medication alterations, emergency treatment orders, and ultimately the quality of life for patient and treating care team members was improved. This case underlines the efficacy of medication initiation in combination with non-pharmacological interventions in the hospital setting to improve the quality of life of patients and staff providing long term care for patients. Data on behavioral intervention and standardization of behavioral intervention is limited and typically is utilized more often in outpatient settings. However, behavioral plans for complex patients with prolonged hospital stays may allow for less agitation, thus alleviating barriers to care and limiting patient discomfort while hospitalized without complicating patient care with adverse effects. Simultaneously, decreased use of restraints, emergency medications for agitation, and staff intervention can be useful for alleviating provider team and staff burnout.

Effects of the valsartan recall on heart failure patients: A nationwide analysis.

Valsartan is commonly used for cardiac conditions. In 2018, the Food and Drug Administration recalled generic valsartan due to the detection of impurities. Our objective was to determine if heart failure patients receiving valsartan at the recall date had a greater likelihood of unfavorable outcomes than patients using comparable antihypertensives. We conducted a cohort study of Optum's de-identified Clinformatics® Datamart (July 2017-January 2019). Heart failure patients with commercial or Medicare Advantage insurance who received valsartan were compared to persons who received non-recalled angiotensin receptor blockers (ARBs) and angiotensin converting enzyme-inhibitors (ACE-Is) for 1 year prior and including the recall date. Outcomes included a composite for all-cause hospitalization, emergency department (ED), and urgent care (UC) use and a measure of cardiac events which included hospitalizations for acute myocardial infarction and hospitalizations/ED/UC visits for stroke/transient ischemic attack, heart failure or hypertension at 6-months post-recall. Cox proportional hazard models with propensity score weighting compared the risk of outcomes between groups. Of the 87 130 adherent patients, 15% were valsartan users and 85% were users of non-recalled ARBs/ACE-Is. Valsartan use was not associated with an increased risk of all-cause hospitalization/ED/UC use six-months post-recall (HR 1.00; 95% CI 0.96-1.03), compared with individuals taking non-recalled ARBs/ACE-Is. Similarly, cardiac events 6-months post-recall did not differ between individuals on valsartan and non-recalled ARBs/ACE-Is (HR 1.04; 95% CI 0.97-1.12). The valsartan recall did not affect short-term outcomes of heart failure patients. However, the recall potentially disrupted the medication regimens of patients, possibly straining the healthcare system.

Success in Heart Failure? An Investigation of Heart Failure Readmission Rates and Medication Regimen Optimization.

In May 2022, the American College of Cardiology updated their guideline-directed medical therapy for congestive heart failure (CHF) to include four pillars of therapy. These pillars aim to better control patients with heart failure (HF) and reduce the incidence of hospitalization by including an evidence-based beta-blocker, an angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker/angiotensin receptor/ neprilysin inhibitor, a mineralocorticoid receptor antagonist, and newly recommended sodium glucose cotransporter 2-inhibitors. This study at University of Florida Health Central Florida Hospitals reviewed patients who were diagnosed with CHF and recorded if they were readmitted with a HF exacerbation within 30 days of an initial index admission. Patients had data obtained retrospectively using electronic medical records from patient hospital encounters within the study inclusion dates; 7/1/2022-9/30/2022. Hospital readmission rates for patients with CHF, and information on each patient's medication regimen was collected to see if they met medication optimization criteria. A total of 252 patients were evaluated, with 157 meeting the inclusion criteria. Of the patients included, 23 (14.6%) experienced a hospital readmission within 30 days because of acute HF exacerbation or worsening HF. After reviewing medication regimens, 60 patients (38.2%) were receiving treatment with one pillar of therapy, 72 (45.8%) with two pillars of therapy, 12 (7.6%) with three pillars of therapy, and one patient was treated with all four pillars of therapy. In conclusion, this study showed that the recommended pillars of therapy are not being implemented and patients with CHF may benefit from medication optimization.

The Impact of Growth Hormone Co-Treatment Duration on Outcomes in IVF/ICSI Cycles Among Poor Ovarian Responders.

