Impact of Pharmacist Counseling at Discharge for Older People

2021 ◽  
Vol 36 (12) ◽  
pp. 652-673
Author(s):  
Daijah Davis ◽  
Melissa Rogers ◽  
Joni Baker ◽  
Erika E. Tillery
Keyword(s):  
Older People ◽  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Statistical Significance ◽  
Hospital Readmissions ◽  
Discharge Process ◽  
Readmission Rates ◽  
Study Characteristics ◽  
Pharmacist Counseling

Objective To examine the evidence surrounding how the implementation of pharmacist discharge counseling affects the number of readmissions. Data Sources A search was conducted using EBSCOhost and the National Library of Medicine databases for articles published through December 2020 with the keywords “discharge counseling,” “discharge teaching,” “discharge education,” “patient education,” “patient teaching,” “medication reconciliation,” “pharmacist,” and “readmission rates.” The authors independently screened citations and applied inclusion and exclusion criteria. Study Selection A total of 32 articles were reviewed and analyzed. Inclusion criteria included articles published in the English language with human subjects, and adults (18 years of age and older) involving pharmacist-led discharge counseling and assessment of readmission rates were included. Data Extraction Study characteristics, intervention type, and outcomes with statistical significance where reported were included in the literature analysis. Data Synthesis Studies examined reported varying health care improvements postdischarge with the implementation of pharmacist services in the discharge process. Not all results were significant for reduction in readmission rates, but a downward trend was observed. Conclusion Implementation of pharmacist discharge counseling may decrease the number of hospital readmissions, particularly in older people.

Use of real-time videoconferencing to deliver physical therapy services: A scoping review of published and emerging evidence

2019 ◽  
Vol 26 (10) ◽  
pp. 581-589 ◽  
Author(s):  
Stephanie Horsley ◽  
Gunnar Schock ◽  
Stacey L Grona ◽  
Kara Montieth ◽  
Bryttnee Mowat ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Real Time ◽  
English Language ◽  
Data Extraction ◽  
Therapy Assessment ◽  
Process Outcomes ◽  
Study Characteristics ◽  
Therapy Services ◽  
Videoconferencing Technology ◽  
Physical Therapy Services

Introduction Telehealth may be a viable means to deliver physical therapy services across a range of practice settings and health conditions; however, there is limited uptake of telehealth in clinical practice. The purpose of this study is to examine and describe trends, gaps and opportunities in published and emerging evidence regarding the use of real-time videoconferencing to deliver physical therapy services. Methods Four databases and three trial registries were searched using terms for physical therapy and telehealth. Inclusion criteria were primary studies, systematic reviews and published trial registries that had the following features: physical therapy assessment and/or treatment, real-time videoconferencing and English language. Title/abstract, full text screening and data extraction were completed by pairs of independent reviewers. Descriptive statistics stratified by published research and trial registry records were used to summarize study characteristics. Results A total of 100 studies (80 published and 20 trial registries) were included. Australia, Canada and the US have the highest proportion of published and emerging research (63%). The majority of conditions studied were musculoskeletal (42%). Computers were the most common videoconferencing technology used (31%) and only 14% of studies reported using a secure platform. The majority of studies examined health outcomes (64%) and process outcomes (65%), while only 32% reported system outcomes. Discussion Research in the field of telehealth and physical therapy is growing and becoming increasingly diverse with the advancements in technology.

Role of Topical Oxymetazoline for Management of Erythematotelangiectatic Rosacea

2017 ◽  
Vol 52 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Rebecca M. Hoover ◽  
John Erramouspe
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Drug Approval ◽  
Current Data ◽  
Patient Response ◽  
Study Selection ◽  
Cochrane Database ◽  
Drug Approval Process ◽  
Individual Patient Response

Objective: To review and summarize topical oxymetazoline’s pharmacology, pharmacokinetics, efficacy, safety, cost, and place in therapy for persistent redness associated with erythematotelangiectatic rosacea. Data Sources: Literature searches of MEDLINE (1975 to September 2017), International Pharmaceutical Abstracts (1975 to September 2017), and Cochrane Database (publications through September 2017) using the terms rosacea, persistent redness, α -agonist, and oxymetazoline. Study Selection and Data Extraction: Results were limited to studies of human subjects, English-language publications, and topical use of oxymetazoline. Relevant materials from government sources, industry, and reviews were also included. Data Synthesis: Data support the efficacy of oxymetazoline for persistent facial redness. Little study beyond clinical trials cited in the drug approval process has been conducted. Current data suggest that oxymetazoline is similar in safety and efficacy to brimonidine. Head-to-head comparisons of topical α-agonists for erythema caused by rosacea are needed. Conclusion: The topical α-agonist, oxymetazoline, is safe and effective for reducing persistent facial redness associated with erythematotelangiectatic subtype of rosacea. Health care practitioners selecting among treatments should consider not only the subtype of rosacea but also individual patient response, preference, and cost.

