64 results on '"Reed BN"'
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2. From symptoms to solutions: A structured approach to alleviating burnout among critical care pharmacists.
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Reed BN
- Subjects
- Humans, Pharmacy Service, Hospital organization & administration, Pharmacists psychology, Burnout, Professional prevention & control, Burnout, Professional psychology, Critical Care methods, Critical Care psychology
- Published
- 2024
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- View/download PDF
3. Exploring the Utility and Fairness of a Multi-institutional Situational Judgment Test.
- Author
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Smith KJ, Reed BN, Neely S, Farland MZ, Haines ST, and Robinson JD
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- Humans, Female, Male, Educational Measurement methods, Pilot Projects, Adult, Young Adult, Judgment, Students, Pharmacy psychology, Empathy, Education, Pharmacy methods
- Abstract
Objective: To pilot a situational judgment test (SJT) developed to assess empathy, integrity, and teamwork and explore differences in performance between first-year (P1) and fourth-year (P4) student pharmacists based on gender, race or ethnicity, and geographical region., Methods: An SJT was developed to assess empathy, integrity, and teamwork, using best practices. The SJT was piloted tested with P1 and P4 student pharmacists at 5 institutions. Scores were adjusted for elevation and scatter to minimize the subgroup differences in response styles., Results: The unadjusted mean SJT scores for P1 and P4 student pharmacists were 79.7 % and 80.7 %, respectively. The adjusted scores for P1 and P4 student pharmacists were 86.3 % and 87.2 %, respectively. Small differences were observed across institutions which can likely explained by multiple factors. The mean scores were higher among students who were older, female, identified as White, and spoke English as their first language. The subgroup differences persisted even after adjusting scores for elevation and scatter., Conclusion: Performance on an SJT designed to assess empathy, integrity, and teamwork was similar to others in the literature; however, differences in performance were observed across subgroups. Additional research is needed to determine whether these differences reflect test bias or other possible factors., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)
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- 2024
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4. An Exploratory Qualitative Study of Student Pharmacist Perspectives on Leadership.
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Murry LT, Reed BN, and Witry MJ
- Subjects
- Humans, Pharmacists, Leadership, Education, Pharmacy, Students, Pharmacy, Pharmacy
- Abstract
Objectives: The objectives of this study were to (1) explore student pharmacists' knowledge and perceptions of leadership characteristics and behaviors, and (2) identify where students have opportunities to observe and exhibit leadership., Methods: Data were collected from 32 students participating in a pharmacy leadership elective. Students submitted reflections about leadership definitions, characteristics, observations of leadership, and times when they felt like a leader. An inductive constant comparative analysis was used to code and categorize text segments from the reflections using NVivo 1.7.1 (Lumivero; Denver, CO). Holistic consideration of the reflections was used to identify an overarching theme., Results: Three categories were specified to organize the data from the qualitative analysis: (1) Leader Characteristics, (2) Leading Behaviors, and (3) Leadership Contexts. One overarching theme was proposed encompassing the categories and sub-categories: Leadership Contradictions. The theme is based on the finding that students seemed able to identify leadership characteristics but emphasized descriptions like holding titles and completing managerial or task-focused duties, suggesting contradictions between conceptual understanding of leadership and leadership behaviors., Conclusion: The contradictions between students' conceptual understanding of leadership and what they offered as examples of how and where leadership was observed or applied to practice suggest additional activities and experiences may be warranted to help students appreciate that leadership extends beyond formal roles and demonstrates the ability to influence and support the achievement of shared goals of a team. Additionally, a multi-modal approach may enhance leadership assessment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)
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- 2024
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5. Opening the Black Box: Agreement and Reliability of a Situational Judgment Test Across Multiple Institutions.
- Author
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Smith KJ, Reed BN, Neely S, Farland MZ, Haines ST, and Robinson JD
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- Humans, Reproducibility of Results, Empathy, Students, Judgment physiology, Education, Pharmacy methods
- Abstract
Objective: The primary objective of this study was to examine the levels of agreement and reliability of a situational judgment test (SJT) using a diverse pool of pharmacy practice faculty as subject matter experts. Secondary aims included analyses to build support for test validity and fairness., Methods: An SJT containing 18 scenarios and 118 responses assessing empathy, integrity, and teamwork was developed and delivered to pharmacy practice faculty at 5 schools of pharmacy across the United States. Reliability was assessed by examining internal consistency, inter-rater reliability, and split-half reliability. Only responses which attained an inter-rater agreement>0.7 were included in the final version of the SJT. All responses were scored using a near-miss system, allowing higher scores for answers more closely aligned with the key, which was determined by the faculty who completed the SJT. Test fairness was reported using descriptive statistics., Results: Thirty-nine faculty across the 5 participating institutions completed the SJT. The final version of the SJT included 105 responses, achieving an inter-rater agreement of>0.7 (inter-rater reliability of 0.98). Split-half reliability was 0.72. The average score was 85.7%, and no differences in performance were observed based on demographic characteristics., Conclusion: An SJT designed to assess empathy, integrity, and teamwork achieved reasonable levels of reliability among pharmacy practice faculty across the United States, and the results provided initial support for test validity and fairness. These results support a pilot to assess this SJT among students representing multiple institutions., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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6. How Resilience and Wellness Behaviors Affected Burnout and Academic Performance of First-Year Pharmacy Students During COVID-19.
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Reed BN, Lebovitz L, and Layson-Wolf C
- Subjects
- Humans, Pandemics, Burnout, Psychological, Students, Pharmacy, COVID-19 epidemiology, Education, Pharmacy, Burnout, Professional prevention & control, Academic Performance
- Abstract
Objective. To determine whether students' levels of resilience and self-reported wellness behaviors predicted burnout and grade point average at the end of the first fall semester of the COVID-19 pandemic. Methods. We measured first-year students' resilience, burnout (exhaustion and disengagement), and self-reported wellness behaviors (sleep, nutrition, social time, and self-care activities) at the beginning and end of the fall 2020 semester of pharmacy school. We also collected students' demographic information and end-of-semester grade point average from their academic records. Using multivariable regression, we assessed whether students' resilience and wellness behaviors predicted burnout and grade point average at the end of the semester. We also assessed for changes in burnout and wellness behaviors over time. Results. Resilience was positively associated with older age and was lower among students of color. Exhaustion and disengagement were high at baseline and continued to worsen over time. Students' self-reported wellness behaviors also decreased over time, except for ratings of sleep adequacy. Resilience predicted lower levels of disengagement at the end of the semester, but its relationship with exhaustion was inconsistent. The only wellness behaviors associated with lower burnout were nutrition and sleep adequacy. Students' end-of-semester grade point average was also related to nutrition and sleep adequacy but not resilience or burnout. Conclusion. Resilience offered some protection from burnout, but its relationship to immutable factors suggests that individual-focused interventions to improve student well-being (eg, wellness behaviors such as mindfulness meditation) should be complemented by organizational support, especially for younger students and students of color., (© 2023 American Association of Colleges of Pharmacy.)
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- 2023
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7. Improving and Expanding Research on Burnout and Stress in the Academy.
- Author
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Pate AN, Reed BN, Cain J, and Schlesselman L
- Subjects
- Humans, Pharmacists psychology, Surveys and Questionnaires, Faculty, Education, Pharmacy, Burnout, Professional psychology
- Abstract
Objective. To conduct an integrative review of existing literature evaluating burnout and stress to identify reliable, valid, psychometrically sound survey instruments that are frequently used in published studies and to provide best practices in conducting burnout and stress research within academic pharmacy. Findings. We reviewed 491 articles and found 11 validated reliable surveys to be most frequently cited in the literature that can be used in future burnout and stress research. We also noted frequent misunderstandings and misuse of burnout and stress terminology along with inappropriate measurement. Additionally, we identified a variety of useful websites during the review. Lastly, we identified a relative dearth of published research evaluating organizational solutions to burnout and stress beyond personal factors, ie, resilience. Summary. Burnout and stress among student pharmacists, faculty, and staff is an important research area that necessitates more robust, rigorous evaluation using validated reliable surveys with appropriate contextualization within psychological frameworks and theory. Future research evaluating organizational-level attempts to remedy sources of burnout and stress is also needed., (© 2023 American Association of Colleges of Pharmacy.)
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- 2023
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8. Selection by design: Using job analysis to guide the selection of postgraduate pharmacy residents.
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Reed BN, Devabhakthuni S, Gale SE, Heil EL, Hsu G, Martinelli AN, Bernhardi CL, Pires S, and Yeung SYA
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- Humans, Pharmaceutical Services, Pharmacies, Pharmacy, Pharmacy Residencies
- Abstract
Purpose: To help ensure that we were accurately and consistently evaluating applicants to our postgraduate year 1 (PGY1) pharmacy residency program, we performed a job analysis to inform a redesign of our selection process., Summary: A diverse panel of subject matter experts from our program was convened to develop a task inventory; a list of knowledge, skills, abilities, and other characteristics necessary for success in our program; and behavioral snapshots representing especially strong or weak resident performance (ie, critical incidents). After achieving a priori thresholds of consensus, these items were used to augment our application screening instrument (eg, development of anchored rating scales), build an online supplemental application consisting of a personality test and situational judgment test, develop a work sample consisting of a patient case presentation, and enhance the structure of our interviews (eg, by asking a consistent pattern of questions for all candidates). Preceptors reported that the redesigned process was more organized, easier to complete, and facilitated greater rating consistency., Conclusion: Job analysis represents an approach to designing selection processes that are more valid, reliable, transparent, and fair. Based on our experiences, recommendations for those who are considering changes to their selection process are provided., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2022
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9. Candidate reactions to a postgraduate year 1 pharmacy residency supplemental application.