The efficiency of in vitro fertilization is improved by growth hormone (GH) during ovarian stimulation. Additionally, patients with diabetes experience impaired insulin resistance and compromised glucose tolerance, which further exacerbate their condition. Due to these side effects, in this study, the duration of GH treatment was compared in IVF/ICSI cycles among poor ovarian responders. In this study, POSEIDON criteria were used to choose patients. Subcutaneous administration of gonadotropin-releasing hormone (GnRH) antagonist was done beginning on the sixth day of the cycle and continuing through the day of human chorionic gonadotropin (hCG) injection. In one group, GH was administered 4 units/day from the 2nd day of the cycle until hCG injection, and in another group, the first dose was administered on the 6th day of the cycle. Following the administration of hCG, which lasted from 24 to 36 hr, oocytes were retrieved with the support of B-mode sonography. In our analysis, no significant differences were observed between the two groups in terms of the number of retrieved oocytes, metaphase II oocytes, and quality of grade A and B embryos. The results show that the treatment or conditions did not have a significant impact on the outcomes among the studied groups. Our findings indicate that a shorter duration of GH administration can yield similar outcomes compared to a longer duration in IVF/ICSI cycles involving poor ovarian responders. This result holds the potential for a more cost-effective and patient-friendly approach in managing assisted reproductive technology procedures. It may lead to reduced side effects and improved adherence to medication regimens in patients.

Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test.

The aldosterone-to-renin activity ratio (ARR) is recommended as a screening test for primary aldosteronism (PA). The use of antihypertensive medication is one of the most important factors to take into account when interpreting the ARR. The goal of this study was to compare the effect of various antihypertensive drug classes on biochemical testing and provide practical recommendations for antihypertensive medication regimens in patients suspected of having PA. We retrospectively investigated 4218 hypertensive patients who underwent PA detection between January 2020 and February 2023. Finally, 25 patients with essential hypertension (EH) and 39 with PA were involved. The enrolled EH patients were selected from EH patients with at least two screening tests with interfering medication changes for at least 4 weeks. A total of 2/18 (11.1%) EH patients had opposite screening results after angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), dihydropyridine-calcium channel blockers (DHP-CCBs) and diuretics were withdrawn. A total of 3/3 (100%) of the patients were initially screened as positive but had results that tested negative after β-blockers withdrawal. A total of 3/39 (7.7%) PA patients were misdiagnosed with EH with drug effects. Only plasma renin activity was markedly reduced after antihypertensive medication washout (P = 0.0173). Not every patient receiving β-blockers, ACEIs, ARBs and DHP-CCBs with negative reports needed withdrawal or switching antihypertensive drugs. We recommend that patients be left on a regimen that includes β-blockers, ACEIs, ARBs, DHP-CCBs and spironolactone when determining the ARR during the initial test.

Effect of Pharmacy Involvement in Transitions of Care for Children With Medical Complexity.

The purpose of this study is to evaluate the effects of pharmacy integration into care transitions for children with medical complexity. These children are at a higher risk for medication errors and adverse effects because of their complex medication regimens. In addition, care transitions increase the risk for medication errors, especially during hospital-to-home transitions. This was a retrospective chart review of patients enrolled in a complex care clinic who were discharged between September 1, 2021, and December 31, 2021, and who had received a discharge medication evaluation. Intervention categories were predetermined (medication reconciliation and clinical interventions) and documented. The primary outcome was to quantify and characterize the types of interventions made by the pharmacist. Descriptive statistics were used for data analysis. Continuous data were analyzed using Wilcoxon rank sum test, and correlation was measured using Spearman correlation values. A total of 92 clinic encounters for 60 patients were included, with a median patient age of 7 years (IQR, 5-12.3), median length of stay of 3.2 days (IQR, 1.2-5.7), and a median number of 18 discharge medications (IQR, 14.8-25). A total of 283 interventions were made, consisting of 192 (68%) clinical interventions and 91 (32%) medication reconciliation interventions. In addition, 82 (89%) of the clinic encounters had at least one pharmacist intervention. Pharmacist evaluation of a patient's discharge medication regimen clarifies and better optimizes the patient's medication regimen.

