1
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Au RT, Hotham E, Esterman A, Shakib S, Suppiah V. Changes in sedative burden at discharge in hospitalised patients experiencing psychotropic polypharmacy. Schizophr Res 2024; 266:90-91. [PMID: 38382356 DOI: 10.1016/j.schres.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Ruby Tszwai Au
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Elizabeth Hotham
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, The Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia.
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2
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Li N, Shakib S, Qian W, Yao X, Li P, Nip TK, Bai X, Shen K. Safety, pharmacokinetics, and pharmacodynamics of anti-IL-4Rα antibody SHR-1819 in healthy subjects: A randomized, controlled phase I study. Clin Transl Sci 2024; 17:e13763. [PMID: 38545854 PMCID: PMC10974694 DOI: 10.1111/cts.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
SHR-1819 is a novel anti-IL-4Rα monoclonal antibody currently under clinical development for use in patients with type 2 inflammatory diseases. In this randomized, double-blind, placebo-controlled, single-dose escalation phase I trial, we evaluated the safety, tolerability, pharmacokinetics, and pharmacodynamics of SHR-1819 in healthy subjects. Subjects received a single subcutaneous injection of SHR-1819 or placebo, with dose escalation starting at 60 mg and subsequently increasing to 120, 240, 360, and 720 mg. A total of 42 eligible subjects were randomized, and 33 received SHR-1819 (1 subject in the 60 mg cohort and 8 subjects each in the 120, 240, 360 , and 720 mg cohorts) and 9 received placebo. SHR-1819 was well-tolerated, with the majority of adverse events being mild in severity. The exposure of SHR-1819 increased in a manner greater than proportionally with a dose range of 120 to 720 mg. The median Tmax was within 4-7 days (60-720 mg), and the mean half-life ranged from 2.88 to 5.97 days (120-720 mg). The clearance rate of SHR-1819 exhibited a decrease with increasing dose level. Administration of SHR-1819 resulted in a certain degree of reduction in the percentage change from baseline in concentrations of inflammatory biomarkers TARC/CCL17 and IgE, while the reduction of TARC/CCL17 concentrations showed a dose-dependent trend. More than half of the total subjects treated with SHR-1819 were reported antidrug antibody-negative. The preliminary data from this phase I study support further development of SHR-1819 for the treatment of type 2 inflammatory diseases.
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Affiliation(s)
- Na Li
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Sepehr Shakib
- CMAX Clinical ResearchAdelaideSouth AustraliaAustralia
- Department of Clinical PharmacologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Weilin Qian
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Xiaoyan Yao
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Puyuan Li
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Tsz Keung Nip
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Xiaoyan Bai
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
| | - Kai Shen
- Jiangsu Hengrui Pharmaceuticals Co., Ltd.ShanghaiChina
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3
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Selby PR, Heffernan AJ, Yeung D, Warner MS, Peake SL, Hahn U, Westley I, Shakib S, Roberts JA. Population pharmacokinetics of posaconazole in allogeneic haematopoietic stem cell transplant patients. J Antimicrob Chemother 2024; 79:567-577. [PMID: 38217845 DOI: 10.1093/jac/dkae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) in the early post-allogeneic HSCT (alloHCT) period is associated with increased likelihood of catastrophic outcomes. The utility of oral modified release (MR) posaconazole tablets is limited by reduced drug absorption from gastrointestinal toxicity induced by cytotoxic chemotherapy, necessitating a switch to the IV posaconazole formulation. OBJECTIVES To describe the population pharmacokinetics of posaconazole for oral MR and IV formulations in alloHCT patients and determine dosing regimens likely to achieve therapeutic exposures. METHODS We performed a prospective observational pharmacokinetic study in adult patients in the early post-alloHCT period requiring a change in posaconazole formulation (oral to IV). Samples were analysed using a validated LC-MS/MS method. Population pharmacokinetic analysis and Monte Carlo simulations (n = 1000) were performed using Pmetrics for R. RESULTS Twenty patients aged between 21 and 70 years were included in the study. A two-compartment model, incorporating mucositis/diarrhoea to modify the bioavailability for oral administration best described the data. To achieve ≥90% PTA, simulations showed that higher than currently recommended doses of oral MR posaconazole were required for prophylaxis Cmin targets (≥0.5 and ≥0.7 mg/L), while increased doses of both formulations were required for IFD treatment PK/PD targets, with patients experiencing oral mucositis/diarrhoea unlikely to achieve these. CONCLUSIONS Increased doses of posaconazole should be considered for both prophylaxis and treatment of IFD to increase the proportion of alloHCT patients achieving therapeutic exposures, particularly the oral formulation in patients with mucositis and/or diarrhoea. Posaconazole therapeutic drug monitoring should be considered for all formulations in this setting.