Do longitudinal orthodontic trials use appropriate statistical analyses? A meta-epidemiological study

2021 ◽  
Author(s):  
Samer Mheissen ◽  
Haris Khan ◽  
Mohammed Almuzian ◽  
Emad Eddin Alzoubi ◽  
Nikolaos Pandis
Keyword(s):  
Statistical Analysis ◽  
Epidemiological Study ◽  
Data Extraction ◽  
Statistical Significance ◽  
Repeated Measure ◽  
Exact Test ◽  
Optimal Analysis ◽  
Study Characteristics ◽  
Measure Analysis ◽  
Repeated Measure Analysis

Summary Background In orthodontic trials, longitudinal designs with multiple outcome measurements over time are common. The aim of this epidemiological study was to examine whether optimal statistical analysis approaches have been used in longitudinal orthodontic trials. Methods Pubmed was searched in August 2021 for longitudinal orthodontic trials with at least three time points of outcome assessment published in the 2017–20 period. Study selection and data extraction were done independently and in duplicate. The analysis approaches undertaken were tabulated and associations between study characteristics and the use of optimal analysis or not were assessed using Fisher’s exact test and logistic regression. Results One hundred forty-seven out of 563 unique records were deemed eligible for inclusion. Only 26.50% of these trials used an optimal statistical analysis for longitudinal data where the data structure is accounted for. None of the study characteristics except the statistical significance of the results were associated with the appropriateness of the statistical analysis. The odds of significant results in studies with suboptimal analyses were higher than that in studies with optimal longitudinal analyses (odds ratio: 3.48, 95% confidence interval: 1.62, 7.46, P = 0.001). For the studies with optimal analysis, the most frequent test was repeated-measure analysis of variance (RM-ANOVA). The reporting of the statistical analysis section was suboptimal in the majority of the trials. Conclusion Most longitudinal orthodontic trials are not analysed using optimal statistical approaches. Inferences and interpretation of their results are likely to be compromised.

scholarly journals Illness perception and high readmission health outcomes

2019 ◽  
Vol 6 (1) ◽  
pp. 205510291984450 ◽  
Author(s):  
Amanda T Sawyer ◽  
Stephanie L Harris ◽  
Harold G Koenig
Keyword(s):  
Health Outcomes ◽  
English Language ◽  
Language Use ◽  
Statistical Significance ◽  
Hospital Readmissions ◽  
Illness Perception ◽  
Quantitative Methodology ◽  
Inclusion Criteria ◽  
Multifaceted Approach ◽  
The Relationship

This review identified associations between illness perception and health outcomes of patients with a medical diagnosis included in the Hospital Readmissions Reduction Program. Inclusion criteria were English language, use of quantitative methodology, health outcomes specified, and identifiable effect size and statistical significance of the relationship. Most of the 31 studies in this review showed that favorable illness perception has been associated with better health outcomes, while unfavorable illness perception has been associated with worse outcomes. A multifaceted approach might include behavioral, clinical, educational, and psychosocial components to improve one’s illness perception through educative, cognitive-behavioral, or psychodynamic counseling.

scholarly journals Amifampridine for the Management of Lambert-Eaton Myasthenic Syndrome: A New Take on an Old Drug

2019 ◽  
Vol 54 (1) ◽  
pp. 56-63
Author(s):  
Connie H. Yoon ◽  
Jocelyn Owusu-Guha ◽  
Adam Smith ◽  
Pamela Buschur
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Phase Iii ◽  
Pharmacokinetic Studies ◽  
First Line ◽  
Two Phase ◽  
Phase Iii Trials ◽  
Improved Stability ◽  
Myasthenic Syndrome

Objective: The purpose of this article is to review the literature for both 3,4-diaminopyridine (3,4-DAP) and amifampridine for the treatment of Lambert-Eaton myasthenic syndrome (LEMS). Amifampridine (Firdapse) is the salt form of 3,4-DAP and was approved by the Food and Drug Administration for the treatment of LEMS. Data Sources: PubMed, TRIP database, and EMBASE searches were conducted without a back date (current to June 2019) utilizing the following search terms: amifampridine, 3,4-diaminopyridine, and Lambert-Eaton myasthenic syndrome. Completed trials were also reviewed at clinicaltrials.gov. Study Selection and Data Extraction: Criteria for article inclusion consisted of human subjects, age ≥18 years, phase II or III clinical trials, and English language for both drugs. Observational and pharmacokinetic studies for amifampridine were also included. Data Synthesis: Prior to the approval of amifampridine, 3,4-DAP was first-line for the management of LEMS symptoms. Two phase III trials have evaluated amifampridine to confirm efficacy, both showing superiority over placebo in the management of LEMS symptoms, with minimal adverse effects. A significant improvement in both quantitative myasthenia gravis scores and Subjective Global Impression scores was established at days 4 and 14. Relevance to Patient Care and Clinical Practice: With an improved stability profile and decreased dose variability, amifampridine will likely assume the role of first-line management of LEMS. Conclusions: Amifampridine has been shown to improve symptoms of LEMS and is generally well tolerated.

