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Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. McManus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane 2019 University of Massachusetts Medical School

Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. Mcmanus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane

Jennifer Tjia

Background: Nursing home residents with atrial fibrillation are at high risk for ischemic stroke and bleeding events. The most recent national estimate (2004) indicated less than one third of this high-risk population was anticoagulated. Whether direct-acting oral anticoagulant ( DOAC ) use has disseminated into nursing homes and increased anticoagulant use is unknown.

Methods and Results: A repeated cross-sectional design was used to estimate the point prevalence of oral anticoagulant use on July 1 and December 31 of calendar years 2011 to 2016 among Medicare fee-for-service beneficiaries with atrial fibrillation residing in long-stay nursing homes. Nursing home residence was determined using Minimum ...


Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. McManus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane 2019 University of Massachusetts Medical School

Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. Mcmanus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane

David D. McManus

Background: Nursing home residents with atrial fibrillation are at high risk for ischemic stroke and bleeding events. The most recent national estimate (2004) indicated less than one third of this high-risk population was anticoagulated. Whether direct-acting oral anticoagulant ( DOAC ) use has disseminated into nursing homes and increased anticoagulant use is unknown.

Methods and Results: A repeated cross-sectional design was used to estimate the point prevalence of oral anticoagulant use on July 1 and December 31 of calendar years 2011 to 2016 among Medicare fee-for-service beneficiaries with atrial fibrillation residing in long-stay nursing homes. Nursing home residence was determined using Minimum ...


The Wet Bridge Transfer System: An Novel In Vitro Tool For Assessing Exogenous Surfactant As A Pulmonary Drug Delivery Vehicle, Brandon J. Baer 2019 University of Western Ontario

The Wet Bridge Transfer System: An Novel In Vitro Tool For Assessing Exogenous Surfactant As A Pulmonary Drug Delivery Vehicle, Brandon J. Baer

Western Research Forum

Background:

Due to its complex branching structure, direct drug delivery to the remote areas of the lung is a major challenge. Consequently, most therapies, such as those treating pulmonary infection and inflammation, must utilize large systemic dosing, with the potential for adverse side effects. A novel alternative strategy is to use exogenous surfactant, a material capable of distributing throughout the lung, as a pulmonary drug delivery vehicle.

Objective:

Utilize an in vitro transferring system to assess exogenous surfactant (BLES) as a pulmonary delivery vehicle for different therapeutics.

Methods:

An in vitro technique was developed to simultaneously study surfactant delivery and ...


Opioid Overdose Deaths And Potentially Inappropriate Opioid Prescribing Practices (Pip): A Spatial Epidemiological Study, Thomas J. Stopka, Harsha Amaravadi, Anna R. Kaplan, Rachel Hoh, Dana Bernson, Kenneth K.H. Chui, Thomas Land, Alexander Y. Walley, Marc R. LaRochelle, Adam J. Rose 2019 Tufts University

Opioid Overdose Deaths And Potentially Inappropriate Opioid Prescribing Practices (Pip): A Spatial Epidemiological Study, Thomas J. Stopka, Harsha Amaravadi, Anna R. Kaplan, Rachel Hoh, Dana Bernson, Kenneth K.H. Chui, Thomas Land, Alexander Y. Walley, Marc R. Larochelle, Adam J. Rose

Open Access Articles

INTRODUCTION: Opioid overdose deaths quintupled in Massachusetts between 2000 and 2016. Potentially inappropriate opioid prescribing practices (PIP) are associated with increases in overdoses. The purpose of this study was to conduct spatial epidemiological analyses of novel comprehensively linked data to identify overdose and PIP hotspots.

METHODS: Sixteen administrative datasets, including prescription monitoring, medical claims, vital statistics, and medical examiner data, covering >98% of Massachusetts residents between 2011-2015, were linked in 2017 to better investigate the opioid epidemic. PIP was defined by six measures: > /=100 morphine milligram equivalents (MMEs), co-prescription of benzodiazepines and opioids, cash purchases of opioid prescriptions, opioid prescriptions ...


Reversal Of P-Glycoprotein And Breast Cancer Resistance Protein Mediated Multidrug Resistance In Vitro Using In Silico Identified Novel Compounds, Amila Nanayakkara 2019 Southern Methodist University

Reversal Of P-Glycoprotein And Breast Cancer Resistance Protein Mediated Multidrug Resistance In Vitro Using In Silico Identified Novel Compounds, Amila Nanayakkara

Biological Sciences Theses and Dissertations

Multidrug resistance (MDR) is a major cause of chemotherapy failure. Overexpression of ATP-binding cassette (ABC) transporters, P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) are two well-studied drug transporters which are associated with MDR. These two transporters also act as a major functional unit of the blood brain barrier to protect the brain from xenobiotics and toxins. Lack of clinically approved P-gp and BCRP inhibitors renders chemotherapy treatments of many MDR cancers ineffective and obstructs drug uptake into the brain.

