1
|
Adelakun AR, De Vera MA, McGrail K, Turgeon RD, Barry AR, Andrade JG, MacGillivray J, Deyell MW, Kwan L, Chua D, Lum E, Smith R, Loewen P. Development and Application of an Attribute-Based Taxonomy on the Benefits of Oral Anticoagulant Switching in Atrial Fibrillation: A Delphi Study. Adv Ther 2024:10.1007/s12325-024-02859-0. [PMID: 38658484 DOI: 10.1007/s12325-024-02859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Patients with atrial fibrillation (AF) often switch between oral anticoagulants (OACs). It can be hard to know why a patient has switched outside of a clinical setting. Medication attribute comparisons can suggest benefits. Consensus on terms and definitions is required for inferring OAC switch benefits. The objectives of the study were to generate consensus on a taxonomy of the potential benefits of OAC switching in patients with AF and apply the taxonomy to real-world data. METHODS Nine expert clinicians (seven clinical pharmacists, two cardiologists) with at least 3 years of clinical and research experience in AF participated in a Delphi process. The experts rated and commented on a proposed taxonomy on the potential benefits of OAC switching. After each Delphi round, ratings were analyzed with the RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness method. Median ratings, disagreement index, and comments were used to modify the taxonomy. The resulting taxonomy from the Delphi process was applied to a cohort of patients with AF who switched OACs in a population-based administrative health dataset from 1996 to 2019 in British Columbia, Canada. RESULTS The taxonomy was finalized in two Delphi rounds, reaching consensus on five switch benefit categories: safety, effectiveness, convenience, economic considerations, and drug interactions. Safety benefit (a switch that could lower the risk of adverse drug events) had three subcategories: major bleeding, intracranial hemorrhage (ICH), and gastrointestinal (GI) bleeding. Effectiveness benefit had four subcategories: stroke and systemic embolism (SSE), ischemic stroke, myocardial infarction (MI), and all-cause mortality. Real-world OAC switches revealed that more OAC switches had convenience (72.6%) and drug interaction (63.0%) benefits compared to effectiveness (SSE 22.0%, ischemic stroke 11.1%, MI 3.1%, all-cause mortality 10.1%), safety (major bleeding 24.3%, GI bleeding 10.6%, ICH 48.5%), and economic benefits (12.1%). CONCLUSIONS The Delphi-based taxonomy identified five criteria for the beneficial effects of OAC switching, aiding in characterizing real-world OAC switching.
Collapse
Affiliation(s)
- Adenike R Adelakun
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Kim McGrail
- UBC School of Population and Public Health, Vancouver, Canada
- UBC Centre for Health Services and Policy Research, Vancouver, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
- Jim Pattison Outpatient Care and Surgery Centre, Surrey, Canada
| | - Jason G Andrade
- Vancouver General Hospital, Vancouver, Canada
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
| | | | - Marc W Deyell
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- Centre for Cardiovascular Innovation, Vancouver, Canada
- St. Paul's Hospital, Vancouver, Canada
| | - Leanne Kwan
- Royal Columbian Hospital, New Westminster, Canada
| | | | - Elaine Lum
- Vancouver General Hospital, Vancouver, Canada
| | | | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada.
- UBC Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.
- Centre for Cardiovascular Innovation, Vancouver, Canada.
| |
Collapse
|
2
|
Barry AR, Wang EH, Chua D, Zhou L, Hong KM, Safari A, Loewen P. Patients' Beliefs About Their Cardiovascular Medications After Acute Coronary Syndrome: A Prospective Observational Study. CJC Open 2023; 5:745-753. [PMID: 37876885 PMCID: PMC10591128 DOI: 10.1016/j.cjco.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/07/2023] [Indexed: 10/26/2023] Open
Abstract
Background Adherence to secondary preventive pharmacotherapy after an acute coronary syndrome (ACS) is generally poor and is associated with recurrent cardiovascular events. Patients' beliefs about their medications are a strong predictor of intentional nonadherence. Methods This prospective, observational study assessed adult patients' beliefs about their post-ACS medications, using the Beliefs About Medicines Questionnaire (BMQ), and adherence, using the Medication Adherence Report Scale (MARS-5) at St. Paul's Hospital in Vancouver, Canada during May-December, 2022. The BMQ and MARS-5 were administered in-hospital and at 4 weeks after discharge. Outcomes included difference in BMQ necessity-concerns differential (BMQ-NCD) from hospitalization to 4-week follow-up and factors associated with the BMQ-NCD. Results Forty-seven participants completed the 4-week follow-up. The mean age was 64 years, and 83% were male. Most presented with a non-ST-segment-elevation ACS. No difference occurred in BMQ-NCD (7.3 vs 6.6, P = 0.29) or MARS-5 scores from discharge to 4 weeks (22.8 vs 23.7, P = 0.06); however, the BMQ specific-necessity subscale score decreased significantly (20.3 vs 18.8, P = 0.002). South Asian and Middle Eastern ethnic origins, compared to European, were associated with a higher BMQ-NCD. Part-time employment and male sex were associated with a lower BMQ-NCD. Conclusions Participants held favourable beliefs about their post-ACS medications, which were largely unchanged from hospitalization to 4 weeks postdischarge, except for beliefs about the necessity of taking their medications. Those of European descent, those with part-time employment, and males had the lowest BMQ-NCD. Self-reported adherence was high. Ongoing reassessment of patients' beliefs about the necessity of taking their post-ACS medications may be warranted to mitigate further decline in BMQ-NCD.
Collapse
Affiliation(s)
- Arden R. Barry
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Jim Pattison Outpatient Care and Surgery Centre, Lower Mainland Pharmacy Services, Surrey, British Columbia, Canada
| | - Erica H.Z. Wang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Lower Mainland Pharmacy Services, Vancouver, British Columbia, Canada
| | - Doson Chua
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Lower Mainland Pharmacy Services, Vancouver, British Columbia, Canada
| | - Lucy Zhou
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin M.H. Hong
- Mississauga Hospital, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Abdollah Safari
- School of Mathematics, Statistics, and Computer Science, College of Science, University of Tehran, Tehran, Iran
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Cameron T, Chua D, Shalansky S, Tam E, Wang E. Comparison of a Fully Weight-Based Protocol with a Non-Weight-Based Dosage Titration Protocol for IV Unfractionated Heparin: A Before-and-After Study. Can J Hosp Pharm 2023; 76:23-28. [PMID: 36683662 PMCID: PMC9817222 DOI: 10.4212/cjhp.3265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Unfractionated heparin (UFH) is used for the prevention and treatment of arterial or venous thromboembolism. The dosage for IV infusion of UFH is generally based on the patient's weight, with adjustment to a specific target for activated partial thromboplastin time (aPTT). In May 2019, the UFH protocols at the study institution were changed from being fully weight-based (i.e., for both initial dosing and subsequent dosage titrations) to weight-based initial dosing and non-weight-based dosage titrations, but the relative effectiveness of these 2 approaches was not known. Objectives The primary objective was to compare the effectiveness in achieving therapeutic aPTT with the fully weight-based and non-weight-based dosage titration protocols. The secondary objective was to compare the effectiveness of the non-weight-based dosage titration protocol with that of the previous fully weight-based one for patients with low-target aPTT. Methods A single-centre, retrospective, observational before-and-after study was conducted for patients receiving therapeutic UFH for any indication. Patients in the "before" group (fully weight-based protocol) were treated from January 2015 to October 2016, and those in the "after" group (non-weight-based titration) from January to October 2020. Results From a total of 1969 charts screened, 137 patients treated according to the fully weight-based protocols and 130 patients treated according to the non-weight-based titration protocols were included. In terms of the co-primary objective, the median number of dosage adjustments to achieve therapeutic anticoagulation was 1 in both groups (p = 0.48), and the proportion of patients with therapeutic anticoagulation at 24 h was similar (96.2% [125/130] with the non-weight-based titration protocols versus 99.3% [136/137] with the fully weight-based protocols; p = 0.09). Among patients treated according to the low-target UFH protocols, those with the non-weight-based titration protocol were less likely to have therapeutic anticoagulation at first measurement of aPTT than those with the fully weight-based protocol (37.9% [25/66] versus 44.6% [41/92], p = 0.033). Conclusions This retrospective, observational, before-and-after study showed that the effectiveness of the non-weight-based dosage titration protocols in achieving therapeutic aPTT was similar to that of fully weight-based UFH protocols.