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Reed BN, Armahizer MJ, Devabhakthuni S, Lemens L, and Yeung SYA
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- Humans, Judgment, Surveys and Questionnaires, Internship and Residency, Pharmacy Residencies
- Abstract
Purpose: The purpose of this study was to gauge postgraduate year 1 (PGY1) pharmacy residency candidates' reactions to supplemental applications, as well as aspects specific to our process, including a personality test and situational judgment test (SJT)., Methods: After rank lists were submitted, applicants to our program were invited to complete an online survey. Outcomes of interest included candidates' perceptions of relevance and fairness. Whether candidates' attitudes differed based on the receipt of an interview offer was also assessed., Results: Of 199 applicants to our program for the 2021-2022 training year, 48 applicants (24.1%) completed the survey, 15 of whom had received an interview offer. Most (64.6%) agreed that supplemental applications were useful, and nearly all (95.8%) indicated that they were willing to submit one for programs in which they were most interested. The process was seen as being fair, although ratings were higher among those who received interview offers. Most respondents believed that the personality test and SJT were relevant to the role of a resident, but attitudes towards the SJT were generally more favorable and less likely to vary according to whether candidates received an interview offer. Candidates believed that the personality test and SJT were not as representative of them as letters of reference or their curriculum vitae, but perceptions of academic performance varied., Conclusion: Applicants responded positively to our supplemental application and indicated that they would be willing to complete one for programs of interest. These findings should help assuage concerns about the use of supplemental applications, particularly when short-answer or essay formats are avoided., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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10. Association of lower urinary tract symptoms and diuretic adherence.
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Miller ML, Reed BN, and Malik RD
- Subjects
- Diuretics therapeutic use, Humans, Quality of Life, Sodium Potassium Chloride Symporter Inhibitors therapeutic use, Heart Failure chemically induced, Heart Failure drug therapy, Hypertension drug therapy, Urinary Bladder, Overactive chemically induced
- Abstract
Objective: To assess whether more severe urinary symptoms and poorer quality of life among patients on diuretic therapy are associated with decreased adherence to the diuretic regimen., Methods: Participants were recruited via ResearchMatch.org and sent a REDCap survey. The Overactive Bladder Questionnaire-Short Form (OAB-q SF) was used to assess urinary symptom bother and health-related quality of life (HRQL). Participants were asked if they skip diuretic doses due to urinary symptoms with a bivariate (yes or no) outcome. Subgroup analyses of loop vs non-loop diuretic and those taking the diuretic for a cardiovascular indication (hypertension or heart failure) were performed., Results: A total of 4029 surveys were sent, 285 were returned (7.1% response rate), and 279 were included in the study. Fifty-three participants admitted to skipping diuretic doses due to urinary symptoms. Lower HRQL scores were significantly associated with poorer adherence scores among all participants (P < .001), among participants taking a loop diuretic (P < .001), and among participants with hypertension and heart failure (P < .039). Association between symptoms and adherence remained significant after adjustment in the multivariate model for the whole cohort and loop diuretic subgroup but lost significance in the hypertension and heart failure subgroup., Conclusions: Worsening quality of life due to urinary symptoms may be associated with poorer adherence to diuretics, particularly loop diuretics., (© 2022 John Wiley & Sons Australia, Ltd.)
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- 2022
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11. Break time: Examining pharmacy residency application deadlines and the potential impact of a proposed timeline shift.
- Author
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Bolina J, Soriano-Pereira N, Bland CM, Reed BN, Quidley AM, and Bookstaver PB
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- Humans, Pharmacists, Retrospective Studies, United States, Internship and Residency, Pharmacy Residencies
- Abstract
Introduction: Many pharmacy residency programs set their application deadlines around the first of the calendar year, only weeks following the American Society of Health-System Pharmacists (ASHP) meeting in mid-December. This contributes to a condensed timeframe for applicants and reference writers to complete and submit materials over the winter holidays. This study examined pharmacy residency program application deadlines and respective timing of application and reference letter submissions., Methods: This retrospective, observational study evaluated all residency programs within the ASHP residency directory. Several scenarios were examined for impact of a universal earliest deadline (UED) designation spanning early January. Subsequent analysis included compilation of application and reference submission dates from a sample of ASHP-accredited residency programs to determine timing of submission in regard to application deadline., Results: A total of 2449 programs representing 4927 positions were identified for the 2018-2019 application cycle. The mean deadline was 5 January (± three days), and 11% of programs had a deadline prior to 1 January. Among the five first-year residency programs that provided application and reference submission data spanning the 2016-2020 application cycles, the average time from submission to application deadline was four days for applicants and 11 days for references., Conclusions: Most pharmacy residency programs have deadlines in early January. Implementation of a UED would cause a major shift for these programs but is only one component of change for the application process., Competing Interests: Declaration of Competing Interest Dr. Quidley and Dr. Bookstaver are residency program directors for ASHP-accredited programs. Dr. Quidley is a site surveyor for ASHP PGY2 Critical Care Programs. All other authors report no relevant conflicts., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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12. Personality: A potentially untapped resource in the selection of postgraduate pharmacy residents.
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Reed BN, Gale SE, Martinelli AN, Sparkes TM, Tata AL, Williams C, Yeung SYA, and Armahizer MJ
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- Humans, Leadership, Personality, Pharmacy, Pharmacy Residencies, Students, Pharmacy
- Abstract
Purpose: This study assessed whether personality testing of postgraduate year 1 (PGY1) pharmacy residency applicants was feasible and predicted important selection outcomes, including interview offers., Methods: Applicants to the PGY1 pharmacy residency program at a large academic medical center were invited to complete a 50-item online personality test based on the 5-factor model (ie, the "Big Five"). Scores were sealed until after matching, at which point they were compared to screening, interview, and ranking and match outcomes. Endpoints of interest included the feasibility of the test (eg, time required for completion, completion rate) and whether personality predicted the odds of an interview offer., Results: The personality test was taken by 137 PGY1 applicants (69.5%) and required a median of 6.8 minutes to complete. Openness to experience was associated with decreased odds of an interview offer (adjusted odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75-0.98), whereas conscientiousness and extraversion were associated with increased odds of an interview offer (conscientiousness: adjusted OR, 1.26; 95% CI, 1.02-1.55; extraversion: OR, 1.16; 95% CI, 1.03-1.31). When combined with traditional screening criteria (eg, awards, leadership positions), openness to experience and extraversion remained predictors of an interview offer (in the directions specified above), whereas conscientiousness did not. In an exploratory analysis of interviewees, agreeableness was a negative predictor of interview score. Personality did not predict screening scores or final ranking., Conclusion: Personality testing, based on the traits desired at individual residency programs, could be a valuable addition to the methods used for selecting PGY1 pharmacy residents., (© American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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13. Continuation Versus Interruption of Renin-Angiotensin System Inhibitors in Acute Decompensated Heart Failure: A Brief Report.
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Bernhardi CA, Fendt S, Reed BN, Ramani G, and Gale SE
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- Angiotensin Receptor Antagonists adverse effects, Angiotensin-Converting Enzyme Inhibitors adverse effects, Antihypertensive Agents therapeutic use, Humans, Renin-Angiotensin System, Retrospective Studies, Stroke Volume, Ventricular Function, Left, Heart Failure diagnosis, Heart Failure drug therapy, Hypotension chemically induced, Hypotension diagnosis
- Abstract
This article is temporarily under embargo.
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- 2022
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14. Rethinking letters of reference: Narrowing the gap between evidence and practice.
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Reed BN
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- Humans, Personnel Selection, Internship and Residency, Pharmacy Residencies
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- 2021
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15. The Impact of Atherosclerotic Cardiovascular Risk on Graft Failure in Deceased-Donor Renal Transplantation.
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Hsu G, Sparkes TM, Reed BN, Gale SE, Crossley BE, and Ravichandran BR
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- Graft Rejection epidemiology, Graft Survival, Heart Disease Risk Factors, Humans, Retrospective Studies, Risk Factors, Treatment Outcome, Cardiovascular Diseases epidemiology, Kidney Transplantation
- Abstract
Introduction: Pretransplant cardiovascular risk may be amplified after renal transplant, but little is known about its impact on graft outcomes., Research Question: The purpose of this study was to determine if pretransplant cardiovascular risk was associated with graft outcomes., Design: This retrospective study included deceased-donor renal transplant recipients from 2010-2015. Atherosclerotic cardiovascular disease risk for patients without prior disease was calculated and patients were categorized into high (score >20%), intermediate (7.5-20%), and low risk (<7.5%). Patients with and without prior cardiovascular disease were also compared. The main endpoint was graft failure at 3-years post-transplant. Other outcomes included major adverse cardiovascular events, biopsy-proven rejection, and mortality., Results: In patients without prior atherosclerotic cardiovascular disease (N = 115), graft failure rates (4.5% vs 11.3% vs 12.5%; ( P = 0.64) and major adverse cardiovascular events (9.1% vs 13.2% vs 5.0%; P = 0.52) were similar in the high, intermediate, and low risk groups. In those with prior disease (N = 220), rates of primary nonfunction (6.8% vs 1.7%; P = 0.04), major adverse cardiovascular events (7.3% vs 2.6%; P = 0.01), and heart failure (10.9% vs 3.5%; P = 0.02) were higher than those without cardiovascular; rates of major adverse cardiovascular events and heart failure were insignificant after adjusting for age, gender, and race. Other outcomes were not different. Outcomes did not differ based on pretransplant cardiovascular risk., Discussion: Pretransplant atherosclerotic cardiovascular disease was associated with increased early graft failure but similar outcomes at 3-years, suggesting cardiac risk alone should not exclude transplantation.