Using computational methods, we have identified new compounds that inhibit P-gp (Brewer et al., Mol. Pharmacol. 2014). Several of these ...


A Robust Delivery System For Rna Therapeutics, Suleyman Bozal 2019 University of Connecticut

A Robust Delivery System For Rna Therapeutics, Suleyman Bozal

Honors Scholar Theses

The field of RNA therapeutics is currently undergoing both transformation and expansion. Specifically, research in lipid nanoparticle (LNP) based RNA therapeutics is gaining significant traction. Other research into mechanisms of gene regulation and manipulation, including siRNA and the CRISPR/Cas9 system have demonstrated the potential of RNA-based disease treatment. This work identifies a delivery system which can regulate expression of green fluorescent protein (GFP) in human embryonic kidney cells (HEK293) stably expressing GFP.

Analysis of siRNA-induced gene knockdown demonstrates that the current siRNA-LNP formulation is equally as effective as a commercially available transfection reagent, Lipofectamine RNAiMAX (RNAiMAX), which is designed ...


A Robust Delivery System For Rna Therapeutics, Suleyman Bozal 2019 University of Connecticut

A Robust Delivery System For Rna Therapeutics, Suleyman Bozal

University Scholar Projects

The field of RNA therapeutics is currently undergoing both transformation and expansion. Specifically, research in lipid nanoparticle (LNP) based RNA therapeutics is gaining significant traction. Other research into mechanisms of gene regulation and manipulation, including siRNA and the CRISPR/Cas9 system have demonstrated the potential of RNA-based disease treatment. This work identifies a delivery system which can regulate expression of green fluorescent protein (GFP) in human embryonic kidney cells (HEK293) stably expressing GFP.

Analysis of siRNA-induced gene knockdown demonstrates that the current siRNA-LNP formulation is equally as effective as a commercially available transfection reagent, Lipofectamine RNAiMAX (RNAiMAX), which is designed ...


Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. McManus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane 2019 University of Massachusetts Medical School

Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. Mcmanus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane

Open Access Articles

Background: Nursing home residents with atrial fibrillation are at high risk for ischemic stroke and bleeding events. The most recent national estimate (2004) indicated less than one third of this high-risk population was anticoagulated. Whether direct-acting oral anticoagulant ( DOAC ) use has disseminated into nursing homes and increased anticoagulant use is unknown.

Methods and Results: A repeated cross-sectional design was used to estimate the point prevalence of oral anticoagulant use on July 1 and December 31 of calendar years 2011 to 2016 among Medicare fee-for-service beneficiaries with atrial fibrillation residing in long-stay nursing homes. Nursing home residence was determined using Minimum ...


Evaluation Of Prophylactic Dosages Of Enoxaparin In Non-Surgical Elderly Patients With Renal Impairment, Nibal Chamoun, Hady Ghanem, Ahmad Hachem, Essa Hariri, Christelle Lteif, Hanine Mansour, Hani Dimassi, Richard Zalloum, Georges Ghanem 2019 Lebanese American University

Evaluation Of Prophylactic Dosages Of Enoxaparin In Non-Surgical Elderly Patients With Renal Impairment, Nibal Chamoun, Hady Ghanem, Ahmad Hachem, Essa Hariri, Christelle Lteif, Hanine Mansour, Hani Dimassi, Richard Zalloum, Georges Ghanem

Open Access Articles

BACKGROUND: Thromboprophylaxis dosing strategies using enoxaparin in elderly patients with renal disease are limited, while dose adjustments or monitoring of anti-Xa levels are recommended. We sought to evaluate the efficacy and safety of enoxaparin 20 mg versus 30 mg subcutaneously daily by comparing anti-Xa levels, thrombosis and bleeding.

METHODS: We conducted a prospective, single-blinded, single-center randomized clinical trial including non-surgical patients, 70 years of age or older, with renal disease requiring thromboprophylaxis. Patients were randomized to receive either 20 mg or 30 mg of enoxaparin. The primary endpoint was peak anti-Xa levels on day 3. Secondary endpoints included trough anti-Xa ...