Collapse
|
4
|
Shi R, Turgeon R, Chua D. SODIUM-GLUCOSE TRANSPORT PROTEIN 2 INHIBITOR ELIGIBILITY FOR PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.125] [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: 11/16/2022] Open
|
5
|
Dingle GA, Sharman LS, Hayes S, Chua D, Baker JR, Haslam C, Jetten J, Haslam SA, Cruwys T, McNamara N. A controlled evaluation of the effect of social prescribing programs on loneliness for adults in Queensland, Australia (protocol). BMC Public Health 2022; 22:1384. [PMID: 35854258 PMCID: PMC9295098 DOI: 10.1186/s12889-022-13743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In social prescribing, link workers support individuals whose persistent health problems are exacerbated by loneliness by connecting them to community-based social activities. This approach is well established in the UK and is gaining attention in Australia. However, a major limitation of research to date has been a lack of theoretically informed and rigorous evaluations of social prescribing. We will address these points in this study, applying a social identity framework to examine the effects of group-based social prescribing (SP) activity compared to primary care treatment as usual (TAU). METHODS Ninety participants experiencing loneliness recruited from primary care services and community centres across five sites in Southeast Queensland will be assigned to one of two conditions (SP, TAU) and assessed at two timepoints (baseline, + 8 weeks). Individuals will be aged 18 years and over, have sufficient English language skills to provide consent, and at the time of recruitment they will not be experiencing acute symptoms or social issues that require urgent intervention. Primary outcomes are loneliness, mental well-being, and health service use (total number of GP, hospital, and allied health visits in the past 3 months). Secondary outcomes will assess social group processes, including number of important social groups, new group identification, multiple identity compatibility, and group-based support and emotion regulation. DISCUSSION This study will provide comprehensive data about the extent to which, and how, social prescribing to community-based group activities may help people to feel less lonely, more socially integrated, and healthy over the first 8 weeks. If effective, this social identity-informed model of social prescribing can be disseminated in communities across Australia. TRIAL REGISTRATION ANZCTR, Registered 8 June 2022 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000801718.aspx.
Collapse
Affiliation(s)
- G A Dingle
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia.
| | - L S Sharman
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia
| | - S Hayes
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia
| | - D Chua
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia.,Inala Primary Care, Brisbane, Australia
| | - J R Baker
- Primary & Community Care Services, Gold Coast, Australia
| | - C Haslam
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia
| | - J Jetten
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia
| | - S A Haslam
- School of Psychology, The University of Queensland, St Lucia QLD, Brisbane, 4072, Australia
| | - T Cruwys
- Australian National University, Canberra, Australia
| | - N McNamara
- Nottingham Trent University, Nottingham, UK
| |
Collapse
|
6
|
Chua D, Brar T. Erroneous Computerized Interpretation of QTc and Changes to Patient Drug Therapy: Cautionary Example for Pharmacists. Ann Pharmacother 2021; 56:850-852. [PMID: 34651506 DOI: 10.1177/10600280211049469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Brar T, Chua D. Direct-Acting Oral Anticoagulant Choice for Stroke Prevention in Obese Patients With Atrial Fibrillation. Can J Cardiol 2021; 37:1489-1492. [PMID: 33865954 DOI: 10.1016/j.cjca.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 11/25/2022] Open
Abstract
Anticoagulation with direct-acting oral anticoagulants (DOACs) is recommended over warfarin for stroke prevention in patients with atrial fibrillation (AF). The efficacy of DOACs over warfarin in obese patients with AF is less defined and may carry the potential for subtherapeutic anticoagulation and reduced efficacy. The best available evidence to guide DOAC use in obese patients with AF is from analysis of obese subgroups of all the major landmark DOAC trials. From these subgroup analyses of the RE-LY, ARISTOTLE, ENGAGE-AF TIMI 48, and ROCKET-AF trials, DOAC use in obese patients demonstrated efficacy similar or superior to warfarin for stroke reduction. Major bleeding rates were similar or higher with DOACs compared with warfarin in these obese subgroup analyses. Meta-analysis of the above major clinical trials concluded that DOACs were more effective compared with warfarin for stroke prevention in obese patients (up to a body mass index [BMI] of 50 kg/m2) and had lower incidence of major bleeding. The totality of evidence supports that DOACs are as effective, if not superior, to warfarin in obese patients with AF. We propose an algorithm, based on the available evidence and current guidelines, to guide the use of DOACs based on severity of obesity. Any DOAC can be used in obese patients with BMI < 40 kg/m2. In patients with a BMI of 40-50 kg/m2, warfarin should be used, but apixaban or edoxaban can be considered. In obese patients with a BMI > 50 kg/m2, warfarin should be used.
Collapse
Affiliation(s)
- Tanveer Brar
- Pharmacy Department, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Doson Chua
- Pharmacy Department, St Paul's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
8
|
Chua D, Brar T. Comment: Walk the Line-The Importance of Well-informed Interpretation of QT Prolongation. Ann Pharmacother 2020; 55:932. [PMID: 33215511 DOI: 10.1177/1060028020973375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
9
|
Nguyen TK, Chua D, Shannon NB, Ng JCF, Tan HK. The show must go on. Br J Surg 2020; 107:e201. [PMID: 32383160 PMCID: PMC7267535 DOI: 10.1002/bjs.11684] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022]
Affiliation(s)
- T K Nguyen
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - D Chua
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - N B Shannon
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - J C F Ng
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - H K Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| |
Collapse
|
10
|
Barry AR, Wang EH, Chua D, Pearson GJ. Comparison of Preventive Cardiovascular Pharmacotherapy in Surgical vs Percutaneous Coronary Revascularization. CJC Open 2019; 1:297-304. [PMID: 32159124 PMCID: PMC7063635 DOI: 10.1016/j.cjco.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/10/2019] [Indexed: 11/27/2022] Open
Abstract
Background Data suggest that patients who undergo coronary artery bypass grafting (CABG) have a lower rate of secondary preventive cardiovascular pharmacotherapy use compared with patients who undergo percutaneous coronary intervention (PCI). This study sought to assess the rate of use of preventive pharmacotherapy at discharge in patients who underwent CABG vs PCI post–acute coronary syndrome (ACS). Methods A prospective cohort study was conducted at St Paul’s Hospital in Vancouver, Canada. Patients aged ≥ 18 years who presented with an ACS and underwent CABG or PCI between January and November 2018 were included. Data on preventive pharmacotherapy use and reasons for justified nonuse (eg, intolerance, contraindication) were collected. Results A total of 275 patients were included. Mean age was 65 years, and 83% were male. Overall, 141 patients (51%) underwent CABG and 134 patients (49%) underwent PCI. All patients received acetylsalicylic acid, but more patients who underwent CABG received 325 mg (vs 80-81 mg) compared to PCI (25% vs 1%, P < 0.01). Use of P2Y12 inhibitors was higher in patients who underwent PCI (primarily ticagrelor) compared with patients who underwent CABG (primarily clopidogrel) (99% vs 26%, P < 0.01). All patients who underwent CABG received a β-blocker vs 96% of patients who underwent PCI (P = 0.017). Use of angiotensin-modulating agents was higher in patients who underwent PCI (98% vs 65%, P < 0.01). Statin use was similar between groups (99% vs 99%, P = 0.96), but more patients who underwent PCI received maximum-dose therapy (89% vs 64%, P < 0.01). Conclusions Use of acetylsalicylic acid, β-blockers, and statins in patients post-ACS was high regardless of revascularization strategy, whereas P2Y12 inhibitors and angiotensin-modulating agents were underused in patients who underwent CABG even after adjusting for justified nonuse.