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- 2021
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16. Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction.
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Gale SE, Mardis A, Plazak ME, Kukin A, and Reed BN
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- Comorbidity, Humans, Heart Failure drug therapy, Heart Failure epidemiology, Stroke Volume physiology
- Abstract
Patients with heart failure with reduced ejection fraction often have one or more noncardiovascular comorbidities. The presence of concomitant disease states is associated with worse outcomes, including increased risk of mortality, decreased quality of life, and increased healthcare resource utilization. Additionally, the presence of heart failure with reduced ejection fraction complicates the management of these comorbidities, including varying safety and efficacy of therapies compared to those without heart failure. This article will review the literature on the pharmacologic management of common noncardiovascular comorbidities-including chronic obstructive pulmonary disease, depression, diabetes mellitus, gout, chronic kidney disease, and iron deficiency-in patients with heart failure with reduced ejection fraction, as well as provide recommendations for appropriate treatment selection in this population., (© 2021 Pharmacotherapy Publications, Inc.)
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- 2021
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17. Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices.
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Plazak ME, Hankinson SJ, Sorensen EN, Reed BN, Ravichandran B, and Ton VK
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- Adult, Erythrocyte Transfusion, Female, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, Prosthesis Implantation instrumentation, Recurrence, Retrospective Studies, Time Factors, Treatment Outcome, Gastrointestinal Hemorrhage prevention & control, Heart-Assist Devices adverse effects, Hemostatics therapeutic use, Prosthesis Implantation adverse effects, Secondary Prevention, Tamoxifen therapeutic use
- Abstract
Gastrointestinal bleeding (GIB) is a frequent complication in patients with continuous-flow left ventricular assist devices (LVAD). We retrospectively evaluated eight patients implanted with a HeartWare LVAD between July 2017 and June 2020 who experienced at least one episode of GIB and were started on tamoxifen 20 mg once daily for secondary prevention. Tamoxifen was associated with a significant decrease in major GIB from a median of 3 (IQR 1.4-7) events/patient-year pre-tamoxifen initiation to 0 (IQR 0-0.9) events/patient-year post-tamoxifen initiation (p = 0.02). Transfusion of packed red blood cells also decreased from 16.8 (IQR 9.9-30.6) units/patient-year pre-tamoxifen initiation to 1.5 (IQR 0-7.5) units/patient-year post-tamoxifen (p = 0.04). Tamoxifen was well tolerated and no thromboembolic complications were observed. This small cohort study suggests that tamoxifen is associated with reduced GIB and transfusion requirements, with no apparent increase in thrombotic risk. A larger, randomized study is warranted to confirm the results of this exploratory analysis. Graphical abstract.
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- 2021
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18. Comparing Diuresis Patterns in Hospitalized Patients With Heart Failure With Reduced Versus Preserved Ejection Fraction: A Retrospective Analysis.
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Broscious R, Kukin A, Noel ZR, Devabhakthuni S, Seung H, Ramani GV, and Reed BN
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Heart Failure drug therapy, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, Tertiary Care Centers, Young Adult, Diuresis physiology, Diuretics therapeutic use, Furosemide therapeutic use, Heart Failure urine, Stroke Volume
- Abstract
Background: Congestion predominates in exacerbations of heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF), but evidence suggests that excess volume may be distributed differently in these 2 subgroups., Methods and Results: In this retrospective study, diuretic efficiency (DE, or net urine output per 40-mg of intravenous furosemide equivalent) during the first 72 hours was compared between patients hospitalized with HFrEF (n = 121) versus HFpEF (n = 120). Multivariate analysis was used to compare the 2 groups based on expected baseline differences (e.g., demographics, heart failure etiology, concomitant therapy). During the first 72 hours, mean daily diuretic doses were higher in patients with HFpEF versus HFrEF (172.0 vs. 159.9 mg, respectively, P = 0.026) but urine output was not significantly different (2603.3 mL vs. 2667.5 mL, respectively, adjusted P = 0.100). Similarly, mean cumulative DE did not differ (-673.5 vs. -637.8 mL/40-mg in the HFrEF and HFpEF groups, respectively, adjusted P = 0.884). An exploratory analysis of propensity-matched cohorts yielded similar findings. Correlations between the components of DE varied considerably and only became weak to moderately correlated toward the end of the observation period., Conclusions: Although cumulative DE did not differ between patients with HFrEF and HFpEF, variable correlations in the components of DE suggest there may be differences in diuretic response that warrant future analysis.
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- 2021
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19. The Impact of Two Longitudinal Professionalism Courses on Student Pharmacists' Empathy.
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Reed BN, Haines ST, and Holmes ER
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- Attitude of Health Personnel, Empathy, Female, Humans, Pharmacists, Professionalism, Education, Pharmacy, Students, Pharmacy
- Abstract
Objective. To determine whether empathy increased in first-year student pharmacists after completing longitudinal professionalism courses at two schools of pharmacy, identify potential moderators, and assess whether students' conceptualization of empathy changed with time. Methods. Surveys to assess empathy and other variables were administered to student pharmacists at baseline and at the end of two professionalism courses. Baseline and follow-up scores were compared to detect changes over time. Multivariable analysis was used to identify predictors of empathy scores. Factor analysis was performed to ascertain changes in the dimensionality of empathy. Results. Students' demographics and baseline empathy scores differed between the two schools. Predictors of empathy at baseline included age, female gender, prior health care experience, and altruism score. A small increase in empathy was observed at one school but not in the combined cohort. Empathy was more likely to increase among female students, those with less health care experience, and those who did not work during the school year. Factor analyses suggested that students' conceptual clarity about empathy improved over time and became more consistent with existing models. Conclusion. Although an increase in empathy was not observed in the overall cohort, subgroups of students who may derive greater benefit from empathy-related interventions were identified. Factor analyses suggested that students' conceptual understanding of empathy improved, representing a potential alternative outcome assessment for affective domains. Given differences in demographics, instructional methodologies, and changes in empathy at each school, this study reinforces the importance of replication and multicenter studies to understand the generalizability of educational research., (© 2021 American Association of Colleges of Pharmacy.)
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- 2021
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20. Clinical Outcomes of Perioperative Desensitization in Heart Transplant Recipients.
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Plazak ME, Gale SE, Reed BN, Hammad S, Ton VK, Kaczorowski DJ, Madathil RJ, and Ravichandran B
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Background: Sensitization remains a barrier to heart transplantation (HT). Perioperative desensitization strategies have been described; however, a paucity of evidence exists to demonstrate efficacy and safety in HT., Methods: This single-center, retrospective study consisted of adults who received an HT. Perioperative desensitization was initiated if virtual crossmatch or flow-cytometry crossmatch was positive. Therapy consisted of plasmapheresis, intravenous immunoglobulin, and rabbit antithymocyte globulin. Historical controls received standard immunosuppression or induction. The primary endpoint was survival at 12 mo. Secondary endpoints included freedom from acute rejection, cardiac allograft vasculopathy (CAV), and infectious complications., Results: Of the 104 patients included, 48 received no induction, 46 received induction, and 10 underwent perioperative desensitization. No differences were observed in the primary endpoint at 12 mo (90.0% versus 97.9%, P = 0.25 for desensitization versus no-induction; 90.0% versus 100%, P = 0.72 for desensitization versus induction). Rates of acute rejection were lower with induction and desensitization compared with no-induction. There were no significant differences in CAV between the groups. Infectious complications were also similar among the groups (10.0% versus 16.7%, P = 0.62 for desensitization versus no-induction; 10.0% versus 30.4%, P = 0.34 for desensitization versus induction)., Conclusions: This study suggests that a perioperative desensitization strategy triggered by positive virtual crossmatch or flow-cytometry crossmatch allows for successful transplantation of sensitized HT recipients and results in acceptable rates of survival, rejection, CAV, and infection at 12 mo., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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21. Addressing burnout with a work design approach.
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Reed BN
- Subjects
- Humans, Job Satisfaction, Leadership, Workplace, Burnout, Professional, Pharmacy
- Published
- 2020
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22. Clinical Pharmacology-Driven Translational Research to Optimize Bedside Therapeutics of Sotalol Therapy.