Rheumatoid arthritis patients are at increased risk for adverse events following lumbar discectomy

BACKGROUND CONTEXTLumbar discectomy is a common procedure for which patients with rheumatoid arthritis (RA) may be considered. RA is an autoinflammatory disease that may predispose patients to postoperative adverse outcomes. PURPOSETo assess the relative odds of adverse events after lumbar discectomy for those with versus without RA in a large, national, administrative dataset. STUDY DESIGN/SETTINGRetrospective cohort study using the 2010 to 2020 MSpine PearlDiver dataset. PATIENT SAMPLEAfter exclusion of patients under 18 years old, those with any trauma, neoplasm, or infection diagnosis within the month before lumbar discectomy, and any patients who had any alternative lumbar spinal surgery performed on the same day as lumbar discectomy, we identified 36,479 lumbar discectomy patients. 2,937 (8.1%) of these patients had a prior diagnosis of RA. After matching 4:1 by patient age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated via ICD-9 and 10 diagnosis codes), 8,485 lumbar discectomy patients without RA and 2,149 with RA were included. OUTCOME MEASURESIncidence of severe and minor adverse events in the 90-days following lumbar discectomy, predictive factors for adverse events within 90-days of lumbar discectomy, risk of adverse events within 90-days of lumbar discectomy stratified by patient medication regimen, 5-year survival to reoperation following lumbar discectomy. METHODSPatients undergoing lumbar discectomy were identified from the PearlDiver MSpine dataset. The subset of those with versus without RA were identified and matched 1:4 based on patient age, sex, and ECI scores. The incidence of 90-day adverse events in the two groups was determined and compared by univariate and multivariate analyses. Subgroup analysis was performed based on RA medications being taken. RESULTSMatched lumbar discectomy patients with RA (n=2,149) and without RA (n=8,485) were identified. Controlling for patient age, sex, and ECI, those with RA were at significantly higher odds of any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse events (p<.0001 for all).Stratifying by medications being taken (and relative to those without RA), there was increasing odds of all adverse events (AAE) based on potency of medications (no biologic or disease modifying antirheumatic drugs [DMARDs] OR 2.33, DMARDs only OR 3.86, biologic±DMARDs OR 5.69 (p<.0001 for all). Despite this, no statistically significant difference in 5-year survival from subsequent lumbar surgery was found between those with versus without RA (p=.1000). CONCLUSIONSLumbar discectomy patients with RA were found to be at significantly higher risk for 90-day adverse events following lumbar discectomy, and this was incrementally greater for those on increasingly suppressive medications. Lumbar discectomy patients with RA bear specific consideration and perioperative monitoring when considered for lumbar discectomy.

Phase 2, placebo-controlled clinical study of oral ganaxolone in PCDH19-clustering epilepsy