Collapse
|
11
|
Wan D, Amon J, Nazzari H, Chua D, Grewal J, Barlow A, Kiess M, Human D, Riahi M, Toma M, Ignaszewski A, Chakrabarti S. SACUBUTRIL/VALSARTAN IS SAFE AND EFFECTIVE IN REDUCING HEART FAILURE SYMPTOMS IN ADULTS WITH CONGENITAL HEART DISEASE. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.569] [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: 10/25/2022] Open
|
12
|
Higgins JM, San C, Lagnado G, Chua D, Mihic T. Incidence and Management of Clozapine-Induced Myocarditis in a Large Tertiary Hospital. Can J Psychiatry 2019; 64:561-567. [PMID: 30599763 PMCID: PMC6681512 DOI: 10.1177/0706743718816058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clozapine, an antipsychotic reserved for management of treatment-resistant schizophrenia, is associated with severe adverse effects, including myocarditis. This study aims to determine the incidence of clozapine-induced myocarditis at a large tertiary hospital compared to what is reported in the literature. METHODS Medical records of adult patients admitted to psychiatry units receiving clozapine between January 1, 2010, and July 31, 2016, were retrospectively reviewed. Cases of clozapine-induced myocarditis were defined as having elevated C-reactive protein (CRP) or detectable troponin and at least 1 sign or symptom of myocarditis, in the absence of alternative plausible aetiologies. The primary outcome was incidence of clozapine-induced myocarditis during the study period. Secondary outcomes included rate and description of the management of clozapine-induced myocarditis. RESULTS In total, 316 patients were screened; 10 patients met the case definition for clozapine-induced myocarditis. The incidence of this adverse drug reaction over the study period was 3.16%. Reduced left ventricular ejection fraction was observed in 60% of cases, and electrocardiography changes were noted in 60% of cases. Clozapine was discontinued in all cases. Rechallenge was performed in 2 patients; recurrent CRP elevation resulted in discontinuation in each case. Medications for management of myocarditis were used in 50% of cases. Although 2 patients required transfer to critical care, the in-hospital mortality rate was 0%. CONCLUSIONS The incidence of clozapine-induced myocarditis at the study hospital was consistent with the higher range reported in the literature. Further research is necessary to elucidate risk factors, definitive diagnostic criteria, and effective management of clozapine-induced myocarditis.
Collapse
Affiliation(s)
- Julia M Higgins
- 1 Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia
| | - Cindy San
- 1 Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia
| | - Gillian Lagnado
- 1 Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia
| | - Doson Chua
- 1 Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia
| | - Tamara Mihic
- 1 Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia
| |
Collapse
|
13
|
Chua D, Shalansky S, Sinova A, Mackay M. Factors Affecting Delay in Filling Prescriptions for Dual Antiplatelet Therapy After Coronary Stenting. Can J Cardiol 2019; 35:931-934. [PMID: 31292093 DOI: 10.1016/j.cjca.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) is critical in preventing stent thrombosis after percutaneous coronary intervention (PCI). Delays in DAPT after PCI have been associated with stent thrombosis, reinfarction, and death. Cases of death, stent thrombosis, and reinfarction at our institution have been attributed to patient delays in accessing DAPT on discharge after PCI. We sought to determine the proportion of patients that delay filling their discharge prescription for DAPT after PCI and factors that influence delays in DAPT prescription-filling. We reviewed all patients who received PCI at St Paul's Hospital from April 1, 2015 to April 1, 2016 and determined the date of the first prescription filling of a P2Y12 antiplatelet agent after hospital discharge. The primary outcome was proportion of patients who delay filling their DAPT discharge prescription. Logistic regression analysis was performed to determine the relationship of various factors with delays in DAPT-filling. Six hundred fifty-one patients were included in the final analysis. Age, sex, and provincial drug coverage status were not associated with delays in DAPT prescription-filling. Distance of patient's residence to St Paul's Hospital was associated with a significant delay in DAPT prescription filling (adjusted odds ratio, 1.90; 95% confidence interval, 1.11-3.22). Hospital discharge processes to ensure timely access to DAPT after PCI should be established.
Collapse
Affiliation(s)
- Doson Chua
- Pharmacy Department, St Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Stephen Shalansky
- Pharmacy Department, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anna Sinova
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha Mackay
- University of British Columbia, Vancouver, British Columbia, Canada; Heart Centre, St Paul's Hospital, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Albert S, Simon F, Tasman AJ, Chua D, Grigg R, Jaklis A, Wang T, Disant F. International consensus (ICON) on functional and aesthetic rhinoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S55-S57. [PMID: 29396223 DOI: 10.1016/j.anorl.2017.12.005] [Citation(s) in RCA: 7] [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] [Received: 11/12/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022]
Abstract
During the 2017 IFOS international congress in Paris, a roundtable discussion on the topic of functional and aesthetic rhinoplasty was organised. Five experts, from the five continents and renown in the field of rhinoplasty, were brought together to discuss the issue from an international perspective and to put forward a consensus or on the contrary practical differences. Five questions were put to the experts beforehand to guarantee independent answers, which were then discussed during the roundtable. The questions were the following: - What are the age limits for achieving a rhinoplasty? - Do you use objective measurements before, during and after surgery? (facial landmarks, airflow, peroperative measurements) - How do you manage the preoperative general information and computer imaging of the patient? - What are the indications in your practice to perform a CT-scan or endoscopic examination before doing a rhinoplasty? - What kind of graft or prosthesis do you use for an augmentation rhinoplasty? This paper offers a synthesis of the roundtable based on the experts' answers to the different questions.
Collapse
Affiliation(s)
- S Albert
- Otolaryngology, head and neck surgery department, facial plastic surgery, Bichat University Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
| | - F Simon
- Pediatric otolaryngology, head and neck surgery department, Necker-Enfants-Malades, University Hospital, 75015 Paris, France
| | - A-J Tasman
- European academy of facial plastic surgery, rhinology, facial plastic surgery, ENT department, Gallen, Switzerland
| | - D Chua
- Otolaryngology, ENT surgeons medical centre, Mount Elizabeth medical centre, Singapore
| | - R Grigg
- Medici medical centre, Toowoomba, Australia
| | - A Jaklis
- Saint-George hospital, University Medical Center, Beirut, Libanon
| | - T Wang
- Facial plastic surgery, Oregon health & science university, Portland, USA
| | - F Disant
- Otolaryngology, head and neck surgery department, facial plastic surgery, Edouard-Herriot hospital, 69003 Lyon, France
| |
Collapse
|
15
|
Chua D, San C. Nonformulary Medication Orders and Discharge Discrepancies. Can J Hosp Pharm 2017; 70:397. [DOI: 10.4212/cjhp.v70i5.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
16
|
Natarajan SK, Chua D, Anbalakan K, Shelat VG. Marginal ulcer perforation: a single center experience. Eur J Trauma Emerg Surg 2017; 43:717-722. [PMID: 27619359 DOI: 10.1007/s00068-016-0723-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/06/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Marginal ulcer (MU) is defined as ulcer on the jejunal side of the gastrojejunostomy (GJ) anastomosis. Most MUs are managed medically but those with complications like bleeding or perforation require intervention. It is recommended that GJ anastomosis be revised in patients with MU perforation (MUP). The aim of this case series is to study the clinical presentation and management of MUP. METHODS Three hundred and thirty-two patients who underwent emergency surgery for perforated peptic ulcer at a single center were studied over a period of 5 years. RESULTS Nine patients (2.7 %) presented with MUP. GJ was previously done for either complicated peptic ulcer (n = 4) or for suspected gastric malignancy (n = 5). Two patients had previously completed H. pylori therapy. None of the patients presented with septic shock. MU was on the jejunal side of GJ in all patients. The median MUP size was 10 mm. Four patients (44.4 %) had omental patch repair, three (33.3 %) had primary closure, and one each had revision of GJ and jejunal serosal patch repair. There were no leaks, intra-abdominal abscess or reoperation and no malignancies. CONCLUSION MUP patients do not present with septic shock. Omental patch repair or primary closure is sufficient enough. Revision of Billroth-II-GJ into Roux-en-Y-GJ is not mandatory.