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Dahmane E, Tang K, Gobburu JVS, Mattingly TJ 2nd, Reed BN, See VY, Ayres J, and Ivaturi V
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- Administration, Oral, Aged, Anti-Arrhythmia Agents pharmacokinetics, Atrial Fibrillation blood, Computer Simulation, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Monitoring, Electrocardiography, Female, Heart Rate drug effects, Humans, Infusions, Intravenous, Male, Middle Aged, Models, Biological, Retrospective Studies, Sotalol pharmacokinetics, United States, Anti-Arrhythmia Agents administration & dosage, Atrial Fibrillation drug therapy, Pharmacology, Clinical methods, Research Design, Sotalol administration & dosage
- Abstract
Oral sotalol, used in adults for sinus rhythm control, is initiated at 80 mg b.i.d. and titrated to a maximum safe dose. The US Food and Drug Administration recommends monitoring the corrected QT interval (QT
c ) for at least 3 days, until steady-state exposure of the drug is reached, before patient discharge, which can significantly impact the total cost of treatment. The objectives of this research were to design an accelerated intravenous sotalol loading and maintenance therapy that will reduce the hospital length of stay and to also evaluate the pharmacoeconomic impact in a hospital setting. Pharmacokinetic simulations of sotalol plasma concentrations vs. times profiles were performed to determine the optimal intravenous/oral transition regimen. A cost minimization analysis from the health sector perspective was conducted to assess the cost savings for these proposed accelerated regimens. For a chosen target dose of 120 mg b.i.d., two infusions of 40 mg over 1 hour and 20 mg over 0.5 hour, each followed up by an evaluation of QTc , can be administered followed immediately by the target oral maintenance dose of 120 mg at the end of the second infusion. Consequently, steady-state exposure and, therefore, steady-state QTc are obtained on the first day of therapy, facilitating an earlier hospital discharge. Two and 1-day mean total cost of -$3,123 (95% confidence interval (CI), -$3,640, -$2,607) -$4,820 (95% CI, -$5,352, -$4,288) were observed for this strategy, respectively. We are proposing an intravenous to oral transition strategy for sotalol that has the potential to significantly reduce cost and increase patient convenience., (© 2019 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of the American Society for Clinical Pharmacology and Therapeutics.)- Published
- 2019
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23. A Systematic Review of Leadership Definitions, Competencies, and Assessment Methods in Pharmacy Education.
- Author
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Reed BN, Klutts AM, and Mattingly TJ 2nd
- Subjects
- Humans, Pharmacists organization & administration, Professional Competence, Students, Pharmacy, Education, Pharmacy methods, Educational Measurement methods, Leadership
- Abstract
Objective. To characterize leadership definitions, competencies, and assessment methods used in pharmacy education, based on a systematic review of the literature. Findings. After undergoing title, abstract, and full-text review, 44 (10%) of 441 articles identified in the initial search were included in this report. Leadership or an aspect of leadership was defined in 37 (84%) articles, and specific leadership competencies were listed or described in 40 (91%) articles. The most common definitions of leadership involved motivating others toward the achievement of a specific goal and leading organizational change. Definitions of leadership in some articles required that individuals hold a formal leadership position whereas others did not. Only two leadership competencies were related to specific areas of knowledge. Most of the competencies identified were interpersonal and self-management skills. In terms of assessment, only one (2.3%) article assessed leadership effectiveness, and none assessed leadership development. Of the remaining 24 (55%) articles that included some type of assessment, most involved behavioral-based tools assessing individual attributes conceptually related to leadership (eg, strengths, emotional intelligence), or self-assessments regarding whether learning objectives in a leadership course had been met. Summary. Definitions for leadership in pharmacy varied considerably, as did leadership competencies. Most conceptualizations of leadership resembled a combination of established approaches rather than being grounded in a specific theory. If leadership development is to remain a focus within accreditation standards for Doctor of Pharmacy education, a consistent framework for operationalizing it is needed., (© 2019 American Association of Colleges of Pharmacy.)
- Published
- 2019
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24. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee.
- Author
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Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, and Storrow AB
- Subjects
- Cardiology methods, Comorbidity, Consensus, Continuity of Patient Care, Decision Making, Diuretics therapeutic use, Hospitalization, Humans, Palliative Care, Patient Discharge, Practice Guidelines as Topic, Societies, Medical, United States, Cardiology organization & administration, Heart Failure diagnosis, Heart Failure therapy, Risk Assessment methods
- Published
- 2019
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25. Continuation of Newly Initiated Midodrine Therapy: Appropriate in Patients With Heart Failure?
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Reed BN, Gale SE, and Ramani G
- Subjects
- Critical Care, Humans, Patient Discharge, Retrospective Studies, Heart Failure, Midodrine
- Published
- 2019
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26. Alemtuzumab Induction Versus Conventional Immunosuppression in Heart Transplant Recipients.
- Author
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Gale SE, Ravichandran B, Ton VK, Pham S, and Reed BN
- Subjects
- Adult, Aged, Alemtuzumab adverse effects, Drug Therapy, Combination, Female, Graft Rejection diagnosis, Graft Rejection immunology, Humans, Immunosuppressive Agents adverse effects, Kidney drug effects, Kidney physiopathology, Kidney Diseases chemically induced, Kidney Diseases physiopathology, Male, Middle Aged, Progression-Free Survival, Retrospective Studies, Risk Factors, Time Factors, Alemtuzumab therapeutic use, Graft Rejection prevention & control, Graft Survival drug effects, Heart Transplantation adverse effects, Immunosuppressive Agents therapeutic use
- Abstract
The use of alemtuzumab for induction therapy in orthotopic heart transplantation remains controversial, despite its observed benefits in other transplant populations. This study aimed to evaluate whether alemtuzumab conferred a lower risk of rejection while reducing toxicities commonly attributed to standard immunosuppression in orthotopic heart transplantation. We included adult patients who underwent orthotopic heart transplantation and received induction therapy with alemtuzumab (n = 26) or standard immunosuppression (n = 26). The primary end point was freedom from grade ≥2 rejection at 12 months. Baseline characteristics were similar between the groups with the exception of poorer renal function in the alemtuzumab group ( P < .05). The primary end point of freedom from grade ≥2 rejection at 12 months was not different between alemtuzumab and standard therapy (76.9% vs 96.2%, P = .077), likely due to similarities in the rates of antibody-mediated rejection in the 2 groups. However, grade ≥2 acute cellular rejection was considerably lower with alemtuzumab (0% vs 19.2%, P = .02), as was acute cellular rejection of any severity (50% vs 7.7%, P = .004). Deterioration in renal function was significantly greater among patients receiving standard therapy as evidenced by decreases in glomerular filtration rate (-25.6 vs -9.2 mL/min, P = .032). No differences in hematologic or infectious complications were observed. In conclusion, alemtuzumab reduced several important rejection-related outcomes while ameliorating the toxicities associated with standard immunosuppression therapy, making it a promising agent for induction in orthotopic heart transplantation.
- Published
- 2019
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27. An aspirin a day? Clinical utility of aspirin therapy for the primary prevention of cardiovascular disease.
- Author
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Plazak ME, Mouradjian MT, Watson K, Reed BN, Noel ZR, Devabhakthuni S, and Gale SE
- Subjects
- Adult, Aged, Diabetes Mellitus, Hemorrhage, Humans, Practice Guidelines as Topic, Primary Prevention, Risk Factors, Aspirin therapeutic use, Cardiovascular Diseases prevention & control
- Abstract
Introduction : Cardiovascular disease remains a leading cause of morbidity and mortality. Since the description of its therapeutic potential, aspirin has been a cornerstone of therapy following vascular events. However, aspirin in the primary prevention setting is controversial and major guideline groups provide inconsistent recommendations. Thus, there is variability in practice as providers are faced with a balance of therapeutic benefit and drug-induced harm. Areas covered : This article provides a critical appraisal of both past and present data for aspirin in the primary prevention setting. PubMed and Cochrane Central Register databases were searched from inception to May 1
st , 2019. Expert opinion : The decision to initiate or withdraw aspirin for primary prevention requires an understanding of the equilibrium between efficacy and safety. In adults greater than 70 years of age, low to moderate cardiovascular risk, controlled diabetes, or at high risk of bleeding, initiation of aspirin for primary prevention should generally be avoided. Instead, risk factor modification should be prioritized. The net benefit of aspirin in those at high risk for cardiovascular disease and in those with uncontrolled diabetes is largely unknown. Ultimately, initiation or withdrawal of aspirin therapy must involve discussion of the patient's wishes and treatment expectations.- Published
- 2019
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28. Effect of Advanced Pharmacy Practice Experience Grading Scheme on Residency Match Rates.