scholarly journals Implementation and Evaluation of a Team-Based Approach to Hospital Discharge Transition of Care

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Matthew Van De Graaf ◽  
Hemal Patel ◽  
Brynn Sheehan ◽  
Jennifer Ryal
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Data Extraction ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Phone Call ◽  
Readmission Rates ◽  
The Cost ◽  
Discharge Transition

Background: Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. We aimed to evaluate the efficacy and self-sustainability of this TCM program. Methods: The TCM team contacted patients upon discharge to schedule the follow-up appointment. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment; (2) successful phone-call contact, patient did not attend appointment; and (3) patient attended appointment. We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We conducted χ2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care. Results: Initial analysis did not indicate significant associations between readmission rates and level of TCM care at 30 (χ2=1.40, P=.50), 60 (χ2=5.48, P=.06), or 90 (χ2=4.23, P=.12) days or significant differences in patient charges at 30 (F[2,59]=2.85, P=.06), 60 (F[2,91]=2.00, P=.14), or 90 (F[2,126]=1.39, P=.25) days. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 (χ2=5.40, P=.02) and 90 (χ2=4.21, P=.04) days, but not at 30 days (χ2=1.39, P=.28). Conclusions: Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge.

Dapagliflozin/Saxagliptin Fixed-Dose Tablets: A New Sodium-Glucose Cotransporter 2 and Dipeptidyl Peptidase 4 Combination for the Treatment of Type 2 Diabetes

2017 ◽  
Vol 52 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Valerie Azzopardi Coppenrath ◽  
Tasmina Hydery
Keyword(s):  
Type 2 Diabetes ◽  
Triple Therapy ◽  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Insurance Coverage ◽  
Fixed Dose ◽  
Dipeptidyl Peptidase 4 ◽  
The Difference

Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of the fixed-dose combination (FDC) product, QTERN (dapagliflozin/saxagliptin) tablets. Data Sources: Searches of MEDLINE (1946 to July 1, 2017) were conducted using the keywords QTERN, saxagliptin, and dapagliflozin. Additional data were obtained from the prescribing information, the product dossier, and Clinicaltrials.gov . Study Selection and Data Extraction: All English language articles related to pharmacology, pharmacokinetics, efficacy, or safety of the combination therapy in human subjects were reviewed. Data Synthesis: The pharmacokinetics of saxagliptin and dapagliflozin were not affected significantly when administered as an FDC product. Saxagliptin may suppress the increased secretion of glucagon associated with dapagliflozin. The combination dapagliflozin/saxagliptin has been studied as add-on therapy to metformin in patients with uncontrolled type 2 diabetes mellitus (T2DM). The difference in hemoglobin A1C (A1C) between saxagliptin + dapagliflozin + metformin (triple therapy) and saxagliptin + metformin was −0.59 (95% CI = −0.81 to −0.37, P < 0.0001), and the difference between triple therapy and dapagliflozin + metformin was −0.27 (95% CI = −0.48 to −0.05, P = 0.0166). The combination was well tolerated when added to metformin. Conclusion: QTERN (dapagliflozin/saxagliptin) tablets are a reasonable option for patients with T2DM not controlled on metformin, but cost, insurance coverage, and a lackluster reduction in A1C will likely limit its use until more data regarding its effects on complications of diabetes and cardiovascular outcomes become available.

Flibanserin

2016 ◽  
Vol 30 (2) ◽  
pp. 256-260 ◽  
Author(s):  
Ximena Vallejos ◽  
Christine Wu
Keyword(s):  
Clinical Trials ◽  
Sexual Desire ◽  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Premenopausal Women ◽  
Relevant Information ◽  
Time Frame ◽  
Double Blind ◽  
Study Selection