Collapse
Affiliation(s)
- S K Natarajan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
- , 481 Yio Chu Kang Road, #03-01, Castle Green, Singapore, 787056, Singapore.
| | - D Chua
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - K Anbalakan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - V G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
17
|
Chua D, Ladha F, Pammett RT, Turgeon RD. Pharmacist Performance of Physical Assessment: Perspectives of Clinical Pharmacists Working in Different Practice Settings. Can J Hosp Pharm 2017; 70:305-308. [PMID: 28894317 DOI: 10.4212/cjhp.v70i4.1682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Doson Chua
- , BSc(Pharm), PharmD, BCPS (AQ Cardiology), is a Clinical Pharmacy Specialist, Cardiology, with St Paul's Hospital, and a Clinical Professor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Fatima Ladha
- , BSc, BSc(Pharm), is a Clinical Pharmacist in Palliative Complex Care and Oncology, Surrey Memorial Hospital, Surrey, British Columbia, and a Clinical Instructor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Robert T Pammett
- , BSc, BSP, MSc, is a Research and Development Pharmacist - Primary Care, Northern Health, Prince George, British Columbia, and an Assistant Professor (Partner) with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Ricky D Turgeon
- , BSc(Pharm), ACPR, PharmD, is a Post-Doctoral Fellow with the Department of Medicine (Division of Cardiology), University of Alberta, Edmonton, Alberta
| |
Collapse
|
18
|
Tai C, Wu H, San C, Chua D. Management of Supratherapeutic International Normalized Ratio without Bleeding after Warfarin Use: An Evaluation of Vitamin K Administration (SUPRA-WAR-K Study). Can J Hosp Pharm 2017; 70:207-214. [PMID: 28680174 DOI: 10.4212/cjhp.v70i3.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2022]
Abstract
BACKGROUND For patients with supratherapeutic international normalized ratio (INR) and no evidence of bleeding, the 2012 guidelines of the American College of Chest Physicians discourage administration of vitamin K. At the study hospital, it was observed that vitamin K was frequently prescribed for patients with INR of 4.5 or higher and no bleeding. OBJECTIVES To compare efficacy and safety outcomes between holding warfarin alone and holding warfarin with administration of vitamin K and to compare these outcomes among various doses and routes of vitamin K administration in non-critical care inpatients experiencing supratherapeutic INR without evidence of bleeding. METHODS This single-centre retrospective chart review involved noncritical care inpatients with supratherapeutic INR (4.5-8.9) without evidence of bleeding. The primary outcomes were the change in INR 1 day after implementation of supratherapeutic INR management and the time to reach INR less than 3.0. The secondary outcomes were length of stay, frequency of warfarin resistance, incidence and duration of bridging anticoagulation, incidence of thromboembolism and major bleeding, and death. RESULTS Regardless of vitamin K dose, the administration of vitamin K combined with holding warfarin, relative to holding warfarin alone, was associated with a greater INR decrease 1 day after the intervention (mean ± standard deviation -3.2 ± 1.9 versus -0.9 ± 1.0, p < 0.001) and a shorter time to reach INR below 3.0 (1.9 ± 1.0 days versus 2.6 ± 1.4 days, p = 0.003). No statistically significant differences in any other outcomes were observed. CONCLUSIONS In hospitalized non-critical care patients with INR between 4.5 and 8.9 without evidence of bleeding, the combination of holding warfarin and administering vitamin K was associated with greater and faster decreases in INR than holding warfarin alone. No significant differences were found in clinically important outcomes. The practice of administering vitamin K in this population warrants further study and re-evaluation.
Collapse
Affiliation(s)
- Claire Tai
- BSc(Pharm), ACPR, is a Clinical Pharmacist with Fraser Health, Surrey, British Columbia
| | - Hilary Wu
- BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacist with Providence Health Care, Vancouver, British Columbia
| | - Cindy San
- BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacy Specialist in Emergency Medicine with St Paul's Hospital, Providence Health Care, Vancouver, British Columbia
| | - Doson Chua
- BSc(Pharm), PharmD, BCPS (AQ), is a Clinical Pharmacy Specialist in Cardiology with St Paul's Hospital, Providence Health Care, and a Clinical Professor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
19
|
Ablett DJ, Navaratne L, Chua D, Streets CG, Tai NRM. The modified 'Jo'burg' technique for securing intercostal chest drains. J ROY ARMY MED CORPS 2017; 163:319-323. [PMID: 28652316 DOI: 10.1136/jramc-2016-000744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/15/2017] [Accepted: 03/18/2017] [Indexed: 11/03/2022]
Abstract
Insertion of an intercostal chest drain (ICD) is a common intervention in the management of either blunt or penetrating thoracic trauma. It is frequently performed by junior medical personnel as an emergency procedure during the initial resuscitation period and often within a stressful environment. Approximately one-fifth of all ICD insertions are associated with complications. In a retrospective review of over 1000 ICD insertions, 7% of the complications observed were due to inadequate fixation, resulting in dislodgement. The risk of dislodgement is greatest during transit or transfer of a casualty. In a military setting, this may involve movement of a casualty in a non-permissive environment and includes transfer on and off rotary wing, fixed wing, road vehicle and maritime transport platforms as well as between stretchers and hospital beds. While ICD insertion follows a standard technique in accordance with the Advanced Trauma Life Support guidelines, the method of securing ICDs has not been standardised across the Defence Medical Services (DMS). The aim of this paper is to first propose a modified version of a tried and tested technique of securing ICDs with alternative steps described for medical staff unfamiliar with surgical knot tying by hand. Second, we present the results from a pilot validation study of this technique when introduced to candidates on a trauma surgical skills course. We describe and demonstrate a robust, easily teachable and reproducible technique for securing ICDs. We would advocate the use of this technique among both surgically and non-surgically trained medical personnel and suggest that this should become the standardised technique for securing ICDs across the DMS. This could be easily implemented by introducing this technique into the various military trauma courses, for example the Military Operational Surgical Training, Medical Emergency Response Team and Critical Care Air Support Team courses.
Collapse
Affiliation(s)
- Daniel J Ablett
- Royal London Hospital, London, UK.,Defence Medical Services, DMS Whittington, Lichfield, UK
| | - L Navaratne
- Royal London Hospital, London, UK.,Defence Medical Services, DMS Whittington, Lichfield, UK
| | - D Chua
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - C G Streets
- Defence Medical Services, DMS Whittington, Lichfield, UK.,Bristol Royal Infirmary, Bristol, UK
| | - N R M Tai
- Royal London Hospital, London, UK.,Defence Medical Services, DMS Whittington, Lichfield, UK
| |
Collapse
|
20
|
Abstract
Objective: To systematically review the evidence evaluating the role of statin therapy in sepsis. Data Sources: MEDLINE, EMBASE, and PubMed were searched (1980–January 2007) for English-language clinical trials that evaluated the use of statins and the development and treatment of sepsis in human subjects. Search terms included statin, HMG-CoA reductase inhibitor, bacteremia, sepsis, septic shock, septicemia, and severe sepsis. In addition, pertinent references from identified articles were obtained. Study Selection and Data Extraction: Only clinical trials with primary efficacy outcomes of mortality, incidence of sepsis, and severe sepsis were included. Data Synthesis: Seven retrospective and 2 prospective cohort studies were included in this review. One was excluded because the patient population was not experiencing sepsis. Three studies demonstrated a reduced mortality with statin use while 2 other studies did not demonstrate this mortality benefit. One study suggested increased mortality with statin use in sepsis. Three studies showed a reduced incidence of development of sepsis or sepsis-related outcomes, while one study did not. The observational and retrospective nature of these studies and the higher rate of cardiovascular comorbidities in the statin groups may have allowed for a confounding influence. The conflicting results and heterogeneity between the studies makes the observed association between statin use and incidence of sepsis and sepsis-related mortality inconclusive. The clinical benefit of statin therapy in sepsis remains to be determined. Conclusions: There is an association between statin use and a lower incidence of sepsis and sepsis-related mortality. However, a causal relationship between stalin use and reduced sepsis-related mortality has not yet been established. Currently, statins cannot be recommended for sepsis prevention or treatment until controlled trials are performed.