Amphotercin Washout Of Fungal Peritonitis In Liver Transplant Recipient: A Novel Approach, Ann Thompson DO, Mara Piltin DO, Alyssa Imperatore DO, Ely Sebastian MD, Sandra Paluzzi MD 2019 Rowan University

Amphotercin Washout Of Fungal Peritonitis In Liver Transplant Recipient: A Novel Approach, Ann Thompson Do, Mara Piltin Do, Alyssa Imperatore Do, Ely Sebastian Md, Sandra Paluzzi Md

Stratford Campus Research Day

Invasive fungal infection has a significant prevalence among organ transplant patients and is associated with high rates of morbidity and mortality. Fungal infection is difficult to identify early and subsequently difficult to effectively treat. In this case presentation we have a 45 y/o orthotopic liver transplant recipient who was profoundly sick from fungal peritonitis and due to the appearance of her abdomen and intestines, with the help of infectious disease, decided to proceed with direct amphotercin washout of the abdomen in the operating room. The patient had complete resolution of her fungal peritonitis and is doing well.


The Effect Of Antihypertensive Dose On Blood Pressure Control In Children With Chronic Kidney Disease, Benjamin A. Matta 2019 Children's Mercy Hospital, Kansas City

The Effect Of Antihypertensive Dose On Blood Pressure Control In Children With Chronic Kidney Disease, Benjamin A. Matta

Presentations

This presentation describes a study to determine the effect of antihypertensive dosing on blood pressure control in children with chronic kidney disease. The original version of this presentation is a prezi show at https://prezi.com/view/4qluDL1gMKFELOf1nLVA/


Pediatric Ppi Use And Fractures, Nathan R. Fleishman, Troy Richardson, Thomas M. Attard 2019 Children's Mercy Hospital

Pediatric Ppi Use And Fractures, Nathan R. Fleishman, Troy Richardson, Thomas M. Attard

Posters

This study compared the rate of fracture among pediatric patients exposed to proton pump inhibitors to the rate among patients without exposure, and also considered the fracture location among children exposed to proton pump inhibitors.


Prospective Evaluation Of A Population Pharmacokinetic Model Of Pantoprazole For Obese Children, Alenka Chapron, Susan M. Abdel-Rahman, Valentina Shakhnovich 2019 Children's Mercy Hospital, Kansas City, MO

Prospective Evaluation Of A Population Pharmacokinetic Model Of Pantoprazole For Obese Children, Alenka Chapron, Susan M. Abdel-Rahman, Valentina Shakhnovich

Posters

We previously developed a population pharmacokinetic (popPK) model of pantoprazole for obese children. Our objective was to evaluate the predictive performance of this model in an independent cohort of normal weight, overweight and obese children.


Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron, Susan M. Abdel-Rahman 2019 Children's Mercy Hospital, Kansas City, MO

Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron, Susan M. Abdel-Rahman

Posters

With the goal of developing a clinician-driven tacrolimus (TAC) pharmacokinetic dosing tool, our initial objectives were 1) to examine whether published TAC population pharmacokinetic (popPK) models could serve as a foundation for the dosing tool, and 2) evaluate their performance predicting TAC concentrations in an independent cohort of Children's Mercy patients.


A Nsqip Analysis Of Post-Operative Antibiotic Utilization In Uncomplicated Appendicitis, Charlene Dekonenko, Robert M. Dorman, Janelle R. Noel-Macdonnell, Tolulope A. Oyetunji 2019 Children's Mercy Hospital

A Nsqip Analysis Of Post-Operative Antibiotic Utilization In Uncomplicated Appendicitis, Charlene Dekonenko, Robert M. Dorman, Janelle R. Noel-Macdonnell, Tolulope A. Oyetunji

Posters

APSA 2010 recommendations do not support antibiotic use post-operatively following appendectomy for uncomplicated appendicitis, but compliance varies by institution. This study determined the rate of post-operative antibiotic use in uncomplicated appendicitis and found that 10% of patients were discharged on antibiotics, using the NSQIP files.


Regional Vitiligo Induced By Imiquimod Treatment For In-Transit Melanoma Metastases, Elizabeth Tkachenko, Jennifer Y. Lin, Rebecca I. Hartman 2019 University of Massachusetts Medical School

Regional Vitiligo Induced By Imiquimod Treatment For In-Transit Melanoma Metastases, Elizabeth Tkachenko, Jennifer Y. Lin, Rebecca I. Hartman

Open Access Articles

Imiquimod is a topical immunomodulator used for the treatment of viral warts and superficial basal cell carcinoma and as an emerging therapy for lentigo maligna and cutaneous melanoma metastases. Vitiligo-like depigmentation has been described as a local adverse effect of topical imiquimod therapy for melanoma1 and at distant sites in patients treated with combination topical monobenzone-imiquimod for metastatic melanoma.2 We present a case in which topical imiquimod resulted in both the resolution of in-transit metastatic melanoma and the depigmentation of local and regional skin, suggesting a regional lymphatic effect of this localized topical treatment.