IntroductionProtocadherin-19 (PCDH19)-clustering epilepsy is a distinct developmental and epileptic encephalopathy characterized by early-onset seizures that are often treatment refractory. Caused by a mutation of the PCDH19 gene on the X chromosome, this rare epilepsy syndrome primarily affects females with seizure onset commonly in the first year of life. A global, randomized, double-blind, placebo-controlled, phase 2 trial was conducted to evaluate the efficacy, safety, and tolerability of ganaxolone compared with placebo as adjunctive therapy to a standard antiseizure medication regimen in patients with PCDH19-clustering epilepsy (VIOLET; NCT03865732). MethodsFemales aged 1–17 years with a molecularly confirmed pathogenic or likely pathogenic PCDH19 variant who were experiencing ≥12 seizures during a 12-week screening period were stratified by baseline allopregnanolone sulfate (Allo-S) levels (low: ≤2.5 ng/mL; high: >2.5 ng/mL) at screening and randomized 1:1 within each strata to receive ganaxolone (maximum daily dose of 63 mg/kg/day if ≤28 kg or 1800 mg/day if >28 kg) or matching placebo in addition to their standard antiseizure treatment for the 17-week double-blind phase. The primary efficacy endpoint was the median percentage change in 28-day seizure frequency from baseline to the 17-week double-blind phase. Treatment-emergent adverse events (TEAEs) were tabulated by overall, system organ class, and preferred term. ResultsOf the 29 patients screened, 21 (median age, 7.0 years; IQR, 5.0–10.0 years) were randomized to receive either ganaxolone (n = 10) or placebo (n = 11). After the 17-week double-blind phase, the median (IQR) percentage change in 28-day seizure frequency from baseline was − 61.5% (−95.9% to −33.4%) among patients in the ganaxolone group and − 24.0% (−88.2% to −4.9%) among patients in the placebo group (Wilcoxon rank-sum test, p = 0.17). TEAEs were reported by 7 of 10 (70.0%) patients in the ganaxolone group and 11 of 11 (100%) patients in the placebo group. Somnolence was the most common TEAE (40.0% ganaxolone vs 27.3% placebo); serious TEAEs were more common in the placebo group (10.0% ganaxolone vs 45.5% placebo); and 1 (10.0%) patient in the ganaxolone group discontinued the study versus none in the placebo group. ConclusionsGanaxolone was generally well tolerated and led to a greater reduction in the frequency of PCDH19-clustering seizures compared to placebo; however, the trend did not reach statistical significance. Novel trial designs are likely needed to evaluate the effectiveness of antiseizure treatments for PCDH19-clustering epilepsy.

ODP220 Latent Autoimmune Diabetes of Adults and PCOS - an Unusual Combination

Abstract Introduction Latent autoimmune diabetes of adults (LADA) is an adult-onset subtype of autoimmune type 1 diabetes mellitus (T1DM), that is often misdiagnosed as T2DM. We present a case of LADA that was diagnosed in a young female with PCOS (polycystic ovaries syndrome) previously unsuccessfully managed as a T2DM patient. Case report 20-years-old female with past medical history of hyperlipidemia, newly diagnosed PCOS and suspected T2DM, presented to the PCP office for a routine follow up. Patient medication regimen consisted of Metformin 500 mg BID, Spironolactone 50 mg daily and oral contraceptive. Her BMI was 27.1. Routine blood work resulted in A1C 12.6% (estimated average glucose of 306 mg/dL), total cholesterol 278 mg/dL, triglycerides 1216 mg/dL, HDL cholesterol 31 mg/dL. She was also found to be Vitamin D deficient (Vitamin D, 25-OH 9.8 ng/mL). Based on a very young age and unusually elevated A1C she was assessed for LADA and found to have glutamic acid decarboxylase antibody (GAD-65) titer greater than 28.9 IU/mL (normal 0 - 5. 0 IU/mL), C-peptide of 0.8 ng/mL (normal 0.8-3.5 ng/mL) and negative anti pancreatic islet cells antibody level. Based on those results, she was diagnosed with LADA and initiated on insulin therapy (long acting and short - acting mealtime insulin). Metformin and OCP were discontinued given very high cholesterol level, but she started on Fenofibrate 160 mg daily, Vitamin D supplements and continued with Spironolactone 50 mg daily. Within 3 months her HbA1c decreased to 6.9% and she is doing remarkably well with the new medication regimen. Discussion LADA shares similar genetic and autoimmune profiles with T1DM, however LADA insidious presentation overlaps with T2DM, often resulting in misdiagnosis and delaying diagnosis and adequate treatment. Insulin resistance appears to underlie many of the endocrine features of PCOS in most of the patients. The risk of T2DM among PCOS patients is 5- to 10-fold higher than normal, however there is no clear correlation established between PCOS and T1DM, including LADA. Our case warrants newly diagnosed young adults with diabetes should be screened for LADA if there are atypical findings (such as very young age, remarkably elevated A1C, close to normal BMI). Among the anti-islet antibodies, GAD-65 are the most sensitive self-antigen-antibody markers of autoimmune diabetes. Early insulin therapy preserves residual β-cell function, improves glycemic control, and reduces the risk of long-term complications. Presentation: No date and time listed

An evaluation of long-acting cabotegravir + rilpivirine for the treatment of virologically suppressed adults living with HIV