Collapse
Affiliation(s)
- Doson Chua
- St. Paul's Hospital, Vancouver, BC, Canada.
| | | | | |
Collapse
|
21
|
Abstract
Objective: To review the evidence evaluating the efficacy of statins in reducing the progression of calcified aortic stenosis (AS). Data Sources: MEDLINE, EMBASE, and PubMed were searched (all up to November 2006) for studies evaluating the use of statins to reduce the progression of calcified AS. Search terms included statin, HMG CoA reductase inhibitor, calcified AS, valve stenosis, and calcified stenosis. Additional primary trials were located by searching references noted in review articles. Study Selection and Data Extraction: Clinical trials published in the English language were selected for review. Primary efficacy outcomes evaluated were changes in aortic valve measurements, hemodynamic measures of AS, and change in measures of AS severity. Data Synthesis: TWO prospective clinical trials and 5 retrospective studies were included in this review. All of the retrospective studies demonstrated that statin use was associated with a statistically significant delay in the progression of AS. One prospective observation trial showed benefit of statin use; however, a large, randomized, double-blind, prospective trial showed no benefit of statin use in decreasing the progression of AS. Conclusions: An association between statin use and a delay in AS progression has been observed in retrospective studies; however, prospective trials showed conflicting results. Currently, statins cannot be recommended for medical treatment of AS until larger trials are conducted.
Collapse
Affiliation(s)
- Doson Chua
- St. Paul's Hospital, Vancouver, BC, Canada.
| | | |
Collapse
|
22
|
Au D, Wu H, San C, Chua D, Su V, Kirkwood A. Impact of PharmaNet-Based Admission Medication Reconciliation on Best Possible Medication Histories for Warfarin. Can J Hosp Pharm 2016; 69:348-355. [DOI: 10.4212/cjhp.v69i5.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Inaccurate documentation of medication histories may lead to medication discrepancies during hospital admissions. Obtaining a best possible medication history (BPMH) for warfarin can be challenging because of frequent dosage changes and nonspecific directions of use (e.g., “take as directed”). On February 27, 2012, the study hospital implemented an admission medication reconciliation (MedRec) process using a form that compiled the most recent 6 months of outpatient prescription dispensing history from a provincial electronic database called PharmaNet. It was unclear whether admission MedRec had improved the process of obtaining warfarin BPMHs and the quality of their documentation.</p><p><strong>Objective: </strong>To compare the rates of complete warfarin BPMH documentation before and after implementation of PharmaNet-based admission MedRec.</p><p><strong>Methods: </strong>A single-centre, retrospective chart review was conducted using the health records of patients receiving warfarin who were admitted to the hospital’s Internal Medicine service before and after implementation of admission MedRec. The study periods were October 1, 2009, to February 26, 2012, and February 27, 2012, to July 31, 2014, respectively. The primary outcome was the rate of complete warfarin BPMH documentation during each period.</p><p><strong>Results: </strong>Data were recorded for 100 patients in the pre-implementation phase and 100 patients in the post-implementation phase. The rates of complete warfarin BPMH documentation were 65% and 84% in these 2 phases, respectively (<em>p </em>= 0.002).</p><p><strong>Conclusion: </strong>Implementation of PharmaNet-based admission MedRec was associated with a statistically significant increase in the rate of complete warfarin BPMH documentation.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>La consignation inexacte des schémas thérapeutiques peut mener à des divergences au chapitre des médicaments durant l’hospitalisation. Il peut être difficile d’établir un meilleur schéma thérapeutique possible (MSTP) pour la warfarine à cause de fréquents changements de posologie et de modes d’emploi imprécis (par exemple, « usage connu »). Le 27 février 2012, l’hôpital où s’est déroulée l’étude a mis en place un processus de bilan comparatif des médicaments (BCM) à l’admission. Celui-ci emploie un formulaire dressant la liste des médicaments d’ordonnance délivrés aux patients externes au cours des six derniers mois selon PharmaNet, une base de données numérique provinciale. On ignorait si les BCM à l’admission avaient amélioré le processus d’obtention et la qualité de la consignation des MSTP liés à la warfarine.</p><p><strong>Objectif : </strong>Comparer les taux de MSTP relatifs à la warfarine parfaitement consignés avant et après la mise en place d’un processus de BCM à l’admission qui s’appuie sur PharmaNet.</p><p><strong>Méthodes : </strong>Une analyse rétrospective des dossiers médicaux de patients menée dans un seul centre a été réalisée. Elle a porté sur les patients recevant de la warfarine et ayant été hospitalisés au service de médecine interne de l’hôpital avant ou après la mise en place d’un processus de BCM à l’admission (respectivement du 1er octobre 2009 au 26 février 2012 et du 27 février 2012 au 31 juillet 2014). Le principal paramètre d’évaluation était le taux de MSTP relatifs à la warfarine parfaitement consignés pendant ces périodes.</p><p><strong>Résultats : </strong>On a recueilli des données sur 100 patients hospitalisés avant la mise en place du processus et sur 100 patients hospitalisés après sa mise en place. Les taux de MSTP relatifs à la warfarine parfaitement consignésétaient de 65 % avant la mise en place et de 84 % après la mise en place (<em>p </em>= 0,002).</p><p><strong>Conclusion : </strong>La mise en place d’un processus de BCM à l’admission s’appuyant sur les données de PharmaNet était associée à une augmentation statistiquement significative du taux de MSTP relatifs à la warfarine parfaitement consignés.</p>
Collapse
|
23
|
Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models - are existing models sufficient? A retrospective cohort study. Int J Surg 2015; 14:38-44. [PMID: 25560748 DOI: 10.1016/j.ijsu.2014.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/10/2014] [Accepted: 12/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Emergency surgery for perforated peptic ulcer (PPU) is associated with significant morbidity and mortality. Accurate and early risk stratification is important. The primary aim of this study is to validate the various existing MRPMs and secondary aim is to audit our experience of managing PPU. METHODS 332 patients who underwent emergency surgery for PPU at a single intuition from January 2008 to December 2012 were studied. Clinical and operative details were collected. Four MRPMs: American Society of Anesthesiology (ASA) score, Boey's score, Mannheim peritonitis index (MPI) and Peptic ulcer perforation (PULP) score were validated. RESULTS Median age was 54.7 years (range 17-109 years) with male predominance (82.5%). 61.7% presented within 24 h of onset of abdominal pain. Median length of stay was 7 days (range 2-137 days). Intra-abdominal collection, leakage, re-operation and 30-day mortality rates were 8.1%, 2.1%, 1.2% and 7.2% respectively. All the four MRPMs predicted intra-abdominal collection and mortality; however, only MPI predicted leak (p = 0.01) and re-operation (p = 0.02) rates. The area under curve for predicting mortality was 75%, 72%, 77.2% and 75% for ASA score, Boey's score, MPI and PULP score respectively. DISCUSSION AND CONCLUSION Emergency surgery for PPU has low morbidity and mortality in our experience. MPI is the only scoring system which predicts all - intra-abdominal collection, leak, reoperation and mortality. All four MRPMs had a similar and fair accuracy to predict mortality, however due to geographic and demographic diversity and inherent weaknesses of exiting MRPMs, quest for development of an ideal model should continue.
Collapse
Affiliation(s)
- K Anbalakan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - G J Pandya
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - V G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore.
| |
Collapse
|
24
|
Bagai A, Chua D, Cohen EA, Saw J, Verma S, Vijayaraghavan R, Welsh R, Fitchett D. Pharmacodynamic and clinical implications of switching between P2Y12 receptor antagonists: considerations for practice. Crit Pathw Cardiol 2014; 13:156-158. [PMID: 25396293 DOI: 10.1097/hpc.0000000000000030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/04/2023]
Abstract
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist, either clopidogrel or the newer more potent agents prasugrel or ticagrelor, is standard therapy in patients receiving a coronary stent and those with a recent acute coronary syndrome. Switching antiplatelet drug regimen may be required in some patients for efficacy, safety, adherence, and cost considerations. However, there are potential concerns when switching from one agent to another that gaps in effective antiplatelet inhibition could lead to thrombotic events, and overlap of agents might cause excessive platelet inhibition thereby increasing the risk of bleeding. This review considers pharmacodynamic and clinical data to guide clinicians when switching between antiplatelet drugs is considered. Loading dose of the new agent should be considered in nearly all situations to avoid any possible gap in adequate platelet inhibition, as overlap of the 2 agents is unlikely to result in bleeding in excess of that with the more potent drug.