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Affiliation(s)
- Philip R Selby
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Pharmacy Department, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Aaron J Heffernan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David Yeung
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Morgyn S Warner
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sandra L Peake
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Uwe Hahn
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Ian Westley
- SA Pathology, Adelaide, Australia
- School of Pharmacy and Biomedical Sciences, University of South Australia, Adelaide, Australia
| | - Sepehr Shakib
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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4
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Wardill HR, Wooley LT, Bellas OM, Cao K, Cross CB, van Dyk M, Kichenadasse G, Bowen JM, Zannettino ACW, Shakib S, Crawford GB, Boublik J, Davis MM, Smid SD, Price TJ. Supporting gut health with medicinal cannabis in people with advanced cancer: potential benefits and challenges. Br J Cancer 2024; 130:19-30. [PMID: 37884682 PMCID: PMC10781684 DOI: 10.1038/s41416-023-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
The side effects of cancer therapy continue to cause significant health and cost burden to the patient, their friends and family, and governments. A major barrier in the way in which these side effects are managed is the highly siloed mentality that results in a fragmented approach to symptom control. Increasingly, it is appreciated that many symptoms are manifestations of common underlying pathobiology, with changes in the gastrointestinal environment a key driver for many symptom sequelae. Breakdown of the mucosal barrier (mucositis) is a common and early side effect of many anti-cancer agents, known to contribute (in part) to a range of highly burdensome symptoms such as diarrhoea, nausea, vomiting, infection, malnutrition, fatigue, depression, and insomnia. Here, we outline a rationale for how, based on its already documented effects on the gastrointestinal microenvironment, medicinal cannabis could be used to control mucositis and prevent the constellation of symptoms with which it is associated. We will provide a brief update on the current state of evidence on medicinal cannabis in cancer care and outline the potential benefits (and challenges) of using medicinal cannabis during active cancer therapy.
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Affiliation(s)
- Hannah R Wardill
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
| | - Luke T Wooley
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Olivia M Bellas
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Katrina Cao
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Courtney B Cross
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Madele van Dyk
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, SA Health, Adelaide, SA, Australia
| | - Ganessan Kichenadasse
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre/Flinders University, SA Health, Adelaide, SA, Australia
- Northern Adelaide Local Health Network South Australia, SA Health, Adelaide, SA, Australia
| | - Joanne M Bowen
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew C W Zannettino
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Sepehr Shakib
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Gregory B Crawford
- Northern Adelaide Local Health Network South Australia, SA Health, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | | | - Mellar M Davis
- The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Scott D Smid
- The School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Timothy J Price
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Queen Elizabeth Hospital, Adelaide, SA, Australia
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5
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Stretton B, Jiang M, Kovoor J, Inglis JM, Lam L, Tan S, Yuson C, Smith W, Shakib S, Bacchi S. Artificial intelligence-enabled penicillin allergy delabelling: an implementation study. Intern Med J 2023; 53:2119-2122. [PMID: 37997266 DOI: 10.1111/imj.16266] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/18/2023] [Indexed: 11/25/2023]
Abstract
Inaccurate penicillin allergy labels may be delabelled following evaluation. The intervention in this study was an email-based notification system regarding the appropriateness for penicillin allergy evaluation, with a view to delabelling, as identified by a deep learning artificial intelligence algorithm. Of the intervention group (n = 59), three (5.1%) individuals had their penicillin allergies delabelled, which was significantly more than the control group (0%, P = 0.002). Further research to optimise such approaches is required.
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Affiliation(s)
- Brandon Stretton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Lydia Lam
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Sheryn Tan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Chino Yuson
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - William Smith
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
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6
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Lam L, Jiang M, Bacchi S, Kovoor J, Inglis JM, Shakib S, Yuson C, Smith W. Prevalence of Trimethoprim-Sulfamethoxazole Adverse Reaction Mislabelling in Australia. Int Arch Allergy Immunol 2023; 184:1225-1229. [PMID: 37673046 DOI: 10.1159/000531975] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/02/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Trimethoprim-sulfamethoxazole (TMP-SMX) is an important antibiotic, with the most compelling indications for Pneumocystis jirovecii pneumonia prophylaxis and methicillin-resistant Staphylococcus aureus treatment. Previous adverse reactions (AR) to TMP-SMX may limit the usability of TMP-SMX. Electronic medical record (EMR) of AR for other antibiotics has previously been shown to be inaccurate; however, the extent to which this occurs for TMP-SMX is unknown. METHODS A multi-centre retrospective observational study was conducted for consecutive inpatient admissions over a 2.5-year period commencing 2020. Adverse reactions to TMP-SMX recorded in the EMR were collected and reviewed by two independent medical officers using pre-defined expert criteria for the classification of allergies and intolerances. RESULTS TMP-SMX AR were present in the EMR of 759 individuals (prevalence 0.6%). The majority were labelled as allergy (725, 95.5%) rather than intolerance (34, 4.5%). Most common AR were rash, vomiting, and swelling. When classified against the gold-standard expert criteria, there were 437 allergies (57.6%) and 159 intolerances (21.0%). Overall, the number of incorrect EMR AR labels was 133/759 (17.5%). Both medical and surgical specialties had significant numbers of patients with TMP-SMX AR labels and incorrectly classified EMR AR labels. CONCLUSION TMP-SMX AR labels affect inpatients admitted under multiple specialty units. The user-entered categorization as allergy or intolerance labels in EMRs are frequently used incorrectly. These incorrect labels may inappropriately contraindicate the use of TMP-SMX, and formal evaluation of TMP-SMX ARs with immunological assessment and relabelling where appropriate may increase the use of this agent.