- Author
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Pincus K, Hammond AD, Reed BN, and Feemster AA
- Subjects
- Cross-Sectional Studies, Educational Measurement methods, Humans, Surveys and Questionnaires, United States, Education, Pharmacy statistics & numerical data, Pharmacy Residencies statistics & numerical data, Schools, Pharmacy statistics & numerical data, Students, Pharmacy
- Abstract
Objective. To examine the effect of advanced pharmacy practice experience (APPE) grading schemes on residency match rates. Methods. A cross-sectional survey was administered to U.S. pharmacy schools and colleges to determine an APPE grading scheme. Post-graduate year 1 residency match data for the years 2013-2015 was obtained from the American Society of Health-System Pharmacists. Additional variables thought to affect residency match rates were collected from publicly available sources and prior research. Unadjusted and adjusted multivariate logistic regression analysis was performed to compare 2013-2015 residency match rates between institutions using letter grading and those using pass/fail grading schemes. Potential confounders for incorporation into the adjusted model were identified by Chi-square or Fisher's exact test as appropriate. Results. There were 110 of 126 schools that responded to the survey. Of these, 100 schools reported using either letter grading or pass/fail grading schemes in APPE courses and were included in the study. Unadjusted analysis revealed no difference in match rates between letter grading and pass/fail grading schemes over the aggregated time frame or in individual years. After adjusting for potential confounders, pass/fail grading was associated with higher match rates in the aggregate analysis and in 2013. However, no association was observed in 2014 or 2015. Conclusion. This study demonstrates that there is limited difference in residency match rates between schools using pass/fail or letter grading schemes in APPEs.
- Published
- 2019
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29. Survey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers.
- Author
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Reed BN, DiDomenico RJ, Allender JE, Coons JC, Cox JF, Johnson D, Oliphant CS, and Jennings DL
- Subjects
- Arginine analogs & derivatives, Heparin administration & dosage, Hirudins administration & dosage, Humans, Peptide Fragments administration & dosage, Pipecolic Acids administration & dosage, Recombinant Proteins administration & dosage, Sulfonamides, Surveys and Questionnaires, United States, Anticoagulants administration & dosage, Heart-Assist Devices, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objectives: To characterize anticoagulation practices with the Impella percutaneous ventricular assist device (pVAD)., Background: Managing anticoagulation in patients being supported by the Impella pVAD is made challenging by several unique features of the device. These include the release of a dextrose-based purge solution containing unfractionated heparin (UFH), the need to concurrently administer systemic anticoagulation with intravenous UFH, and the lack of an alternative strategy in patients with contraindications to UFH., Methods: To characterize anticoagulation practices with the Impella pVAD, we conducted a survey of centers in the United States performing a high volume of Impella cases, which we defined as > 1 per month. Centers were contacted via email or phone and individuals who agreed to participate were provided with a link to complete the survey online. The primary measures of interest were variations in practice across centers and variations from the manufacturer's recommendations., Results: Practices varied considerably among respondents (65 of 182 centers, or 35.7%) and often diverged from manufacturer recommendations. Approximately half of centers (52.4%) reported using a UFH concentration of 50 units/mL in the purge solution, whereas most of the remaining centers (41.3%) reported using lower concentrations. Strategies for the initiation and adjustment of systemic therapy also varied, as did practices for routinely monitoring for hemolysis. Nearly one-fifth of centers (16.7%) had not developed an alternative strategy for the purge solution in patients with contraindications to UFH. Most centers (58.4%) reported using argatroban or bivalirudin in this scenario, a strategy that diverges from the manufacturer's recommendations., Conclusions: Given these findings, studies to determine a systematic approach to anticoagulation with the Impella device are warranted., Competing Interests: The authors of this manuscript do not have any relevant personal or financial relationships to disclose., (Copyright © 2019 Brent N. Reed et al.)
- Published
- 2019
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30. Antithromboembolic Strategies for Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.
- Author
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Ather A, Laliberte B, Reed BN, Schenk A, Watson K, Devabhakthuni S, and See VY
- Subjects
- Anticoagulants adverse effects, Drug Therapy, Combination, Factor Xa Inhibitors administration & dosage, Factor Xa Inhibitors adverse effects, Humans, Observational Studies as Topic, Percutaneous Coronary Intervention adverse effects, Platelet Aggregation Inhibitors adverse effects, Randomized Controlled Trials as Topic, Vitamin K antagonists & inhibitors, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Hemorrhage chemically induced, Percutaneous Coronary Intervention methods, Platelet Aggregation Inhibitors administration & dosage
- Abstract
We set out to synthesize available data on antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), with a focus on triple antithrombotic therapy (triple therapy [TT]; dual antiplatelet therapy plus an anticoagulant) versus dual therapy (DT; one antiplatelet agent and an anticoagulant). We searched OVID MEDLINE and PubMed from January 2005 to September 2017 using the search terms oral anticoagulant, triple therapy, dual therapy, acute coronary syndrome, percutaneous coronary intervention, and atrial fibrillation (limited to randomized controlled trials, observational studies, English language, minimum 6-12 months of follow-up, minimum 100 human patients). We excluded surveys, literature reviews, articles not directly related to TT versus DT, incomplete studies, and short-term in-hospital studies. All eligible studies were reviewed to evaluate possible antithrombotic management strategies for patients with AF undergoing PCI. Extracted studies were categorized according to the specific anticoagulant (vitamin K antagonist vs. direct-acting oral anticoagulant) and P2Y
12 inhibitor used. Each category review was followed by a discussion providing insight into the quality of evidence and implications for practice. We found that the risk of bleeding with TT was higher than with DT, without demonstrated added benefit of reducing major adverse cardiovascular events. TT use should be minimized in patients with high bleeding risk, and patient-specific factors should be critically analyzed to select appropriate antiplatelet and anticoagulant agents.- Published
- 2018
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31. Diuretic Strategies and Renal Dysfunction in Heart Failure With Preserved Ejection Fraction.
- Author
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Reed BN and Gottlieb SS
- Subjects
- Diuretics, Dopamine, Humans, Stroke Volume, Heart Failure, Kidney Diseases
- Published
- 2018
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32. Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support.
- Author
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Allender JE, Reed BN, Foster JL, Moretz JD, Oliphant CS, Jennings DL, DiDomenico RJ, and Coons JC
- Subjects
- Anticoagulants administration & dosage, Blood Coagulation drug effects, Hemodynamics drug effects, Heparin administration & dosage, Humans, Intra-Aortic Balloon Pumping methods, Practice Guidelines as Topic, Shock, Cardiogenic blood, Treatment Outcome, Anticoagulants therapeutic use, Heart Ventricles physiopathology, Heart-Assist Devices adverse effects, Heparin therapeutic use, Intra-Aortic Balloon Pumping instrumentation, Shock, Cardiogenic therapy
- Abstract
Percutaneous mechanical circulatory support (MCS) devices, including the intraaortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure. Each device also has specific monitoring requirements and goal ranges. This review provides an overview of percutaneous MCS devices commonly used in the acute management of left ventricular failure, with an emphasis on pharmacologic considerations. We review recent evidence and guidelines and provide recommendations for appropriate use of anticoagulation during device support. Approaches to managing heparinized purge solutions, monitoring, and the utility of nonheparin anticoagulants are also provided because high-quality evidence in the literature is limited., (© 2017 Pharmacotherapy Publications, Inc.)
- Published
- 2017
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33. Diuretic Resistance in Acute Decompensated Heart Failure: A Challenging Clinical Conundrum.
- Author
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Reed BN and Devabhakthuni S
- Subjects
- Acute Disease, Humans, Diuretics administration & dosage, Heart Failure therapy, Sodium Potassium Chloride Symporter Inhibitors administration & dosage
- Abstract
Most patients with acute decompensated heart failure (ADHF) present with signs and symptoms of volume overload, and those with a significant history of diuretic exposure may demonstrate varying degrees of diuretic resistance. Although this phenomenon is commonly reported, no consensus definition exists and recommendations regarding an optimal therapeutic approach remain limited. Optimizing the use of intravenous (IV) loop diuretic therapy is the most common initial approach, and therapy may be augmented by the addition of a thiazide-type diuretic or an IV vasodilator. Patients whose resistance to diuretic therapy is due to low cardiac output may require inotropic therapy, and other options (eg, ultrafiltration and vasopressin antagonists) may be considered in select populations. The purpose of this review is to describe diuretic resistance and its underlying mechanisms in ADHF, as well as the most commonly employed strategies for overcoming it. A stepwise approach to managing volume overload in patients with ADHF and diuretic resistance is also provided.
- Published
- 2017
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34. Observation of Patients Transitioned to an Oral Loop Diuretic Before Discharge and Risk of Readmission for Acute Decompensated Heart Failure.
- Author
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Laliberte B, Reed BN, Devabhakthuni S, Watson K, Ivaturi V, Liu T, and Gottlieb SS
- Subjects
- Acute Disease, Administration, Oral, Adult, Aged, Female, Follow-Up Studies, Heart Failure diagnosis, Humans, Male, Middle Aged, Mortality trends, Prospective Studies, Retrospective Studies, Risk Factors, Heart Failure drug therapy, Heart Failure mortality, Patient Discharge trends, Patient Readmission trends, Sodium Potassium Chloride Symporter Inhibitors administration & dosage
- Abstract
Background: Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF)., Methods and Results: This was a retrospective study of adult patients admitted for ADHF at a large academic medical center. A total of 123 patients were included. Baseline characteristics were similar between groups. The primary outcome of 30-day HF readmission occurred in 11 of 61 patients (18%) observed on an oral loop diuretic for <24 hours and in 2 of 62 patients (3.2%) observed on an oral loop diuretic for ≥24 hours (P = .023). Readmissions for 60- and 90-day HF were also significantly lower in patients observed for ≥24 hours (P = .014 and P = .049, respectively). Associations became stronger after multivariate analysis (P < .001). Observation for <24 hours and previous admission within 30 days were independent predictors of 30-day HF readmission (P = .03)., Conclusions: Observation of patients on an oral loop diuretic for <24 hours was associated with significantly higher 30-day HF readmission. Therefore, observation on an oral loop diuretic for ≥24 hours before discharge in patients presenting with ADHF should be strongly considered., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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35. Lessons in Bridge-Building: A Multidisciplinary Approach to Heart Failure Care.