Collapse
Affiliation(s)
- Akshay Bagai
- From the *Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; †St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; ‡Sunnybrook and Women's Health Sciences Center, University of Toronto, Toronto, ON, Canada; §Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; ¶Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; ‖Rouge Valley Health System, Toronto, ON, Canada; and **Mazankowski Heart Institute, University of Alberta, Edmonton, Canada
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Wu H, San C, Chua D, Ye J. COMPARISON OF WARFARIN DOSAGE REQUIREMENTS BEFORE AND AFTER CARDIAC SURGERY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.400] [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: 11/26/2022] Open
|
26
|
Steinberg C, Padfield G, Swampillai J, Cheung C, Yeung-Lai-Wah J, Chua D, Kerr C, Chakrabarti S, Tung S, Andrade J, Bennett M, Krahn A, Deyell M. ORAL PROCAINAMIDE IN PATIENTS WITH STRUCTURAL HEART DISEASE AND REFRACTORY VENTRICULAR TACHYCARDIA. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.739] [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: 10/24/2022] Open
|
27
|
Chua D, Amadio A, San C. EPOETIN DOSING FOR BLOOD CONSERVATION IN JEHOVAH’S WITNESS PATIENTS UNDERGOING CARDIAC SURGERY - A SYSTEMATIC REVIEW. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.398] [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: 10/24/2022] Open
|
28
|
Chua D, Nishi C. Not quite the full story on new antiplatelets. CMAJ 2014; 186:533. [DOI: 10.1503/cmaj.114-0028] [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: 11/01/2022] Open
|
29
|
Lung HL, Man OY, Yeung MC, Ko JMY, Cheung AKL, Law EWL, Yu Z, Shuen WH, Tung E, Chan SHK, Bangarusamy DK, Cheng Y, Yang X, Kan R, Phoon Y, Chan KC, Chua D, Kwong DL, Lee AWM, Ji MF, Lung ML. SAA1 polymorphisms are associated with variation in antiangiogenic and tumor-suppressive activities in nasopharyngeal carcinoma. Oncogene 2014; 34:878-89. [PMID: 24608426 DOI: 10.1038/onc.2014.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 12/13/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a cancer that occurs in high frequency in Southern China. A previous functional complementation approach and the subsequent cDNA microarray analysis have identified that serum amyloid A1 (SAA1) is an NPC candidate tumor suppressor gene. SAA1 belongs to a family of acute-phase proteins that are encoded by five polymorphic coding alleles. The SAA1 genotyping results showed that only three SAA1 isoforms (SAA1.1, 1.3 and 1.5) were observed in both Hong Kong NPC patients and healthy individuals. This study aims to determine the functional role of SAA1 polymorphisms in tumor progression and to investigate the relationship between SAA1 polymorphisms and NPC risk. Indeed, we have shown that restoration of SAA1.1 and 1.3 in the SAA1-deficient NPC cell lines could suppress tumor formation and angiogenesis in vitro and in vivo. The secreted SAA1.1 and SAA1.3 proteins can block cell adhesion and induce apoptosis in the vascular endothelial cells. In contrast, the SAA1.5 cannot induce apoptosis or inhibit angiogenesis because of its weaker binding affinity to αVβ3 integrin. This can explain why SAA1.5 has no tumor-suppressive effects. Furthermore, the NPC tumors with this particular SAA1.5/1.5 genotype showed higher levels of SAA1 gene expression, and SAA1.1 and 1.3 alleles were preferentially inactivated in tumor tissues that were examined. These findings further strengthen the conclusion for the defective function of SAA1.5 in suppression of tumor formation and angiogenesis. Interestingly, the frequency of the SAA1.5/1.5 genotype in NPC patients was ~2-fold higher than in the healthy individuals (P=0.00128, odds ratio=2.28), which indicates that this SAA1 genotype is significantly associated with a higher NPC risk. Collectively, this homozygous SAA1.5/1.5 genotype appears to be a recessive susceptibility gene, which has lost the antiangiogenic function, whereas SAA1.1 and SAA1.3 are the dominant alleles of the tumor suppressor phenotype.
Collapse
Affiliation(s)
- H L Lung
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - O Y Man
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - M C Yeung
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - J M Y Ko
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - A K L Cheung
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - E W L Law
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - Z Yu
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - W H Shuen
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - E Tung
- 1] Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China [2] Center for Nasopharyngeal Carcinoma Research, University of Hong Kong, Hong Kong (SAR), People's Republic of China
| | - S H K Chan
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - D K Bangarusamy
- Genome Institute of Singapore, Biomedical Sciences Institutes, Singapore
| | - Y Cheng
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - X Yang
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - R Kan
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - Y Phoon
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - K C Chan
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - D Chua
- 1] Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China [2] Center for Nasopharyngeal Carcinoma Research, University of Hong Kong, Hong Kong (SAR), People's Republic of China [3] Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong (SAR), People's Republic of China
| | - D L Kwong
- 1] Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China [2] Center for Nasopharyngeal Carcinoma Research, University of Hong Kong, Hong Kong (SAR), People's Republic of China
| | - A W M Lee
- 1] Center for Nasopharyngeal Carcinoma Research, University of Hong Kong, Hong Kong (SAR), People's Republic of China [2] Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (SAR), People's Republic of China [3] Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
| | - M F Ji
- Cancer Center, Zhongshan City Hospital, Zhongshan, People's Republic of China
| | - M L Lung
- 1] Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China [2] Center for Nasopharyngeal Carcinoma Research, University of Hong Kong, Hong Kong (SAR), People's Republic of China
| |
Collapse
|
30
|
|
31
|
Chua D, Chu E, Lo A, Lo M, Pataky F, Tang L, Bains A. Effect of Misalignment between Hospital and Provincial Formularies on Medication Discrepancies at Discharge: PPITS (Proton Pump Inhibitor Therapeutic Substitution) Study. Can J Hosp Pharm 2012; 65:98-102. [PMID: 22529401 DOI: 10.4212/cjhp.v65i2.1115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/10/2022]
Abstract
BACKGROUND Medication discrepancies may occur on admission, transfer, or discharge from hospital. Therapeutic interchange within a drug class is a common practice in hospitals, and orders for specific proton pump inhibitors (PPIs) are often substituted with the hospital's formulary PPI through therapeutic interchange protocols. Rabeprazole is the PPI on the formulary of the British Columbia PharmaCare program. However, different PPIs may appear on the formularies of the province's hospitals. This misalignment and use of therapeutic interchange may lead to increased rates of medication discrepancies at the time of discharge. OBJECTIVE To evaluate the effect of formulary misalignment for PPIs between St Paul's Hospital in Vancouver and the British Columbia PharmaCare program and use of therapeutic interchange on the occurrence of medication discrepancies at discharge. METHODS A cohort chart review was performed to compare discharge discrepancy rates for PPI orders between 2 periods: June 2006 to June 2008, when the same PPI appeared on the hospital and provincial formularies, and July 2008 to July 2010, when the designated PPIs differed between the hospital and provincial formularies. Data for the first study period were used to establish the baseline discharge discrepancy rate, and data for the later period represented the discharge discrepancy rate in the presence of misalignment between the hospital and PharmaCare formularies. RESULTS The discharge discrepancy rate for PPIs was 27.3% (24/88) when the 2 formularies were aligned and 49.1% (81/165) when the formularies were misaligned. This represents an absolute increase of 21.8 percentage points in the risk of discharge discrepancies (95% confidence interval 9.8-33.9 percentage points; p < 0.001) when the hospital and provincial formularies were misaligned and the hospital's therapeutic interchange protocol was used. CONCLUSIONS Misalignment between the PPIs specified in the hospital and provincial formularies, combined with use of therapeutic interchange, was associated with a significant increase in medication discrepancies at discharge.