ABSTRACT Introduction HIV is a global disease that has seen significant improvements in care over the past decades. Despite improvements, treatments for maintaining suppression are complex for patients and include two to three oral medications. The approval of intramuscular cabotegravir (CAB) and rilpivirine (RPV) offers a new therapeutic modality with the opportunity of a longer dosing frequency. The data from recent trials including FLAIR and ATLAS have shown non-inferiority in treatment based on the current standard of care. This approval has the potential to simplify patient medication regimens, while maintaining virologic suppression in HIV-1 patients. Areas Covered Cabotegravir + rilpivirine’s recent approval for the treatment of HIV and its significant impact it may have on people living with HIV. Expert Opinion Cabotegravir + rilpivirine is a long-acting injectable that can be used for patients who want to reduce the frequency antiretroviral administration. CAB+RPV allows for virologic suppression with monthly or less often administration, but comes with a significant price point, although injection site reactions may limit utility for many patients.

Spica Casting of Pediatric Femur Fractures: The Pain Management Experience at One Institution.

ObjectivesCurrently, very little literature exists regarding the "fifth vital sign" in pediatric orthopedics, pain. Multiple studies have highlighted the utility of non-narcotic pain medications in treating acute pain. The objective of this study is to determine the type and amount of pain medication(s) administered and subsequently prescribed to pediatric patients ages six months to five years old with femur fractures treated with spica casting in the ER (emergency room) and OR (operative room). We also determined the incidence of spica cast change necessary for the two groups as a secondary outcome.MethodsA retrospective review was completed at a single level 1 pediatric trauma center, evaluating 82 patients who met the inclusion criteria between six months to five years of age with isolated femoral shaft fractures requiring intervention at one institution. Descriptive statistics and Wilcoxon Rank-Sum or Fisher'sFisher's Exact test were used to assess differences between OR and ER groups for either continuous or categorical variables, respectively. The electronic medical record was then queried for demographic information, location of spica cast placement, hours in the hospital, and amount and type of analgesic medications administered and prescribed.ResultsOverall, we noted a preponderance of femur fractures in young males (72%), with the mean age of our cohort being 2.3 years old. Our patients spent a median of 20.9 hours in the hospital and had a median worst pain score of 7/10 during their hospital stay. No difference was found between standardized amounts of morphine equivalent administration between groups in the hospital. Upon discharge from the hospital, most patients received opioid and acetaminophen prescriptions (72% and 83%), but few received an ibuprofen prescription (24.4%). More spica casts placed in the ER needed to be revised in the OR compared to spica casts placed in the OR (57% vs. 8%, p<0.01).ConclusionsThere are various medication regimens for patients with femoral shaft fractures treated with spica casting at one institution. Our study revealed that patients received more prescription opioids if treated in the OR. Additionally, spica casting in the ER did not significantly decrease hospital stay, and it significantly increased the risk of needing a reduction in the OR in our institution.

Medication regimen complexity and its association with adherence and blood pressure control among hypertensive patients at selected hospitals of South Gondar Zone: A hospital based cross sectional study.

Despite the availability of effective antihypertensive medications, blood pressure (BP) control is suboptimal. High medication regimen complexity index (MRCI) is known to reduce adherence and may be the reason for poor BP control. However, there is no data in the present study areas. Hence, the aim of this study was to assess MRCI and its association with adherence and BP control among hypertensive patients at selected hospitals of South Gondar Zone. A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021 at selected hospitals of South Gondar Zone. Medication regimen complexity and adherence was evaluated using 65-item validated tool called MRCI (Text removed at time of retraction. See retraction notice for more information.). Multivariable logistic regression analysis was done to determine the association between predictive and outcome variables. About 3.3% of participants were classified as having high HTN specific MRCI whereas 34.75% of participants were classified as having high patient level MRCI. (Text removed at time of retraction. See retraction notice for more information.) Being illiterate, and having low HTN MRCI were more likely to have controlled BP in adjusted analyses. On the contrary, (Text removed at time of retraction. See retraction notice for more information.) not having health insurance, and having lower monthly income were less likely to have controlled BP. A considerable proportion of patients had high MRCI. Having low HTN MRCI was more likely to have controlled BP. Simplification of a complex medication regimen for patients with HTN should be sought by physicians and pharmacists to improve BP control.

