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  • 1
    Online Resource
    Online Resource
    Applicability of Pharmacogenomically Guided Medication Treatment during Hospitalization of At-Risk Minority Patients
    MDPI AG ; 2021
    In:  Journal of Personalized Medicine Vol. 11, No. 12 ( 2021-12-10), p. 1343-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 11, No. 12 ( 2021-12-10), p. 1343-
    Abstract: Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulnerable populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm11121343
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662248-8
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  • 2
    Online Resource
    Online Resource
    Does Adherence to National Comprehensive Cancer Network Guidelines Improve Pain-Related Outcomes? An Evaluation of Inpatient Cancer Pain Management at an Academic Medical Center
    Elsevier BV ; 2014
    In:  Journal of Pain and Symptom Management Vol. 48, No. 3 ( 2014-09), p. 451-458
    Details
    In: Journal of Pain and Symptom Management, Elsevier BV, Vol. 48, No. 3 ( 2014-09), p. 451-458
    Type of Medium: Online Resource
    ISSN: 0885-3924
    URL: Article
    DOI: 10.1016/j.jpainsymman.2013.09.016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 1500639-6
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  • 3
    Online Resource
    Online Resource
    Evaluation of a low, weight-based dose of rasburicase in adult patients for the treatment or prophylaxis of tumor lysis syndrome
    SAGE Publications ; 2011
    In:  Journal of Oncology Pharmacy Practice Vol. 17, No. 3 ( 2011-09), p. 147-154
    Details
    In: Journal of Oncology Pharmacy Practice, SAGE Publications, Vol. 17, No. 3 ( 2011-09), p. 147-154
    Abstract: Purpose: Rasburicase is a recombinant urate oxidase enzyme generally reserved for the treatment or prevention of hyperuricemia in patients that are at high risk of developing tumor lysis syndrome (TLS). The primary objective of this study is to evaluate and characterize the outcomes of patients receiving low dose rasburicase for treatment or prophylaxis of hyperuricemia secondary to TLS. Patients/Methods: A retrospective chart review between April 1, 2007 and September 31, 2008 was completed. All adult patients who received a dose of 0.05mg/kg with either a leukemia or lymphoma diagnosis in addition to at least two TLS risk factors: WBC ≥ 50 × 109/L, LDH 2 × ULN, uric acid ≥ 8 mg/dl, SCr ≥ 1.5 mg/dl were included. Forty-eight patients received rasburicase for prophylaxis (n = 18) or treatment (n = 30) of TLS. Results: Forty patients achieved and maintained a uric acid less than 8 mg/dL, 24 h after receipt of a single dose of rasburicase without the requirement for renal replacement therapy. A statistically significant decrease in UA was achieved in all patients when compared to baseline (p 〈 0.001). Cost analysis revealed a $ 1.96 million (96%) direct cost savings for the 48 patients in this study when compared to the cost of manufacturer’s dosing recommendation. Conclusions: Low dose rasburicase was efficacious and cost effective for both prophylaxis and treatment of TLS. Administration of a single dose of 0.05mg/kg of rasburicase was sufficient in correcting uric acid levels for most patients.
    Type of Medium: Online Resource
    ISSN: 1078-1552 , 1477-092X
    URL: Article
    DOI: 10.1177/1078155210364180
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2026590-6
    SSG: 15,3
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  • 4
    Online Resource
    Online Resource
    Alternative trastuzumab dosing strategies in HER2-positive early breast cancer are associated with patient out-of-pocket savings
    Springer Science and Business Media LLC ; 2022
    In:  npj Breast Cancer Vol. 8, No. 1 ( 2022-03-14)
    Details
    In: npj Breast Cancer, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2022-03-14)
    Abstract: Patients with breast cancer frequently experience financial hardship, often due to the high costs of anti-cancer drugs. We sought to develop alternative trastuzumab dosing strategies, compare their pharmacokinetic effectiveness to standard dosing, and assess the expected financial implications of transitioning to them. We extracted clinical data from the records of 135 retrospectively identified patients with HER2-positive early breast cancer at a single, urban comprehensive cancer center who were treated with trastuzumab between 2017 and 2019. We performed pharmacokinetic simulations on a range of trastuzumab dose levels and frequencies, assessing efficacy by trough trastuzumab concentration (C trough ) and population and individual likelihoods of C trough exceeding trastuzumab minimum effective concentration (MEC). We performed deterministic financial modeling to estimate the treatment-associated financial savings from alternative dosing strategies. Trastuzumab maintenance doses of 4 mg/kg every 3 weeks (Q3W) and 6 mg/kg every 4 weeks (Q4W) had nearly identical probabilities of C trough being above MEC as standard of care 6 mg/kg every 3 weeks. In the primary financial analysis, both trastuzumab 4 mg/kg Q3W and 6 mg/kg Q4W were associated with significant drug- and administration-related out-of-pocket cost savings over the duration of therapy, ranging from $765 (neoadjuvant, Q4W) to $2791 (adjuvant, Q4W). In particular, Q4W trastuzumab increased savings related to lost wages and travel cost avoidance. Low-dose and reduced frequency trastuzumab in appropriately selected patients may significantly reduce total drug utilization and meaningfully reduce patient financial toxicity. Prospective clinical trials evaluating low-dose or reduced-frequency administration of therapeutic monoclonal antibodies are warranted and needed.
