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Xu L, Xie D, Griffin K, Staley B, Nichols D, Benca R, Pack A, Redline S, Walsh J, Kushida C, Kuna S. Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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2
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Xu L, Mazzotti D, Keenan B, Wiemken A, Staley B, Benedikstdottir B, Juliusson S, Pack A, Gislason T, Schwab R. Structural risk factors for obstructive sleep apnea at different levels of obesity. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jeon N, Staley B, Henriksen C, Lipori GP, Winterstein AG. Development and validation of an automated algorithm for identifying patients at higher risk for drug-induced acute kidney injury. Am J Health Syst Pharm 2019; 76:654-666. [PMID: 31361856 DOI: 10.1093/ajhp/zxz043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Using information from institutional electronic health records, we aimed to develop dynamic predictive models to identify patients at high risk of acute kidney injury (AKI) among those who received a nephrotoxic medication during their hospital stay. METHODS Candidate predictors were measured for each of the first 5 hospital days where a patient received a nephrotoxic medication (risk model days) to predict an AKI, using logistic regression with reduced backward variables elimination in 100 bootstrap samples. An AKI event was defined as an increase of serum creatinine ≥ 200% of a baseline SCr within 5 days after a risk model day. Final models were internally validated by replication in 100 bootstrap samples and a risk score for each patient was calculated from the validated model. As performance measures, the area under the receiver operation characteristic curves (AUC) and the number of AKI events among patients who had high risk scores were estimated. RESULTS The study population included 62,561 admissions followed by 1,212 AKI events (1.9 events/100 admissions). We constructed 5 risk models corresponding to the first 5 hospital days where patients were exposed to at least one nephrotoxic medication. Validated AUCs of the 5 models ranged from 0.78 to 0.81. Depending on risk model day, admissions ranked in the 90th percentile of the risk score captured between 43% to 49% of all AKI events. CONCLUSION A dynamic prediction model was built successfully for inpatient AKI with excellent discriminative validity and good calibration, allowing clinicians to focus on a select high-risk population that captures the majority of AKI events.
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Affiliation(s)
- Nakyung Jeon
- Department of Pharmacotherapy, College of Pharmacy University of Utah, Salt Lake City, UT
| | - Ben Staley
- Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida, Gainesville, FL
| | | | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, Department of Epidemiology, College of Public Health and Health Profession & College of Medicine, University of Florida, Gainesville, FL
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Choi Y, Staley B, Soria-Saucedo R, Henriksen C, Rosenberg A, Winterstein AG. Common inpatient hypoglycemia phenotypes identified from an automated electronic health record-based prediction model. Am J Health Syst Pharm 2019; 76:166-174. [PMID: 30689749 DOI: 10.1093/ajhp/zxy017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Common inpatient hypoglycemia risk factor patterns (phenotypes) from an electronic health record (EHR)-based prediction model and preventive strategies were identified. METHODS Patients admitted to 2 large academic medical centers who were in the top fifth percentile of a previously developed hypoglycemia risk score and developed hypoglycemia (blood glucose [BG] of <50mg/dL) were included in the study. Frequencies of all combinations of ≥4 risk factors contributing to the risk score among these patients were determined to identify common risk patterns. Clinical pharmacists developed clinical vignettes for each common pattern and formulated medication therapy management recommendations for hypoglycemia prevention. RESULTS A total of 401 admissions with a hypoglycemic event were identified among 1,875 admissions whose hypoglycemic risk was in the top fifth percentile among all admissions that received antihyperglycemic drugs and evaluated. Five distinct phenotypes emerged: (1) frail patients with history of hypoglycemia receiving insulin on hospital day 1, (2) a rapid downward trend in BG values in patients receiving an insulin infusion or with a history of hypoglycemia, (3) administration of insulin in the presence of an active nothing by mouth order in frail patients, (4) repeated low BG level in frail patients, and (5) inadequate night-time BG monitoring for patients on long-acting insulin. The 5 themes jointly described 53.0% of high-risk patients who experienced hypoglycemia. CONCLUSION Five distinct phenotypes that are prevalent in patients at greatest risk for inpatient hypoglycemia were identified.