- Author
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Reed BN
- Subjects
- Cardiology methods, Heart Failure diagnosis, Humans, Pharmacists trends, Physician Assistants trends, Physicians trends, Social Workers, Cardiology trends, Heart Failure therapy, Intersectoral Collaboration, Patient Care Team trends
- Published
- 2017
- Full Text
- View/download PDF
36. No filter: A characterization of #pharmacist posts on Instagram.
- Author
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Hindman FM Jr, Bukowitz AE, Reed BN, and Mattingly TJ 2nd
- Subjects
- Cross-Sectional Studies, Delivery of Health Care statistics & numerical data, Humans, Retrospective Studies, Pharmacists statistics & numerical data, Social Media statistics & numerical data
- Abstract
Objectives: The primary objective was to characterize the underlying intent of Instagram posts using the hashtag metadata term "#pharmacist" over a 1-year period. The secondary objective was to determine whether statistically significant relationships existed between the categories and the 2 dichotomous variables tested, self-portrayed images, and relation to health care., Design: Retrospective, cross-sectional, mixed methods, exploratory, descriptive study., Setting: A review of available Instagram posts using the hashtag metadata "#pharmacist" from November 4, 2014, to November 3, 2015. Data were collected using software provided by NEXT Analytics. A sample of 14 random days was selected., Participants: Six hundred sixty-one Instagram posts containing "#pharmacist" in the caption., Outcome Measures: Categorization of post (including both picture and primary caption), self-portrayed images (i.e., "selfie"), and health care-related images., Results: One thousand three hundred thirty-eight posts were collected from the 14-day sample. Of the posts, 661 (49.4%) were analyzed; the remainder were excluded for being written in a non-English language or containing "#pharmacist" in the comments of the post, rather than the primary caption; 19.7% of all posts fell into the Celebration category, followed by Work Experience and Advertisement with 18.6% and 12.6%, respectively. The remainder of the categories contained 10% or fewer posts. Less than 25% of posts were self-portrayed images, and 88% of posts were deemed health care-related., Conclusions: Instagram is an emerging social media platform that can be used to expand patient education, professional advocacy, and public health outreach. In this study, the majority of #pharmacist posts were celebratory in nature, and the majority were determined to be related to health care. Posts containing #pharmacist may provide the opportunity to educate the public regarding the knowledge and capabilities of pharmacists., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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37. Use of an argatroban-based purge solution in a percutaneous ventricular assist device.
- Author
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Laliberte B and Reed BN
- Subjects
- Aged, Anticoagulants adverse effects, Arginine analogs & derivatives, Drug Substitution, Female, Heparin adverse effects, Humans, Shock, Cardiogenic etiology, Shock, Cardiogenic surgery, Sulfonamides, Takotsubo Cardiomyopathy complications, Thrombocytopenia chemically induced, Treatment Outcome, Anticoagulants administration & dosage, Blood Coagulation drug effects, Heart-Assist Devices adverse effects, Pipecolic Acids administration & dosage, Thrombocytopenia prevention & control
- Abstract
Purpose: The use of an argatroban-based percutaneous ventricular assist device (pVAD) purge solution in a patient with suspected heparin-induced thrombocytopenia (HIT) is described., Summary: A 70-year-old woman in cardiogenic shock was admitted to a coronary care unit after being discovered unresponsive at home. A transthoracic echocardiogram revealed a low ejection fraction and findings consistent with takotsubo cardiomyopathy. Administration of multiple inotropes and vasopressors was initially required for hemodynamic support. The patient was implanted with an Impella pVAD (Abiomed, Inc., Danvers, MA) using a heparin-based purge solution; an i.v. heparin infusion was initiated for supplemental systemic anticoagulation. Over the next 24 hours, the patient's platelet count decreased from 168,000 to 37,000 cells/μL. Given a differential diagnosis that included HIT, the patient was transitioned to an argatroban-based purge solution. Due to prolonged activated partial thromboplastin times, a systemic argatroban infusion was not initiated, and the patient remained fully anticoagulated throughout pVAD support with only the argatroban-based purge solution. An HIT antibody test was negative. On hospitalization day 9 (day 6 of pVAD support with argatroban use), the patient became hemodynamically stable and was weaned off pVAD support. Three days later, the platelet count had recovered to 117,000 cells/μL (from a nadir of 21,000 cells/μL). During pVAD support, the patient developed hemolytic anemia with minimal bleeding complications., Conclusion: Argatroban was used as a purge solution anticoagulant in a patient with an Impella pVAD and found to be a safe and effective alternative to heparin., (Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)
- Published
- 2017
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38. Diltiazem versus metoprolol for rate control in atrial fibrillation with rapid ventricular response in the emergency department.
- Author
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Hines MC, Reed BN, Ivaturi V, Bontempo LJ, Bond MC, and Hayes BD
- Subjects
- Administration, Intravenous, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Cohort Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Adrenergic beta-Antagonists administration & dosage, Atrial Fibrillation drug therapy, Calcium Channel Blockers administration & dosage, Diltiazem administration & dosage, Emergency Service, Hospital, Metoprolol administration & dosage
- Abstract
Purpose: The impact of patient-specific factors on the choice of β-blocker versus calcium channel blocker therapy for rate control in emergency department (ED) patients treated for atrial fibrillation (AF) was investigated., Methods: A retrospective cohort study was conducted to evaluate the influence of demographics, prior medication use, hemodynamic and clinical characteristics, and other variables on selection of first-line therapy for AF among patients admitted to the ED of an academic medical center over a 22-month period (October 2012-July 2014) who received i.v. treatment with either the β-blocker metoprolol (n = 45) or the calcium channel blocker diltiazem (n = 55) for rate control., Results: Significant predictors of the selection of metoprolol versus diltiazem included a past history of AF (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.396-72.713; p = 0.032) or diabetes mellitus (OR, 7.2; 95% CI, 1.208-58.490; p = 0.042) and being prescribed a β-blocker prior to presentation (OR, 27.8; 95% CI, 4.704-272.894; p = 0.001); a history of calcium channel blocker use prior to ED presentation was a negative predictor of β-blocker use for initial rate control (OR, 0.1; 95% CI, 0.005-0.265; p = 0.002). No differences in the effectiveness or safety of diltiazem and metoprolol were identified. Indicators of hemodynamic and clinical response to ED management were not predictive of discharge medication selection., Conclusion: The drug class used for rate control prior to ED admission was the most significant predictor of medication selection for rate control in the ED setting., (Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)
- Published
- 2016
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39. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association.
- Author
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Wiggins BS, Saseen JJ, Page RL 2nd, Reed BN, Sneed K, Kostis JB, Lanfear D, Virani S, and Morris PB
- Subjects
- Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Clinical Decision-Making, Comorbidity, Consensus, Drug Interactions, Dyslipidemias diagnosis, Dyslipidemias epidemiology, Evidence-Based Medicine, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacokinetics, Polypharmacy, Risk Assessment, Risk Factors, Treatment Outcome, United States, American Heart Association, Cardiovascular Diseases drug therapy, Dyslipidemias drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects
- Published
- 2016
- Full Text
- View/download PDF
40. Interactive Web-based regional journal club for postgraduate year 2 pharmacy residents in cardiology.
- Author
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Devabhakthuni S, Reed BN, and Watson K
- Subjects
- Cardiology education, Humans, Pharmacy methods, Cardiology methods, Education, Pharmacy methods, Internet, Periodicals as Topic, Pharmacy Residencies methods, Simulation Training methods
- Published
- 2016
- Full Text
- View/download PDF
41. Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy.
- Author
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Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, and Baker-Smith CM
- Subjects
- Cardiomyopathies etiology, Defibrillators, Implantable, Female, Heart Failure etiology, Humans, Lactation, Pregnancy, Pregnancy Complications, Cardiovascular etiology, Systole, Ventricular Dysfunction, Left, Cardiomyopathies therapy, Heart Failure therapy, Pregnancy Complications, Cardiovascular therapy
- Abstract
Peripartum cardiomyopathy (PPCM) is an uncommon, idiopathic complication of pregnancy associated with significant (10-30%) mortality. The disease occurs late in pregnancy or in the months following delivery, resulting in reduced systolic function and heart failure (HF) symptoms. Limited direction is provided for the management of PPCM, and the safe and effective use of medications in pregnant and breastfeeding women with PPCM presents a unique challenge. Although several HF therapies in pregnant and lactating women are supported by robust evidence, evidence to support the use of other therapies is significantly lacking. Current guidelines recommend treatment as in other forms of HF with reduced left ventricular ejection fraction (LVEF) but with consideration for the important nuances in this population as well as the unique and potential teratogenic effects of these therapies. Since most patients with PPCM recover their LVEF, the duration of therapy is currently unknown and warrants further study. We review the available literature surrounding pharmacologic and device therapy for PPCM and provide insight into managing patients with the condition., (© 2016 Pharmacotherapy Publications, Inc.)