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Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Immunology and Allergy Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | - Joshua Kovoor
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlo Yuson
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - William Smith
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Immunology and Allergy Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Inglis JM, Bacchi S, Troelnikov A, Smith W, Shakib S. Machine learning models automate classification of penicillin adverse drug reaction labels. Intern Med J 2023; 53:1485-1488. [PMID: 37599225 DOI: 10.1111/imj.16194] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/18/2023] [Indexed: 08/22/2023]
Abstract
There is a growing interest in the appropriate evaluation of penicillin adverse drug reaction (ADR) labels. We have developed machine learning models for classifying penicillin ADR labels using free-text reaction descriptions, and here report external and practical validation. The models performed comparably with expert criteria for the categorisation of allergy or intolerance and identification of high-risk allergies. These models have practical applications in detecting individuals suitable for penicillin ADR evaluation. Implementation studies are required.
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Affiliation(s)
- Joshua M Inglis
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Alexander Troelnikov
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Clinical Immunology & Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - William Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Clinical Immunology & Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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8
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Shakib S. What Is the Role of a Pharmacist in the Management of Complexity as It Applies to the Older Patient? Sr Care Pharm 2023; 38:262-263. [PMID: 37381140 DOI: 10.4140/tcp.n.2023.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Sepehr Shakib
- Professor, Clinical Pharmacology School of Medicine Faculty of Health Sciences The University of Adelaide Adelaide, Australia
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9
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Selby PR, Heffernan AJ, Yeung D, Warner MS, Peake SL, Hahn U, Wallis SC, Mcwhinney B, Ungerer JPJ, Shakib S, Roberts JA. Population Pharmacokinetics of Ganciclovir in Allogeneic Hematopoietic Stem Cell Transplant Patients. Antimicrob Agents Chemother 2023; 67:e0155022. [PMID: 36815858 PMCID: PMC10019199 DOI: 10.1128/aac.01550-22] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Treatment of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (alloHCT) patients with ganciclovir is complicated by toxicity and resistance. This study aimed to develop an intravenous ganciclovir population pharmacokinetic model for post-alloHCT patients and to determine dosing regimens likely to achieve suggested therapeutic exposure targets. We performed a prospective observational single-center pharmacokinetic study in adult alloHCT patients requiring treatment with intravenous ganciclovir for CMV viremia or disease. Samples were analyzed using a validated ultraperformance liquid chromatography method. Population pharmacokinetic analysis and Monte Carlo simulations (n = 1000) were performed using Pmetrics for R. Twenty patients aged 18 to 69 years were included in the study. A 2-compartment model with linear elimination from the central compartment and between occasion variability best described the data. Incorporating creatinine clearance (CLCR) estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and presence of continuous renal replacement therapy as covariates for ganciclovir clearance improved the model. Compared to current dosing recommendations, simulations demonstrated loading doses were required to achieve a target AUC24 of 80 to 120 mg.h/L on day 1 of induction therapy. Increased individualization of post-loading induction and maintenance doses based on CLCR is required to achieve the suggested exposures for efficacy (AUC24 >80/>40 mg.h/L for induction/maintenance) while remaining below the exposure thresholds for toxicity (AUC24 <120/<60 mg.h/L for induction/maintenance). Intravenous ganciclovir dosing in alloHCT patients can be guided by CLCR estimated by CKD-EPI. Incorporation of loading doses into induction dosing regimens should be considered for timely achievement of currently suggested exposures.