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Affiliation(s)
- Yoonyoung Choi
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Services, UF Health Shands, University of Florida, Gainesville, FL
| | - Rene Soria-Saucedo
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Carl Henriksen
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Amy Rosenberg
- Department of Pharmacy Services, UF Health Shands, University of Florida, Gainesville, FL
| | - Almut G Winterstein
- Pharmaceutical Outcomes and Policy, College of Pharmacy, Epidemiology, and Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
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Winterstein AG, Jeon N, Staley B, Xu D, Henriksen C, Lipori GP. Development and validation of an automated algorithm for identifying patients at high risk for drug-induced hypoglycemia. Am J Health Syst Pharm 2018; 75:1714-1728. [DOI: 10.2146/ajhp180071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, and Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Nakyung Jeon
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT
| | - Ben Staley
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL
| | - Dandan Xu
- Division of Biostatistics, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
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Staley B, Keenan BT, Simonsen S, Warrell R, Schwab R, Breen M, Bae C, Pack A, Schutte-Rodin S. 1082 Using an Electronic Health Record (EHR) to Collect and Use Quality-Of-Life Data for AASM Process and Outcomes Quality Measures. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Staley
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B T Keenan
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Simonsen
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Warrell
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Breen
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bae
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Pack
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Schutte-Rodin
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kuna ST, Townsend RR, Keenan B, Maislin D, Sif Arnardottir E, Gislason T, Benediktsdottir B, Gudmundsdottir S, Sifferman A, Staley B, Pack FM, Guo X, Maislin G, Chirinos J, Pack AI. 0520 Blood Pressure Effects of Positive Airway Pressure Treatment in Obese and Non-obese Adults with Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S T Kuna
- Crescenz VA Medical Center, Philadelphia, PA
- University of Pennsylvania, Philadelphia, PA
| | | | - B Keenan
- University of Pennsylvania, Philadelphia, PA
| | - D Maislin
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - A Sifferman
- University of Pennsylvania, Philadelphia, PA
| | - B Staley
- University of Pennsylvania, Philadelphia, PA
| | - F M Pack
- University of Pennsylvania, Philadelphia, PA
| | - X Guo
- University of Pennsylvania, Philadelphia, PA
| | - G Maislin
- University of Pennsylvania, Philadelphia, PA
| | - J Chirinos
- University of Pennsylvania, Philadelphia, PA
| | - A I Pack
- University of Pennsylvania, Philadelphia, PA
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Tan M, Keenan B, Staley B, Anafi R, Schwab R, Schutte-Rodin S. 1083 Using an Electronic Health Record (EHR) to Identify Chronic CPAP Users with Abnormal HL7 CPAP Data. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Tan
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Keenan
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Staley
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Anafi
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Schutte-Rodin
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Kuna ST, Tanayapong P, Maislin G, Staley B, Pack FM, Pack AI, Younes M. 0211 Odds Ratio Product: A Measure of Sleep Homeostasis Following Prolonged Wakefulness. Sleep 2018. [DOI: 10.1093/sleep/zsy061.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S T Kuna
- Crescenz VA Medical Center, Philadelphia, PA
- University of Pennsylvania, Philadelphia, PA
| | | | - G Maislin
- University of Pennsylvania, Philadelphia, PA
| | - B Staley
- University of Pennsylvania, Philadelphia, PA
| | - F M Pack
- University of Pennsylvania, Philadelphia, PA
| | - A I Pack
- University of Pennsylvania, Philadelphia, PA
| | - M Younes
- University of Manitoba, Winnipeg, MB, CANADA
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Mastromatto N, Killough N, Keenan BT, Schwab R, Staley B, Simonsen S, Bergmann A, Bae C, Schutte-Rodin S. 1084 CPAP Adherence Varies with Type of Patient Insurance. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - B T Keenan
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Staley
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Simonsen
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Bergmann
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bae
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Schutte-Rodin
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Mastromatto N, Killough N, Keenan B, Schwab R, Bergmann A, Simonsen S, Staley B, Bae C, Schutte-Rodin S. 1075 The Effect of Changing the First CPAP Mask on Compliance. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - B Keenan
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - R Schwab
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - A Bergmann
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - S Simonsen
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - B Staley
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - C Bae
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
| | - S Schutte-Rodin
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadlephia, PA
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Chang Y, Staley B, Simonsen S, Breen M, Keenan B, Schwab R, Bae C, Pack A, Schutte-Rodin S. 1087 Transitioning from Paper to Electronic Health Record Collection of Epworth Sleepiness Scale (ESS) for Quality Measures. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Chang
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Staley
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Simonsen
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Breen
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Keenan
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Schwab
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bae
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Pack
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Schutte-Rodin
- Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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13
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Winterstein AG, Staley B, Henriksen C, Xu D, Lipori G, Jeon N, Choi Y, Li Y, Hincapie-Castillo J, Soria-Saucedo R, Brumback B, Johns T. Development and validation of a complexity score to rank hospitalized patients at risk for preventable adverse drug events. Am J Health Syst Pharm 2017; 74:1970-1984. [DOI: 10.2146/ajhp160995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Dandan Xu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Gloria Lipori
- UF Health Shands Hospital, University of Florida, Gainesville, FL
| | - Nakyung Jeon
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - YoonYoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Juan Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Rene Soria-Saucedo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions, and College of Medicine, University of Florida, Gainesville, FL
| | - Thomas Johns
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
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Jeon N, Sorokina M, Henriksen C, Staley B, Lipori GP, Winterstein AG. Measurement of selected preventable adverse drug events in electronic health records: Toward developing a complexity score. Am J Health Syst Pharm 2017; 74:1865-1877. [PMID: 29118045 DOI: 10.2146/ajhp160911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The defining of a select number of high-priority preventable adverse drug events (pADEs) for measurement in the electronic health record (EHR) and the estimation of pADE incidences in two tertiary care facilities are described. METHODS This study was part of a larger effort aimed at developing an automated electronic health record (EHR)-based complexity-score (C-score) that ranks hospitalized patients according to their risk for pADEs for clinical intervention. We developed measures for 16 high-priority pADEs often deemed preventable using discrete clinical and administrative EHR data. For each pADE we specified inclusion and exclusion criteria that were used to define risk populations for each specific pADE. The incidence of each type of pADE was then measured during a designated follow-up period considering all adult admissions to 2 large academic tertiary care hospitals, who were eligible for the pADE-specific risk populations during any of their first 5 hospital days. RESULTS Utilizing the data from 83,787 admissions who were at risk for at least one pADE during at least one of their first five hospital days, we found that 27,193 admissions (32.5%) developed at least one pADE. Uncontrolled postsurgical pain, uncontrolled pneumonia, and drug-associated hypotension had the highest incidences with the following number of days with pADE per number of patients at risk: 13,484 of 19,640; 527 of 1,530; and 13,394 of 43,630, while drug-associated falls (446 of 75,036), drug-associated acute mental status changes (262 of 66,875) and venous thromboembolism (214 of 74,283) had the lowest incidence rates. CONCLUSION EHR-based definitions of clinically important pADEs were developed, and the incidence of the pADEs was estimated. These definitions will be advanced for the creation of prediction models to develop a C-score for identifying patients at risk for pADEs to prioritize pharmacist intervention.