- Published
- 2016
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42. Efficacy and Safety of Intravenous Chlorothiazide versus Oral Metolazone in Patients with Acute Decompensated Heart Failure and Loop Diuretic Resistance.
- Author
-
Shulenberger CE, Jiang A, Devabhakthuni S, Ivaturi V, Liu T, and Reed BN
- Subjects
- Acute Disease, Administration, Intravenous, Administration, Oral, Adult, Aged, Chlorothiazide adverse effects, Cohort Studies, Drug Resistance, Female, Humans, Male, Metolazone adverse effects, Middle Aged, Retrospective Studies, Chlorothiazide therapeutic use, Diuretics therapeutic use, Heart Failure drug therapy, Metolazone therapeutic use
- Abstract
Study Objective: To assess the efficacy and safety of intravenous (IV) chlorothiazide versus oral metolazone when added to loop diuretics in patients with acute decompensated heart failure (ADHF) and loop diuretic resistance., Design: Retrospective cohort study., Setting: Large urban academic medical center., Patients: Adults admitted with ADHF between 2005 and 2015 who had loop diuretic resistance, defined as administration of IV furosemide at a dose of 160 mg/day or higher (or an equivalent dose of IV bumetanide), during hospitalization, and who then received at least one dose of IV chlorothiazide (88 patients) or oral metolazone (89 patients) to augment diuresis., Measurements and Main Results: The primary efficacy end point was a change in 24-hour net urine output (UOP) from before to after thiazide-type diuretic administration, and the study was designed to test for the noninferiority of metolazone. Safety end points included changes in renal function and electrolyte concentrations. The mean dose of IV loop diuretic therapy (in IV furosemide equivalents) at baseline (before thiazide-type diuretic administration) was higher in the chlorothiazide group (mean ± SD 318.9 ± 127.7 vs 268.4 ± 97.6 mg/day in the metolazone group, p=0.004), but net UOP was similar (mean ± SD 877.0 ± 1189.0 ml in the chlorothiazide group vs 710.6 ± 1145.9 ml in the metolazone group, p=0.344). Mean doses of chlorothiazide and metolazone were 491 ± 282 mg and 5.8 ± 3.5 mg, respectively. Following thiazide-type diuretic administration, net UOP improved to a similar degree (2274.6 ± 1443.0 ml vs 2030.2 ± 1725.0 ml in the chlorothiazide and metolazone groups, respectively, p=0.308). For the primary efficacy end point, metolazone met the threshold for noninferiority by producing a net UOP of 1319.6 ± 1517.4 ml versus 1397.6 ± 1370.7 ml for chlorothiazide (p=0.026 for noninferiority). No significant differences in renal function were observed between the groups. Although hypokalemia was more frequent in the chlorothiazide group (75% with chlorothiazide vs 60.7% with metolazone, p=0.045), no significant differences in the rates of severe hypokalemia or other electrolyte abnormalities were observed between the groups., Conclusion: Oral metolazone was noninferior to IV chlorothiazide for enhancing net UOP in patients with ADHF and loop diuretic resistance and was similarly safe with regard to renal function and electrolyte abnormalities. Given the significant cost disparity between the two agents, these findings suggest that oral metolazone may be considered a first-line option in this patient population., (© 2016 Pharmacotherapy Publications, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
43. Beliefs and behaviors of professionally engaged pharmacists.
- Author
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Miklich MA, Reed BN, Mattingly TJ 2nd, and Haines ST
- Subjects
- Aged, Attitude of Health Personnel, Delphi Technique, Female, Humans, Job Satisfaction, Leadership, Male, Middle Aged, Pharmacists psychology, Professional Role psychology, Professionalism
- Abstract
Objectives: To define professional engagement and establish a list of beliefs and behaviors characteristic of professionally engaged pharmacists., Design: A 4-round online Delphi consensus technique. Round 1: Panelists were asked to identify the beliefs and behaviors characteristic of professionally engaged pharmacists. Investigators then crafted representative statements. Round 2: Panelists agreed with statements as written, agreed with changes, or disagreed. Round 3: Panelists distributed 100 points among the modified belief and behavior statements, reflecting the relative weight and importance of each. Round 4: Panelists rated overall agreement with statements and the definition of professional engagement with the use of a 4-point Likert scale., Setting: Not applicable., Participants: Fifteen pharmacists with a deep interest in and knowledge of professional engagement., Intervention: Not applicable., Main Outcome Measures: Consensus statements regarding the beliefs and behaviors characteristic of a professionally engaged pharmacist and a consensus definition of professional engagement., Results: From 128 submissions regarding beliefs provided by panelists in round 1, 18 statements were crafted and 12 statements achieved consensus. From 72 submissions regarding behaviors provided by panelists in round 1, 15 statements were crafted and 9 statements achieved consensus. Panelists' agreement with each of the final statements achieved a mean score greater than 3.9 on a 4-point Likert scale. Consensus was achieved regarding the definition of professional engagement. The professionally engaged pharmacist "thinks and behaves in ways that positively affect patients' health and advance the profession's values and societal mission.", Conclusion: Professional engagement in pharmacists is composed of cognitive, behavioral, and affective components. This work provides a framework to describe professional engagement and lays the foundation for future scholarly work. The ability to measure professional engagement will allow us to correlate professional engagement with outcomes and design interventions to catalyze increased engagement in the profession., (Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)
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- 2016
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44. The impact of drug shortages on patients with cardiovascular disease: causes, consequences, and a call to action.
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Reed BN, Fox ER, Konig M, Jackevicius CA, Masoudi FA, Rabinstein AA, and Page RL 2nd
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- Health Services Needs and Demand, Humans, Quality Improvement, United States, Cardiovascular Agents supply & distribution, Cardiovascular Diseases drug therapy, Health Services Accessibility standards
- Abstract
Shortages of cardiovascular drugs have become increasingly common, representing an ongoing public health crisis. Given few therapeutic alternatives to many of the drugs in short supply, these shortages also pose a major challenge for cardiovascular care professionals. Although changes in the regulatory environment have led to some improvements in recent years, problems involving manufacturing processes remain the most common underlying cause. Because of the complex nature of drug shortages, sustainable solutions to prevent and mitigate them will require collaboration between regulatory agencies, drug manufacturers, and other key stakeholder groups. In this report, we describe the scope of the cardiovascular drug shortage crisis in the United States, including its underlying causes and the efforts currently being made to address it. Furthermore, we provide specific recommendations for how cardiovascular care professionals can be involved in efforts to limit the impact of drug shortages on patient care as well as policy changes aimed at preventing and mitigating them., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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45. From Pilot to Practice: A Trainee-Integrated Pharmacy Practice Model in Cardiology.
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Kalich BA, Cicci JD, Shah S, and Reed BN
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- Cardiovascular Agents therapeutic use, Hospitalization, Humans, Medication Reconciliation organization & administration, North Carolina, Pilot Projects, Medication Errors prevention & control, Pharmacy Service, Hospital organization & administration
- Abstract
Objectives: Problems related to medication use portend poor outcomes, but resources for expanding clinical pharmacy services are limited. We conducted a pilot study in the area of cardiology to determine the impact and feasibility of a trainee-integrated pharmacy practice (TIPP) model comprised of pharmacy residents and a clinical pharmacist., Methods: Coverage of 2 acute care and 1 intensive care team was distributed among 1 clinical pharmacist and 3 pharmacy residents. Patient care services included interdisciplinary rounds, order verification, medication reconciliation, counseling, clinical monitoring, and documentation. A pharmacy technician collected medication histories for newly admitted patients. Data related to medication reconciliation, clinical interventions, and time requirements were collected. Clinical services were compared to historical controls where data were available., Results: Over the 18-day pilot study, the mean daily census consisted of 33.4 ± 5.3 patients. Admission medication reconciliation was performed on 8.1 patients per day, resulting in the discovery of 3.5 discrepancies per patient. Of 18 patients receiving anticoagulant therapy, 9 were counseled prior to discharge. Compared to historical controls, the number of patients receiving medication reconciliation and discharge counseling improved by 81% and 70%, respectively (both P < .05). A total of 763 clinical interventions were recommended (42.4 per day), with many recognized in peer-reviewed literature as conferring improvements in clinical outcomes. Members of the model were active for a mean of 10-12 hours each day, with 6.3-7.2 hours corresponding to direct patient care., Limitations: This was a single-arm, observational pilot study., Conclusion: Implementation of a TIPP model significantly expanded clinical pharmacy services on an acute care cardiology service, but it required significant time commitments., (©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)
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- 2016
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46. Impact of video technology on efficiency of pharmacist-provided anticoagulation counseling and patient comprehension.