    Type of Medium: Online Resource
    ISSN: 2374-4677
    URL: Article
    DOI: 10.1038/s41523-022-00393-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2843288-5
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  • 5
    Online Resource
    Online Resource
    Alternative Trastuzumab Dosing Schedules Are Associated With Reductions in Health Care Greenhouse Gas Emissions
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  JCO Oncology Practice Vol. 19, No. 9 ( 2023-09), p. 799-807
    Details
    In: JCO Oncology Practice, American Society of Clinical Oncology (ASCO), Vol. 19, No. 9 ( 2023-09), p. 799-807
    Abstract: Cancer care–related greenhouse gas (GHG) emissions harm human health. Many cancer drugs are administered at greater-than-necessary doses, frequencies, and durations. Alternative dosing strategies may enable reductions in cancer care GHG emissions without compromising patient outcomes. MATERIALS AND METHODS We used streamlined life-cycle analysis in a case-control simulation to estimate the relative reductions in GHG emissions that would be expected to result from using each of three alternative dosing strategies of trastuzumab (6-month adjuvant treatment duration, once every 4-week dosing, and both) in human epidermal growth factor receptor 2 (HER2)+ breast cancer. Using primary data and conversion factors from the environmental science literature, we estimated per-patient relative reduction in GHG emissions and, using SEER data, health impacts (in terms of disability-adjusted life-years [DALYs] and excess mortality per kg CO 2 ) on bystanders for each alternative dosing strategy. RESULTS Compared with the trastuzumab dosing strategy commonly used at baseline (12-month duration of adjuvant therapy and once every 3-week dosing in all settings), adoption of both 6-month adjuvant trastuzumab and once every 4-week trastuzumab dosing would reduce GHG emissions by 4.5%, 18.7%, and 14.6% in the neoadjuvant, adjuvant, and metastatic settings, respectively. We estimate that US-based adoption of alternative trastuzumab dosing would reduce annual DALYs and excess lives lost due to environmental impact of US-based trastuzumab therapy for HER2+ breast cancer by 1.5 and 0.9, respectively. CONCLUSION Alternative dosing strategies may materially reduce the population health impacts of cancer care by reducing environmental impact. Regulatory decision making and health technology assessments should consider a treatment's environmental and population health impacts. Clinical trials of alternative dosing strategies are justified on the basis of environmental and population health impacts.
    Type of Medium: Online Resource
    ISSN: 2688-1527 , 2688-1535
    URL: Article
    DOI: 10.1200/OP.23.00227
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 3005549-0
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  • 6
    Online Resource
    Online Resource
    Impact of electronic interventions on guideline concordant ordering of rituximab infusion rate
    SAGE Publications ; 2022
    In:  Journal of Oncology Pharmacy Practice Vol. 28, No. 5 ( 2022-07), p. 1157-1162
    Details
    In: Journal of Oncology Pharmacy Practice, SAGE Publications, Vol. 28, No. 5 ( 2022-07), p. 1157-1162
    Abstract: Rituximab carries a boxed warning for severe or fatal infusion reactions; most occurring with the initial infusion. Prior studies established that if the initial rituximab infusion is tolerated, subsequent infusions can be given safely over 90 min. The University of Chicago Medicine (UCM) did not have a standardized method to document infusion reactions for outpatient chemotherapy patients, making it challenging for providers to know a patients’ eligibility for rapid infusion. This quality improvement project focused on a series of interventions to improve documentation and electronic ordering of rituximab. Methods A flowsheet for nurses to record patients’ tolerance of chemotherapy infusions was created within the electronic health record (EHR). Following results of flowsheet impact, a second intervention was implemented to modify ordering of rituximab. The primary endpoint was the incidence of guideline concordant rate ordering of rituximab. Secondary endpoints included the incidence of accurate chair time scheduling pre- and post-interventions and nursing compliance with flowsheet documentation. Results Prior to flowsheet implementation, 85% of patients were infused at the guideline concordant rate, compared to 79% post-implementation. Prior to modification of rituximab ordering in the EHR, 85% of patients were infused at the guideline concordant rate, compared to 87% after implementation. Complete nursing documentation was done 89% of the time when the flowsheet was utilized, compared to 11% pre-interventions. Conclusion No difference in primary or secondary endpoints was found following our interventions. However, the infusion documentation flowsheet, when used, provided more complete reaction data compared to when it was not used.