Technology-based therapy-response evaluation of axial motor symptoms under daily drug regimen of patients with Parkinson's disease.

BackgroundAxial disturbances are the most disabling symptoms of Parkinson’s disease (PD). Kinect-based objective measures could extract motion characteristics with high reliability and validity.PurposeThe present research aimed to quantify the therapy–response of axial motor symptoms to daily medication regimen and to explore the correlates of the improvement rate (IR) of axial motor symptoms based on a Kinect camera.Materials and methodsWe enrolled 44 patients with PD and 21 healthy controls. All 65 participants performed the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale part III and the Kinect-based kinematic evaluation to assess arising from a chair, gait, posture, and postural stability before and after medication. Spearman’s correlation analysis and multiple linear regression model were performed to explore the relationships between motor feature IR and clinical data.ResultsAll the features arising from a chair (P = 0.001), stride length (P = 0.001), velocity (P < 0.001), the height of foot lift (P < 0.001), and turning time (P = 0.001) improved significantly after a daily drug regimen in patients with PD. In addition, the anterior trunk flexion (lumbar level) exhibited significant improvement (P = 0.004). The IR of the axial motor symptoms score was significantly correlated with the IRs of kinematic features for gait velocity, stride length, foot lift height, and sitting speed (rs = 0.345, P = 0.022; rs = 0.382, P = 0.010; rs = 0.314, P = 0.038; rs = 0.518, P < 0.001, respectively). A multivariable regression analysis showed that the improvement in axial motor symptoms was associated with the IR of gait velocity only (β = 0.593, 95% CI = 0.023–1.164, P = 0.042).ConclusionAxial symptoms were not completely drug-resistant, and some kinematic features can be improved after the daily medication regimen of patients with PD.

Medication Use Among Patients Reporting Xerostomia of an Academic Dental Clinic.

Global prevalence of xerostomia has been reported at 22% (range 0.01%-45%), negatively impacting oral health, nutrition intake, and quality of life. The causal relationship between xerostomia and medications remains uncertain but greater understanding could guide interventions. To describe the demographic characteristics and medication regimens in patients with xerostomia of an academic dental clinic. This is a retrospective academic dental clinic record review from July 1, 2018 to October 27, 2020. Patient records were obtained from the University at Buffalo, School of Dental Medicine. Xerostomia status was determined via query of electronic health records and validated by manual review. Pharmacologic class and xerostomic potential of medications were identified by the Veterans Affairs Drug Classification System and drug compendia, respectively. Predictors of medication use were assessed using a multiple logistic regression model. Of 37 403 examined records, 366 (0.98%) were identified as xerostomic. After excluding confounding factors (Sjogren's and radiation), 275 of 317 patients received at least one xerostomic medication, majority were female (240, 66%) versus male (126, 34%). Mean ± (SD) age was 64.9 ± 15.11 years. A total of 208 (57%) patients were aged ≥65. The median number of total and xerostomic medications were 8 (interquartile range [IQR], 4-12) and 4 (IQR, 2-7), respectively. The 3 most prevalent xerostomic pharmacologic classes were antidepressants (131, 35%), gastric medications (101, 28%), and vitamin D (87, 24%). Despite observed prevalence of xerostomia lower than global prevalence, xerostomic medication burden for patients experiencing xerostomia was high. Pharmacist-led interprofessional collaborations should be investigated to reduce xerostomic burden.