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Affiliation(s)
- Nakyung Jeon
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Magarita Sorokina
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Service, UF Health Shands Hospital, Gainesville, FL
| | | | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, and Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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Jeon N, Staley B, Johns T, Lipori GP, Brumback B, Segal R, Winterstein AG. Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals. Am J Health Syst Pharm 2017; 74:1774-1783. [DOI: 10.2146/ajhp160387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nakyung Jeon
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Ben Staley
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | - Thomas Johns
- Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL
| | | | - Babette Brumback
- Department of Biostatistics, College of Public Health and Health Professions, and Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, and Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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16
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Jeon N, Staley B, Klinker KP, Hincapie Castillo J, Winterstein AG. Acute kidney injury risk associated with piperacillin/tazobactam compared with cefepime during vancomycin therapy in hospitalised patients: a cohort study stratified by baseline kidney function. Int J Antimicrob Agents 2017; 50:63-67. [DOI: 10.1016/j.ijantimicag.2017.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/31/2022]
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17
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Kim J, Mohler ER, Keenan BT, Maislin D, Arnardottir ES, Gislason T, Benediktsdottir B, Sifferman A, Staley B, Pack FM, Maislin G, Chirinos JA, Pack AI, Kuna ST. 0519 CAROTID ARTERY WALL THICKNESS IN OBESE AND NON-OBESE WITH OBSTRUCTIVE SLEEP APNEA BEFORE AND FOLLOWING POSITIVE AIRWAY PRESSURE TREATMENT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Urry FM, Komaromy-Hiller G, Staley B, Crockett DK, Kushnir M, Nelson G, Struempler RE. Nitrite adulteration of workplace urine drug-testing specimens. I. Sources and associated concentrations of nitrite in urine and distinction between natural sources and adulteration. J Anal Toxicol 1998; 22:89-95. [PMID: 9547404 DOI: 10.1093/jat/22.2.89] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The active ingredient in the commercial workplace urine drug-testing adulterant, Klear, was previously determined to be nitrite ion. Nitrite adulteration compromises the confirmation of some drugs, notably the marijuana metabolite. A previously reported bisulfite step overcomes some nitrite adulteration, but it cannot do so in every case, which leaves the laboratory to report the specimen as not suitable for testing. Unlike many other adulterants, nitrite is found in normal urine at low concentrations. In order to defend a report of nitrite adulteration, it is necessary to provide evidence that the amount of nitrite in a workplace urine specimen could not arise by normal means. The objectives of this study were to identify all sources of nitrite in urine and the range of concentrations associated with these sources and to determine if nitrite adulteration can be supported based upon a quantitative result. The scientific literature was reviewed for internal and external sources of nitrite and their concentration ranges and are reported. The following specimens were obtained and nitrite concentrations measured by a spectrophotometric method: clinical specimens nitrite positive by test strip (< 15 micrograms/mL); specimens culture positive for nitrate-reducing microorganisms (< 36 micrograms/mL); specimens from patients on medications that may metabolize to nitrite (< 6 micrograms/mL); and drug-test specimens, both negative (< 130 micrograms/mL) and others that appeared to be adulterated with nitrite (range 1910-12,200 micrograms/mL, mean 5910). The literature and the nitrite measurements of this study indicate a substantial difference between concentrations from natural sources compared with adulteration. A quantitative measurement of nitrite by a well-structured assay can provide scientifically valid and forensically defensible proof of adulteration with a nitrite-containing substance.
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Affiliation(s)
- F M Urry
- ARUP Laboratories, Inc, Salt Lake City, Utah 84108, USA
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