Collapse
Affiliation(s)
- Doson Chua
- , BSc(Pharm), PharmD, BCPS(AQ), is with the Department of Pharmacy, St Paul's Hospital, Vancouver, British Columbia
| | | | | | | | | | | | | |
Collapse
|
32
|
Chua D, Ho P, Lee V, Sham J. A Randomized Phase II Study of External Beam Reirradiation versus External Beam Reirradiation Plus Radiosurgery Boost in Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1033] [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: 11/28/2022]
|
33
|
Chua D, Buttar A, Kaan A, Andrews H, Kealy J, Lam S. 453 Development of a home intravenous inotrope program for end-stage heart failure patients awaiting heart transplantation. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.103] [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: 11/26/2022] Open
|
34
|
Chua D, Buttar A, Kaan A, Andrews H, Kealy J, Lam S. Home Inotrope Program for Patients with End-Stage Heart Failure Awaiting Heart Transplant. Can J Hosp Pharm 2011; 64:292-3. [DOI: 10.4212/cjhp.v64i4.1061] [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: 11/10/2022]
|
35
|
Law EWL, Cheung AKL, Kashuba VI, Pavlova TV, Zabarovsky ER, Lung HL, Cheng Y, Chua D, Lai-Wan Kwong D, Tsao SW, Sasaki T, Stanbridge EJ, Lung ML. Anti-angiogenic and tumor-suppressive roles of candidate tumor-suppressor gene, Fibulin-2, in nasopharyngeal carcinoma. Oncogene 2011; 31:728-38. [PMID: 21743496 DOI: 10.1038/onc.2011.272] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fibulin-2 (FBLN2) has been identified as a candidate tumor-suppressor gene in nasopharyngeal carcinoma (NPC). Originally identified through a chromosome 3 NotI genomic microarray screen, it shows frequent deletion or methylation in NPC. FBLN2 is located on chromosome 3p25.1 and is associated with tumor development through its important interactions with the extracellular matrix (ECM) proteins. FBLN2 encodes two isoforms. The short isoform (FBLN2S) is expressed abundantly in normal tissues, but is dramatically downregulated in NPC, while the long isoform (FBLN2L) is either not detectable or is expressed only at low levels in both normal and tumor tissues. Reintroduction of this FBLN2S inhibited cell proliferation, migration, invasion and angiogenesis in vitro. Furthermore, in vivo studies in nude mice show its expression is associated with tumor and angiogenesis suppression. FBLN2-associated angiogenesis occurs via concomitant downregulation of vascular endothelial growth factor and matrix metalloproteinase 2. This study provides compelling evidence that FBLN2S has an important tumor-suppressive and anti-angiogenic role in NPC.
Collapse
Affiliation(s)
- E W L Law
- Department of Clinical Oncology and Center for Cancer Research, University of Hong Kong, Pokfulam, Hong Kong (SAR), PR China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Chua D. Cardiovascular Pharmacotherapy: A Point-of-Care Guide. Can J Hosp Pharm 2010. [DOI: 10.4212/cjhp.v63i6.967] [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: 11/10/2022]
|
37
|
Chua D, Shalansky SJ, Legal MG, Jung J. Conflicting evidence surrounding the clopidogrel and proton pump inhibitor drug interaction. Arch Intern Med 2010; 170:1507-8; author reply 1508. [PMID: 20837843 DOI: 10.1001/archinternmed.2010.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
38
|
Chua D, Lo A, Lo C. Spironolactone use in heart failure patients with end-stage renal disease on hemodialysis: is it safe? Clin Cardiol 2010; 33:604-608. [PMID: 20960534 PMCID: PMC6653125 DOI: 10.1002/clc.20838] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 08/04/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Spironolactone is used in the treatment of cardiovascular disease, but is contraindicated in renal dysfunction due to the risk of hyperkalemia. It is not known if patients with end-stage renal disease (ESRD) on hemodialysis are at the same risk for hyperkalemia. The objective of this study was to systematically review the evidence evaluating the incidence of hyperkalemia with spironolactone use in ESRD patients on hemodialysis. HYPOTHESIS Spironolactone use in ESRD patients on hemodialysis may not lead to greater incidence of hyperkalemia. METHODS We searched the MEDLINE, Embase, CINAHL, Cochrane, and PubMed databases up to January 2010 for English-language, human-subject clinical trials that evaluated the rate of hyperkalemia with spironolactone use in ESRD patients on hemodialysis. Search terms included were "spironolactone," "eplerenone," "aldosterone antagonist," "heart failure," "kidney failure," "hemodialysis," "dialysis," and "renal replacement therapy." RESULTS Six prospective trials demonstrated that spironolactone use was safe in ESRD patients on hemodialysis. The incidence of hyperkalemia with spironolactone treatment in these studies was similar to control groups. The studies involved a small population of compliant subjects who were at low risk for hyperkalemia. CONCLUSIONS Small pilot studies demonstrated that spironolactone treatment in ESRD patients on hemodialysis did not result in higher hyperkalemia rates. Larger studies are needed to confirm these preliminary results before spironolactone is routinely considered in hemodialysis patients.
Collapse
Affiliation(s)
- Doson Chua
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anita Lo
- Ridge Meadows Hospital, Maple Ridge, British Columbia, Canada
| | - Chris Lo
- Langley Memorial Hospital, Langley, British Columbia, Canada
| |
Collapse
|
39
|
Chua D, Lo A, Jung J. Evidence for interaction between clopidogrel and proton-pump inhibitors. Am J Health Syst Pharm 2010; 67:604-5; author reply 605-6. [DOI: 10.2146/ajhp090613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Doson Chua
- St. Paul’s Hospital 1081 Burrard Street Vancouver, British Columbia Canada V6Z 1Y6
| | - Angela Lo
- Providence Health Care–Vancouver Coastal Authority Vancouver, British Columbia Canada
| | - Joanne Jung
- Providence Health Care–Vancouver Coastal Authority Vancouver, British Columbia Canada
| |
Collapse
|
40
|
Lee V, Kwong D, Khong P, Chua D, Ng S, Wong K, Chan K, Leung T, Au G. 102 poster: The Optimal Window Setting of Pet Co-Registered with CT And MRI in Target Localization for Nasopharyngeal Carcinoma. Radiother Oncol 2010. [DOI: 10.1016/s0167-8140(10)80016-7] [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: 10/19/2022]
|
41
|
Affiliation(s)
- Anita Lo
- , BSc(Pharm), PharmD, is Pharmacy Manager/Clinical Practice Leader, Eagle Ridge Hospital, Port Moody, British Columbia
| | | | | | | | | |
Collapse
|
42
|
Chua D, Bolt J, Lo A, Lo A. Clopidogrel and Proton Pump Inhibitors: A New Drug Interaction? Can J Hosp Pharm 2010; 63:47-50. [DOI: 10.4212/cjhp.v63i1.869] [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: 11/10/2022]
|
43
|
Chua D, Lo A, Day J, Drummond I, McCollum R. Comment: Drug-Drug Interaction Between Clopidogrel and the Proton Pump Inhibitors. Ann Pharmacother 2010; 44:225-6; author reply 2256-7. [DOI: 10.1345/aph.1m051a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Doson Chua
- Clinical Pharmacy Specialist—Cardiology, Providence Health Care—Vancouver Coastal Medication Use, Management Group, Pharmacy Department, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada, fax 604/806-8154,
| | - Angelo Lo
- Head, Providence Health Care—Vancouver Coastal Medication Use, Management Group
| | - Jane Day
- Medication Use Management Pharmacist, Providence Health Care—Vancouver Coastal Medication Use, Management Group
| | - Isla Drummond
- Medication Use Management Pharmacist, Providence Health Care—Vancouver Coastal Medication Use, Management Group
| | - Robert McCollum
- Clinical Coordinator, Providence Health Care—Vancouver Coastal Medication Use, Management Group
| |
Collapse
|
44
|
Xu B, Zefei J, Chua D, Shao Z, Luo R, Wang X, Yuan P, Newstat B, Liu Y, Gagnon R, Chi H, Martin A, Stein S, Wang L. Frequency of PIK