Elevated Serum Uric Acid and Cardiovascular Disease: A Review and Potential Therapeutic Interventions

Several landmark studies found a relationship between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD). In fact, the association between hyperuricemia and hypertension (HTN), coronary artery disease (CAD), and heart failure (HF) is currently well-established. While the mechanism linking hyperuricemia and CVD is not fully known, a systemic inflammatory response by the host is believed to play a role. With the goal of decreasing the morbidity and mortality of CVD in patients with hyperuricemia, the focus has now turned to properly optimizing a medication regimen for this patient population. Recent studies have shown that controlling underlying inflammation can, in fact, lead to better cardiovascular outcomes for populations with acute and chronic coronary disease. In this paper, we will discuss the current state of understanding on the association of hyperuricemia and cardiovascular disease. Furthermore, we will look into the most recent clinical trials showing the effects anti-inflammatory medications have on both decreasing and recovering from cardiovascular events. We will conclude with a discussion on, given the information mentioned above, how to properly optimize a medication regimen in patients with elevated SUA levels with a focus on decreasing the morbidity and mortality associated with CVD.

Characterization of advanced Parkinson\u2019s disease in Germany: results of the non-interventional OBSERVE-PD study

BackgroundParkinson’s disease (PD) is a progressive, neurodegenerative disorder. In the advanced stages it can result in severe disability despite optimal treatment. Data suggests heterogeneous classification of PD stages among physicians in different countries. The purpose of the OBSERVE-PD study was to evaluate the proportion of patients with advanced PD (APD) according to physicians’ judgments in an international cohort.MethodsA cross-sectional, observational study was conducted in 18 countries. Data were collected during a single patient visit. Demographic data, disease status, current medical treatment, and quality of life were evaluated for the German cohort and compared to the international cohort. Potential prognostic factors of physicians’ classification of APD in the German and international cohorts were identified using logistic regression.ResultsIn total, 177 German and 2438 international patients were enrolled. 68.9% of the German and 50.0% of the international patients were classified by physicians as APD. Despite similar demographics and comparable disease severity, motor fluctuations (odds ratio [OR], 49.7; 95% confidence interval [CI], 8.5–291.9) and current device-aided treatment (OR 8.7; CI 5.5–13.8) showed the strongest association to physicians’ classification of APD in the German and the international cohorts, respectively. The number of different oral anti-Parkinson-medications showed opposed associations with APD-classification between the international (OR 1.19; CI 1.03–1.37) and German (OR 0.46; CI 0.18–1.18) cohort. Although 58.2% of the German patients diagnosed with APD were considered eligible for device-aided treatment, only 40.8% actually received it.ConclusionsThis study highlights the challenges in the recognition and the effective management of APD in Germany and emphasizes the necessity of complying with standard diagnostic criteria for identification of patients with APD. Therapeutic approaches differed internationally, with a tendency in Germany towards a more complex oral medication regimen for patients with APD. In view of similar quality of life and disease status in both cohorts, our findings may prompt further exploration of parameters for disease classifications, and consideration of optimal treatment strategies.

Medication Optimization Using Pharmacogenomic Testing in a Complex Mental Health Population Prescribed Psychiatric Polypharmacy.

The use of polypharmacy has become significantly more common over the past two decades, increasing the risk of drug-drug interactions and adverse drug reactions. Pharmacogenomic (PGx) assays have the purported benefit of being able to predict an individual's response to a specific medication based on genetic markers, which may facilitate the development of optimized medication regimens for patients prescribed polypharmacy. This 12-week pilot study examined the impact of the PGx results on the clinical management of Veterans who were prescribed psychiatric polypharmacy. Psychiatric medication providers were given access to the PGx assay results, including notification of drug-drug-gene interactions computed from an algorithm decision tool, to assist with medication management decisions. Veteran outpatients (N=53) prescribed polypharmacy (mean=13.15 medications) were enrolled into the study. In 92.4% of cases, providers changed medications at baseline, with 83% of providers indicating that they changed their original medication plan based on the PGx results. Clinical improvement over the 12-week treatment phase was seen in depression (F(1.63,45)=5.45, P=.01, η2 =.11) and mental health quality of life (F(2.00,45)=4.16, P<.05, η2 =.16). Adverse drug effects were unchanged or improved over time. Rates of polypharmacy remained unchanged. The results suggest that medication changes based on the PGx assay may be beneficial in a complex patient population prescribed polypharmacy.

Optimization of Medication Regimens in Patients with Type 2 Diabetes and Clinical Atherosclerotic Cardiovascular Disease.

The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population.