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Moore SJ, Blair EA, Steeb DR, Reed BN, Hull JH, and Rodgers JE
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- Academic Medical Centers, Aged, Aged, 80 and over, Comprehension, Female, Humans, Male, Middle Aged, Patient Discharge, Prospective Studies, Anticoagulants therapeutic use, Counseling methods, Pharmacists organization & administration, Warfarin therapeutic use
- Abstract
Background: Discharge anticoagulation counseling is important for ensuring patient comprehension and optimizing clinical outcomes. As pharmacy resources become increasingly limited, the impact of informational videos on the counseling process becomes more relevant., Objective: To evaluate differences in pharmacist time spent counseling and patient comprehension (measured by the Oral Anticoagulation Knowledge [OAK] test) between informational videos and traditional face-to-face (oral) counseling., Methods: This prospective, open, parallel-group study at an academic medical center randomized 40 individuals-17 warfarin-naïve ("New Start") and 23 with prior warfarin use ("Restart")-to receive warfarin discharge education by video or face-to-face counseling. "Teach-back" questions were used in both groups., Results: Although overall pharmacist time was reduced in the video counseling group (P < 0.001), an interaction between prior warfarin use and counseling method (P = 0.012) suggests the difference between counseling methods was smaller in New Start participants. Following adjustment, mean total time was reduced 8.71 (95% CI = 5.15-12.26) minutes (adjusted P < 0.001) in Restart participants and 2.31 (-2.19 to 6.81) minutes (adjusted P = 0.472) in New Start participants receiving video counseling. Postcounseling OAK test scores did not differ. Age, gender, socioeconomic status, and years of education were not predictive of total time or OAK test score., Conclusion: Use of informational videos coupled with teach-back questions significantly reduced pharmacist time spent on anticoagulation counseling without compromising short-term patient comprehension, primarily in patients with prior warfarin use. Study results demonstrate that video technology provides an efficient method of anticoagulation counseling while achieving similar comprehension., (© The Author(s) 2015.)
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- 2015
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47. Medication management of cardiac allograft vasculopathy after heart transplantation.
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Hollis IB, Reed BN, and Moranville MP
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- Allografts, Antioxidants therapeutic use, Calcineurin Inhibitors therapeutic use, Cardiovascular Agents therapeutic use, Cytomegalovirus Infections prevention & control, Everolimus therapeutic use, Graft Occlusion, Vascular immunology, Graft Occlusion, Vascular pathology, Graft Rejection immunology, Graft Rejection pathology, Graft Survival, Humans, Immunosuppressive Agents therapeutic use, Mycophenolic Acid therapeutic use, Postoperative Complications immunology, Postoperative Complications pathology, Sirolimus therapeutic use, Tacrolimus therapeutic use, Graft Occlusion, Vascular prevention & control, Graft Rejection prevention & control, Heart Transplantation, Postoperative Complications prevention & control
- Abstract
Cardiac allograft vasculopathy (CAV) is a common complication following heart transplantation (HT), resulting in diminished graft survival. The preferred strategy for preventing CAV is optimal medical management; however, for patients who develop CAV, delaying disease progression through effective medication management is equally important. A review of the literature regarding medication management of CAV was conducted via a search of the MEDLINE database. Studies were included if they were published in English, conducted in humans ≥ 18 years of age or older, and used noninvestigational medications. Immunosuppressive medications such as the antiproliferative mycophenolate, the calcineurin inhibitor tacrolimus, and the proliferation signal inhibitors sirolimus and everolimus have been shown to prevent the development of CAV. Certain cardiovascular medications, such as HMG-CoA reductase inhibitors (statins), gemfibrozil, calcium channel blockers, and angiotensin-converting enzyme inhibitors, have also demonstrated efficacy in preventing this disease process. Prevention of CAV has also been observed with prophylaxis against cytomegalovirus infection and antioxidant medications. Despite being commonly used in HT patients, neither antiplatelet agents nor glycemic control have proved effective at preventing CAV. Only sirolimus has been shown to arrest the progress of existing CAV., (© 2015 Pharmacotherapy Publications, Inc.)
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- 2015
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48. Safety of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease.
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Danelich IM, Wright SS, Lose JM, Tefft BJ, Cicci JD, and Reed BN
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- Anti-Inflammatory Agents, Non-Steroidal pharmacology, Anticoagulants adverse effects, Aspirin adverse effects, Atrial Fibrillation etiology, Atrial Fibrillation physiopathology, Blood Pressure drug effects, Cardiovascular Diseases physiopathology, Coronary Artery Disease etiology, Coronary Artery Disease physiopathology, Cyclooxygenase Inhibitors adverse effects, Drug Interactions, Heart Failure etiology, Heart Failure physiopathology, Hemorrhage chemically induced, Humans, Platelet Aggregation Inhibitors adverse effects, Risk, Stroke etiology, Stroke physiopathology, Surgical Procedures, Operative, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Cardiovascular Diseases etiology
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Nonsteroidal antiinflammatory drugs (NSAIDs) are used in the management of a variety of conditions, but their prevalence is likely underreported as a result of widespread availability and the perception that nonprescription therapies are unnecessary to report during medication history taking. However, NSAIDs are associated with a number of adverse effects, especially in patients with cardiovascular disease (CVD). Patients with CVD and comorbidities for which NSAIDs may provide symptomatic relief (e.g., osteoarthritis, rheumatoid arthritis) tend to be older, which places them at greater risk of harm. For these reasons, the use of NSAIDs in patients with CVD is a significant public health concern. An understanding of the risks associated with NSAIDs is critical for clinicians across practice settings. In this review, we detail the safety of NSAIDs in patients with CVD, provide recommendations on their use in specific disease states, and discuss therapeutic alternatives., (© 2015 Pharmacotherapy Publications, Inc.)
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- 2015
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49. Effects of an accelerated intravenous iron regimen in hospitalized patients with advanced heart failure and iron deficiency.
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Reed BN, Blair EA, Thudium EM, Waters SB, Sueta CA, Jensen BC, and Rodgers JE
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- Anemia, Iron-Deficiency blood, Anemia, Iron-Deficiency complications, Female, Ferric Compounds adverse effects, Ferric Compounds blood, Ferric Compounds therapeutic use, Heart Failure blood, Heart Failure complications, Hematinics adverse effects, Hematinics blood, Hematinics therapeutic use, Hemoglobins analysis, Hospitalization, Humans, Infusions, Intravenous, Male, Pilot Projects, Prospective Studies, Time Factors, Treatment Outcome, Anemia, Iron-Deficiency drug therapy, Ferric Compounds administration & dosage, Heart Failure drug therapy, Hematinics administration & dosage
- Abstract
Study Objective: To assess the short-term efficacy and safety of an accelerated intravenous iron regimen in hospitalized patients with heart failure and iron deficiency., Design: Prospective, single-arm, open-label study., Setting: Large tertiary care medical center., Patients: Thirteen patients with New York Heart Association class III-IV heart failure, anemia (hemoglobin level ≤ 12.0 g/dl), and iron deficiency (ferritin level < 100 ng/ml, or ferritin level of 100-300 ng/ml with transferrin saturation < 20%) hospitalized between April 2011 and December 2013., Intervention: All patients received sodium ferric gluconate 250 mg in 100 ml of normal saline intravenously over 2 hours twice/day until the iron deficit was corrected or the patient was discharged., Measurements and Main Results: Changes in hematologic parameters were assessed at 1-4 weeks after therapy. Patients received a mean ± standard deviation (SD) total iron dose of 1269 ± 207 mg over 3.4 ± 1.0 days. After a mean ± SD follow-up of 13.1 ± 5.6 days, intravenous iron increased hemoglobin level by 1.2 g/dl (95% confidence interval [CI] 0.45-1.9, p=0.005), ferritin level by 364.2 ng/ml (95% CI 129.7-598.7, p=0.007), and transferrin saturation by 10.5% (95% CI 6.5-14.6%, p<0.001). Changes in hemoglobin level did not correlate with volume status, as determined by differences in body weight. No significant changes in blood pressure or heart rate were observed. Adverse events were few and minor in severity (e.g., nausea, constipation, and abdominal discomfort)., Conclusion: An accelerated intravenous iron regimen improved hematologic parameters and was well tolerated in hospitalized patients with advanced heart failure. A randomized multicenter trial comparing this regimen with placebo is warranted., (© 2014 Pharmacotherapy Publications, Inc.)
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- 2015
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50. Stage B: what is the evidence for treatment of asymptomatic left ventricular dysfunction?
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Reed BN and Sueta CA
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- Adrenergic beta-Antagonists therapeutic use, Angiogenesis Inhibitors therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Clinical Trials as Topic, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Ventricular Dysfunction, Left drug therapy
- Abstract
Although patients with American College of Cardiology / American Heart Association (ACC/AHA) Stage B heart failure, or asymptomatic left ventricular dysfunction (ALVD) are at high risk for developing symptomatic heart failure, few management strategies have been shown to slow disease state progression or improve long-term morbidity and mortality. Of the pharmacologic therapies utilized in patients with symptomatic disease, only angiotensin converting enzyme (ACE) inhibitors (and to a lesser extent, angiotensin receptor blockers, or ARBs) have been shown to improve clinical outcomes among patients with ALVD. Although evidence to support the use of beta blockers in this setting has been primarily derived from retrospective studies or subgroup analyses, they are generally recommended in most patients with ALVD, especially those with ischemic etiology. Statins are associated with improvements in both major adverse cardiovascular events and heart failure events among patients with a history of acute myocardial infarction. Finally, in eligible patients, placement of an automatic implantable cardioverter defibrillator (ICD) has been associated with reduced mortality rates among those with ALVD due to ischemic cardiomyopathy, and some subgroups may derive benefit from cardiac resynchronization therapy or biventricular pacing.
- Published
- 2015
- Full Text
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