3CA Mutations in Chinese HER2+ Metastatic Breast Cancer Patients and Association with Clinical Benefit to Lapatinib and Capecitabine Treatment. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Activating mutations in PIK3CA are frequent in breast cancer (Campbell et al. Cancer Res 2004;64:7678-7681). Previous analyses suggest that the presence of PIK3CA activating mutations were associated with poor clinical outcome (Li et al. Breast Can Res Treat 2006;96:91-95) and could confer resistance to treatment with trastuzumab (T) (Berns et al. Cancer Cell 2007;12:395-402). Lapatinib (L) is an oral tyrosine kinase inhibitor targeting EGFR and HER2 pathways. L plus capecitabine (C) has demonstrated efficacy in women with HER2+ metastatic breast cancer (MBC) previously treated with T (Geyer et al. N Engl J Med 2006;355(26):2733-2743). EGF109491 evaluated the efficacy of L+C in 52 Chinese HER2+ MBC patients. The clinical benefit rate (CBR) was 57.7% (PR 44% and SD 44%) and median progression free survival (PFS) was 6.3 months. The purpose of this analysis was to establish the frequency of PIK3CA mutations in this small cohort of Chinese patients and to determine if the presence of a PIK3CA mutation has any impact on clinical benefit to L+C.Methods: 38/52 patients provided tumor samples for biomarker analysis. Briefly, DNA was extracted from these tumor samples, amplified by PCR and sequenced by Pyrosequencing methods to identify the presence of frequent activating mutations in exons 9 and 20 in PIK3CA. Mutation status was tested for association with CBR and PFS using contingency table analysis and proportional hazards analysis respectively.Results:11/38 (29%) patients harbored a mutation in the PIK3CA gene, consistent with published frequencies. 9/11 mutations reside in the catalytic domain and 2/11 mutations reside in the accessory domain of the gene. There was no statistical association with CBR (p=0.639) or PFS (HR=1.01, p=0.989) in PIK3CA wildtype patients vs. PIK3CA mutant patients. PIK3CA wildtype n=27 (%)PIK3CA Mutation n=11 (%)CR0 (0)0 (0)PR12 (44%)4 (36%)SD13 (48%)5 (45%)PD1 (4%)1 (9%)Unknown1 (4%)1 (9%)HR1.01 (p=0.989) Conclusion: The frequency of PIK3CA mutations in this small cohort of Chinese HER2+ MBC patients is consistent with published frequencies. There was no statistically significant association between the presence of a PIK3CA mutation and clinical benefit to L+C in these patients. These results are in agreement with previous reports that mutations in PIK3CA do not seem to impact clinical outcome following L-containing treatment regimens.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1140.
Collapse
Affiliation(s)
- B. Xu
- 1Cancer Hospital, Chinese Academy of Medical Sciences, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - J. Zefei
- 2PLA 307 Hospital, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - D. Chua
- 3Queen Mary Hospital, Hong Kong Special Administrative Region of China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - Z. Shao
- 4Cancer Hospital Affiliated to Fudan University, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - R. Luo
- 5Nanfang Hospital, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - X. Wang
- 6Zhejiang Cancer Hospital, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - P. Yuan
- 1Cancer Hospital, Chinese Academy of Medical Sciences, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - B. Newstat
- 10GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - Y. Liu
- 8GlaxoSmithKline, PA, GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - R. Gagnon
- 8GlaxoSmithKline, PA, GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - H. Chi
- 11GlaxoSmithKline Company, Ltd, China, ChinaGlaxoSmithKline, GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - A. Martin
- 8GlaxoSmithKline, PA, GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - S. Stein
- 8GlaxoSmithKline, PA, GlaxoSmithKline,
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| | - L. Wang
- 14GlaxoSmithKline Company Ltd, China, China
- 7Chinese Academy of Medical Sciences Cancer Hospital & Institute, China
| |
Collapse
|
45
|
Abstract
Abstract
Background: Breast cancer is a heterogeneous disease with different molecular subtypes. It is known that triple negative breast cancer and the HER-2 positive breast cancer subtypes are associated with more brain metastases. We further explored different subtypes of breast cancer patients with brain metastasis and analyzed their clinical behaviour with particular reference to the Hong Kong Chinese population. Methodology: We reviewed all breast cancer patients with brain metastasis presented to the Department of Clinical Oncology in the Queen Mary Hospital, the University of Hong Kong which is a teaching hospital during January 2004 to June 2008. Sociodemographic factors, date of primary breast cancer diagnosis and the tumour features, clinical behaviour at presentation, treatment received such as surgery, chemotherapy, hormonal therapy and targeted therapy, time of local recurrence, metastasis including brain metastasis, the recursive partitioning analysis (RPA) classes and treatment for the brain metastasis were all recorded. We classified the patients into 3 main subtypes, hormone positive, triple-negative (TNC) and HER-2 positive subtypes and further studied the clinical features and brain metastasis behaviour. Statistical analysis using SPSS 16.0 version was applied. Results: Altogether, there were 60 breast cancer patients with brain metastasis occurred during January 2004 to June 2008 requiring further management in our Department. Hormone positive patients constituted 46.6% while TNC accounted for 15.5% and HER-2 positive patients accounted for 37.9% of the cohort. The majority presented with symptoms at the time of the brain metastasis (93.1%) with headache being the most common symptom (43.1%), and 54 patients received whole brain radiotherapy (WBRT) and 8 patients received surgical resection of the brain metastasis. There were no significant statistical significance between the breast cancer subtypes and the metastatic behaviour except that the TNC patients were associated with concurrent lung metastasis when they first presented with brain metastasis (p = 0.03) when compared to the hormone positive and HER-2 positive patients. The ANOVA analysis showed there was a statistically significant difference between the RPA Classes of the patients and their time of survival after the brain metastasis (p = 0.002). Further ANOVA Post Hoc showed the RPA Class 3 patients were associated with shorter time of survival after brain metastasis when compared to the Class 1 patients (2.4 months vs 11.8 months, p = 0.001). However, patients with brain metastasis and different breast cancer subtypes did not have statistically significant different time of survival after their brain metastases. Conclusion: Hong Kong Chinese triple negative breast cancer patients with brain metastasis were associated with more concurrent lung metastasis. The RPA Classification still serves as a prognostic indicator with reference to the survival after brain metastasis in the breast cancer patients when compared to the breast cancer subtypes. Further large-scale multi-centre epidemiology study is warranted to confirm the above findings.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3072.
Collapse
Affiliation(s)
- J. Tsang
- 1Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region of China
| | - V. Li
- 1Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region of China
| | - E. Lai
- 1Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region of China
| | - G. Au
- 1Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region of China
| | - D. Chua
- 1Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region of China
| |
Collapse
|
46
|
Chua D, Lee V, Tsang J, Ng S, Leung T, Au G. Re-treatment of Nasopharyngeal Carcinoma by Sequential Chemo-radiotherapy with or without Cetuximab. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.969] [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: 10/20/2022]
|
47
|
Chua D, Legal M, Shalansky SJ. Clopidogrel plus aspirin in atrial fibrillation. N Engl J Med 2009; 361:1312-3; author reply 1314-5. [PMID: 19780214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
48
|
Xu B, Jiang Z, Chua D, Shao Z, Luo R, Wang X, Newstat B, Chi H, Chen G, Wang L. 5052 An open-label, single arm study of lapatinib and capecitabine in Chinese women with advanced or metastatic breast cancer (MBC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70944-9] [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: 12/01/2022] Open
|
49
|
Lee V, Ng S, Chua D, Kwong D, Leung T, Au G. DOSIMETRIC PREDICTORS OF RADIATION-INDUCED ACUTE NAUSEA AND VOMITING IN INTENSITY MODULATED RADIATION THERAPY ALONE FOR UNDIFFERENTIATED CARCINOMA OF THE NASOPHARYNX. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72776-7] [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: 11/15/2022]
|
50
|
Chua D, Ignaszewski A. Authors' reply. West J Med 2009. [DOI: 10.1136/bmj.b2006] [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: 11/03/2022]
|