Objective: To review pivotal clinical trials, pharmacology, contraindications, precautions, and key patient education points of flibanserin for the treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. Data Sources: A literature search of PubMed using the key words flibanserin and HSDD was conducted in September 2015. There was no time frame to exclude relevant clinical trials. All trials referenced were published between March 2012 and June 2014. Other relevant information was obtained from the Food and Drug Administration (FDA) Web site, press releases, prescribing information from the manufacturer, and ClinicalTrials.gov . Study Selection/Data Extraction: All articles in the English language and involving human subjects were reviewed. Data Synthesis: There are three 24-week, multicenter, randomized, double-blind, placebo-controlled trials that evaluated the efficacy of flibanserin in North American premenopausal women with HSDD. There was 1 trial that studied the effects of flibanserin in postmenopausal women. In all of the trials, the investigators found statistical significant improvements in Female Sexual Function Index (FSFI) desire domain score and satisfying sexual events (SSEs). The most frequently reported adverse events in all flibanserin arms of treatment were somnolence, dizziness, and nausea. Conclusion: Flibanserin, a novel, nonhormonal agent that modulates excitatory and inhibitory neurotransmitters was studied in premenopausal women and has shown efficacy in improving sexual desire and SSEs.

Key components of intravenous chemotherapy labeling: A systematic review and practice guideline

2010 ◽  
Vol 17 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Maureen Trudeau ◽  
Esther Green ◽  
Roxanne Cosby ◽  
Flay Charbonneau ◽  
Tony Easty ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
English Language ◽  
Data Extraction ◽  
Sources Of Information ◽  
Inclusion Criteria ◽  
Intravenous Chemotherapy ◽  
Safe Delivery ◽  
Environmental Scan ◽  
Relevant Evidence ◽  
Study Characteristics

Objective. To determine the necessary components and formatting of an intravenous chemotherapy label to maximize safe delivery and minimize errors. Date sources. The MEDLINE and EMBASE databases (up to April 2009) were searched for relevant evidence. Reference lists from retained studies were then searched for additional trials. An environmental scan was also conducted to locate other published and unpublished sources of information. Study selection. Relevant articles were selected and reviewed by one methodologist. Articles were selected for inclusion if they were published English language reports of Phases II or III randomized controlled trials, other comparative studies, single-arm studies, practice guidelines, or systematic reviews with or without meta-analyses, which related to the study question. MEDLINE and EMBASE searches yielded 685 potential studies of which 17 met the inclusion criteria. The environmental scan located one guideline. Three additional relevant studies were identified during the external review process. In total, 21 documents met the inclusion criteria. Data extraction. Data were extracted by one methodologist. Quality of systematic reviews was assessed using the AMSTAR tool. All other studies were evaluated based on study characteristics applicable to the particular study design. Data synthesis. The evidence collected and the consensus of expert opinion of Cancer Care Ontario’s Chemotherapy Labeling Panel form the basis of a series of recommendations for the generation of intravenous chemotherapy labels including formatting, required information, and order of information. These guidelines inform the efficient, effective, and safe administration of intravenous chemotherapy. Illustrative examples are provided.

A Critical Evaluation of the Therapeutic Range of Indinavir

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1230-1237 ◽  
Author(s):  
Craig R Rayner ◽  
Kirsten J Galbraith ◽  
Jennifer L Marriott ◽  
Gregory J Duncan
Keyword(s):  
Therapeutic Range ◽  
English Language ◽  
Data Extraction ◽  
Critical Evaluation ◽  
Concentration Effect ◽  
Pharmacokinetic Parameters ◽  
Study Selection ◽  
Study Characteristics ◽  
Literature Search Strategy ◽  
Available Information

OBJECTIVE: To provide a summary of the patient population, study characteristics, and important findings of the key studies in the literature evaluating concentration—effect relationships and the therapeutic range for indinavir. DATA SOURCES: Literature search strategy involved using MEDLINE (1966–July 2001) and AIDSLINE (MEDSCAPE) databases (up to July 2001). Reference lists from primary literature and review articles were also examined, and conference abstracts were obtained. STUDY SELECTION: English-language articles were considered suitable for review if the clinical trials in HIV patients reported on concentration—effect relationships and/or pharmacokinetic breakpoints or threshold concentrations. A search of the literature identified 20 peer-reviewed references from 18 separate studies including journal articles and conference abstracts. DATA EXTRACTION: The targeted pharmacokinetic parameters and breakpoint values, the rationale for their selection or method of identification, and other study details and limitations were summarized. DISCUSSION: This article highlights the heterogeneity of studies evaluating the therapeutic range of indinavir and provides a summary of important findings of the key studies in the literature evaluating concentration-effect relationships and therapeutic range. Tables are provided to enable clinicians to make use of currently available information on the therapeutic range of indinavir. CONCLUSIONS: There is insufficient evidence to recommend a general therapeutic range for indinavir. Future investigations should incorporate both pharmacokinetics and pharmacodynamics in order to define a broadly applicable therapeutic range.

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