Rgd-Decorated Cholesterol Stabilized Polyplexes For Targeted Sirna Delivery To Glioblastoma Cells., Bo Lou, Kate Connor, Kieron Sweeney, Ian S. Miller, Alice C. O'Farrell, Eduardo Ruiz-Hernandez, David M. Murray, Garry P. Duffy, Alan Wolfe, Enrico Mastrobattista, Annette Byrne, Wim E. Hennink 2019 Utrecht University

Rgd-Decorated Cholesterol Stabilized Polyplexes For Targeted Sirna Delivery To Glioblastoma Cells., Bo Lou, Kate Connor, Kieron Sweeney, Ian S. Miller, Alice C. O'Farrell, Eduardo Ruiz-Hernandez, David M. Murray, Garry P. Duffy, Alan Wolfe, Enrico Mastrobattista, Annette Byrne, Wim E. Hennink

Physiology and Medical Physics Articles

The development of an effective and safe treatment for glioblastoma (GBM) represents a significant challenge in oncology today. Downregulation of key mediators of cell signal transduction by RNA interference is considered a promising treatment strategy but requires efficient, intracellular delivery of siRNA into GBM tumor cells. Here, we describe novel polymeric siRNA nanocarriers functionalized with cRGD peptide that mediates targeted and efficient reporter gene silencing in U87R invasive human GBM cells. The polymer was synthesized via RAFT copolymerization of N-(2-hydroxypropyl)-methacrylamide (HPMA) and N-acryloxysuccinimide (NAS), followed by post-polymerization modification with cholesterol for stabilization, cationic amines for siRNA complexation, and ...


The Pharmabiotic For Phenylketonuria: Development Of A Novel Therapeutic, Chloé Elizabeth LeBegue 2019 University of South Carolina

The Pharmabiotic For Phenylketonuria: Development Of A Novel Therapeutic, Chloé Elizabeth Lebegue

Senior Theses

Phenylketonuria, now known as phenylalanine hydroxylase (PAH) deficiency, is a genetic disorder of metabolism affecting approximately one in every 15,000 infants born in the United States. Patients have nonfunctional PAH enzyme secondary to one or more genetic mutations. The enzyme deficit results in destructive supraphysiologic blood phenylalanine levels upon consumption of the essential dietary amino acid phenylalanine. Current standards of care mitigate signs and symptoms of the disorder, but do not approach a cure. The methods for creating a prototype pharmabiotic as an innovative treatment strategy for PAH deficiency are described herein.

DNA molecular cloning techniques were utilized to ...


Impact Of Pharmacogenomics On Clinical Outcomes In Major Depressive Disorder In The Guided Trial: A Large, Patient- And Rater-Blinded, Randomized, Controlled Study, John F. Greden, Anthony J. Rothschild 2019 University of Michigan-Ann Arbor

Impact Of Pharmacogenomics On Clinical Outcomes In Major Depressive Disorder In The Guided Trial: A Large, Patient- And Rater-Blinded, Randomized, Controlled Study, John F. Greden, Anthony J. Rothschild

Open Access Articles

Current prescribing practices for major depressive disorder (MDD) produce limited treatment success. Although pharmacogenomics may improve outcomes by identifying genetically inappropriate medications, studies to date were limited in scope. Outpatients (N=1167) diagnosed with MDD and with a patient- or clinician-reported inadequate response to at least one antidepressant were enrolled in the Genomics Used to Improve DEpression Decisions (GUIDED) trial - a rater- and patient-blind randomized controlled trial. Patients were randomized to treatment as usual (TAU) or a pharmacogenomics-guided intervention arm in which clinicians had access to a pharmacogenomic test report to inform medication selections (guided-care). Medications were considered congruent ('use ...


Systematic Literature Review Of Quetiapine For The Treatment Of Psychosis In Patients With Parkinsonism, Jack J. Chen, Henry Hua, Lilian Massihi, Ivan Portillo, Azita Alipour, William Ondo, Khashayar Dashtipour 2019 American University of Health Sciences

Systematic Literature Review Of Quetiapine For The Treatment Of Psychosis In Patients With Parkinsonism, Jack J. Chen, Henry Hua, Lilian Massihi, Ivan Portillo, Azita Alipour, William Ondo, Khashayar Dashtipour

Library Articles and Research

Objective:

The purpose of this article was to determine the efficacy and tolerability of quetiapine compared with placebo or other interventions for psychosis in parkinsonism.

Methods:

Participants with a diagnosis of parkinsonism participated in randomized controlled trials (RCTs) investigating the efficacy and tolerability of quetiapine for psychotic symptoms within a defined follow-up period. The authors conducted searches on PubMed, Cochrane Controlled Register of Trials, and EMBASE for articles published from January 1991 to October 2017. Study methodology and patient- and treatment-level data were independently extracted and summarized by using descriptive statistics. Studies underwent quality assessment for risk of bias.

Results ...


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