    Type of Medium: Online Resource
    ISSN: 1078-1552 , 1477-092X
    URL: Article
    DOI: 10.1177/10781552221080722
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2026590-6
    SSG: 15,3
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  • 7
    Online Resource
    Online Resource
    Implementation of a controlled substance collection receptacle
    Oxford University Press (OUP) ; 2019
    In:  American Journal of Health-System Pharmacy Vol. 76, No. 10 ( 2019-05-02), p. 641-643
    Details
    In: American Journal of Health-System Pharmacy, Oxford University Press (OUP), Vol. 76, No. 10 ( 2019-05-02), p. 641-643
    Type of Medium: Online Resource
    ISSN: 1079-2082 , 1535-2900
    URL: Article
    DOI: 10.1093/ajhp/zxz038
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    SSG: 15,3
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  • 8
    Online Resource
    Online Resource
    Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen
    SAGE Publications ; 2018
    In:  Journal of Oncology Pharmacy Practice Vol. 24, No. 4 ( 2018-06), p. 299-308
    Details
    In: Journal of Oncology Pharmacy Practice, SAGE Publications, Vol. 24, No. 4 ( 2018-06), p. 299-308
    Abstract: Asparaginase is a critical component of acute lymphoblastic leukemia (ALL) treatment in children; however, its use in adults is often avoided as a result of toxicities including hepatotoxicity, thrombosis, and pancreatitis which have been reported more commonly in adults than in children. In this retrospective analysis, short-acting L-asparaginase (L-ASP) and long-acting polyethylene glycol (PEG)-asparaginase (PEG-ASP) were compared for grade 3–4 toxicities and characterized by patient and drug-related factors to identify strategies for toxicity avoidance in adults with ALL. Asparaginase was administered during sequential courses of chemotherapy using a pediatric-inspired treatment regimen. Forty-eight patients who received PEG-ASP and nine patients who received L-ASP were identified. The rates of toxicity were as follows for the PEG-ASP and L-ASP groups, respectively: hepatotoxicity (60% vs. 33%, P = 0.275), pancreatitis (17% vs. 22%, P = 0.650), thrombosis (19.0% vs. 0%, P = 0.328), or any grade 3–4 toxicity (71% vs. 44%, P = 0.143). Toxicity did not correlate with dose, either by individual dose based on flat or BSA-based measures. Logistic regression identified obesity as a risk factor for heptatotoxicity (OR = 8.44, 95% CI: 1.395–51.117). Hypofibrinogenemia was identified as a pharmacodynamic marker for predicting hepatotoxicity. In conclusion, grade 3–4 toxicity was not statistically different between adult ALL patients receiving PEG-ASP and L-ASP, but toxicity was strongly associated with obesity and hypofibrinogenemia, not dose.
    Type of Medium: Online Resource
    ISSN: 1078-1552 , 1477-092X
    URL: Article
    DOI: 10.1177/1078155217701291
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2026590-6
    SSG: 15,3
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  • 9
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    Online Resource
    The ImPre SS Trial: Implementation of Point‐of‐Care Pharmacogenomic Decision Support in Perioperative Care
    Wiley ; 2019
    In:  Clinical Pharmacology & Therapeutics Vol. 106, No. 6 ( 2019-12), p. 1179-1183
    Details
    In: Clinical Pharmacology & Therapeutics, Wiley, Vol. 106, No. 6 ( 2019-12), p. 1179-1183
    Type of Medium: Online Resource
    ISSN: 0009-9236 , 1532-6535
    URL: Issue
    URL: Article
    DOI: 10.1002/cpt.v106.6
    DOI: 10.1002/cpt.1567
    RVK:
    XA 36900
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2040184-X
    SSG: 15,3
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  • 10
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    Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain
    Mary Ann Liebert Inc ; 2021
    In:  Health Equity Vol. 5, No. 1 ( 2021-09-01), p. 596-605
    Details
    In: Health Equity, Mary Ann Liebert Inc, Vol. 5, No. 1 ( 2021-09-01), p. 596-605
    Type of Medium: Online Resource
    ISSN: 2473-1242
    URL: Article
    DOI: 10.1089/heq.2020.0062
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 2021
    detail.hit.zdb_id: 2880059-X
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