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Affiliation(s)
- Philip R. Selby
- School of Medicine, University of Adelaide, Adelaide, Australia
- Pharmacy Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Aaron J. Heffernan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Yeung
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Morgyn S. Warner
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sandra L. Peake
- School of Medicine, University of Adelaide, Adelaide, Australia
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Uwe Hahn
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Steven C. Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Brett Mcwhinney
- Pathology Queensland, Queensland Health, Brisbane, Australia
| | - Jacobus P. J. Ungerer
- Pathology Queensland, Queensland Health, Brisbane, Australia
- Faculty of Health and Behavioural Science, University of Queensland, Brisbane, Australia
| | - Sepehr Shakib
- School of Medicine, University of Adelaide, Adelaide, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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10
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Jiang M, Lam A, Lam L, Kovoor J, Inglis J, Shakib S, Smith W, Abou-Hamden A, Bacchi S. Artificial intelligence and the potential for perioperative delabeling of penicillin allergies for neurosurgery inpatients. Br J Neurosurg 2023:1-4. [PMID: 36794659 DOI: 10.1080/02688697.2023.2173724] [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] [Received: 07/18/2022] [Accepted: 11/28/2022] [Indexed: 02/17/2023]
Abstract
PURPOSE OF THE ARTICLE Patients with penicillin allergy labels are more likely to have postoperative wound infections. When penicillin allergy labels are interrogated, a significant number of individuals do not have penicillin allergies and may be delabeled. This study was conducted to gain preliminary evidence into the potential role of artificial intelligence in assisting with perioperative penicillin adverse reaction (AR) evaluation. MATERIAL AND METHODS A single-centre retrospective cohort study of consecutive emergency and elective neurosurgery admissions was conducted over a two-year period. Previously derived artificial intelligence algorithms for the classification of penicillin AR were applied to the data. RESULTS There were 2063 individual admissions included in the study. The number of individuals with penicillin allergy labels was 124; one patient had a penicillin intolerance label. Of these labels, 22.4% were not consistent with classifications using expert criteria. When the artificial intelligence algorithm was applied to the cohort, the algorithm maintained a high level of classification performance (classification accuracy 98.1% for allergy versus intolerance classification). CONCLUSIONS Penicillin allergy labels are common among neurosurgery inpatients. Artificial intelligence can accurately classify penicillin AR in this cohort, and may assist in identifying patients suitable for delabeling.
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Affiliation(s)
- Melinda Jiang
- Department of Immunology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Antoinette Lam
- Department of Immunology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Lydia Lam
- Department of Immunology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Joshua Kovoor
- Department of Immunology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Joshua Inglis
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sepehr Shakib
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - William Smith
- Department of Immunology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Amal Abou-Hamden
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Neurosurgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Stephen Bacchi
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Neurology, Flinders Medical Centre, Adelaide, SA, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
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11
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Selby PR, Warner MS, Peake SL, Bardy P, Hiwase D, Singhal D, Beligaswatte A, Hahn U, Roberts JA, Yeung D, Shakib S. Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches. Transpl Infect Dis 2022; 24:e13988. [PMID: 36349869 PMCID: PMC10909427 DOI: 10.1111/tid.13988] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited consensus exists on the optimal use of antifungal agents to prevent invasive fungal infection in the early post allogeneic hematopoietic stem cell transplant (alloHCT) period, particularly when patients cannot tolerate oral medication administration. METHODS We undertook a retrospective observational cohort study to assess the tolerability, efficacy, and cost of a new antifungal prophylaxis pathway at a major tertiary alloHCT centre. Patients aged ≥16 years who underwent alloHCT between February 2018 and October 2019 (cohort 1) or between April 2020 and November 2021 (cohort 2) were included. In both cohorts, first line prophylactic therapy was oral posaconazole. The second line drugs where oral therapy was unable to be administered were intravenous voriconazole (cohort 1) versus intravenous posaconazole (cohort 2). RESULTS There were 142 patients enrolled in the study, 71 in each cohort. The proportion of patients remaining on first-line prophylaxis or progressing to second-, third-, and fourth-line options was 22.5%, 39.4%, 29.6%, and 8.5% in cohort 1 and 39.4%, 59.2%, 1.4%, and 0% in cohort 2, respectively. The frequency of neuropsychiatric adverse events was significantly higher in cohort 1 compared to cohort 2 (49.3% vs. 19.8%, p = .0004). Occurrence of proven and probable fungal infections was not significantly different between cohorts. Antifungal drug expenditure was $359 935 (AUD) more in cohort 1 ($830 486 AUD) compared to cohort 2 ($477 149 AUD). CONCLUSION The antifungal prophylaxis pathway used in cohort 2 resulted in reduced antifungal-associated adverse effects, less patients requiring progression to 3rd and 4th line prophylaxis and reduced antifungal drug costs.
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Affiliation(s)
- Philip R. Selby
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Pharmacy DepartmentRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Morgyn S. Warner
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Infectious Diseases UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
| | - Sandra L. Peake
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Intensive Care MedicineThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Peter Bardy
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Devendra Hiwase
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Deepak Singhal
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Ashanka Beligaswatte
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Uwe Hahn
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Herston Infectious Diseases Institute (HeIDI)Metro North HealthBrisbaneQueenslandAustralia
- Department of Pharmacy and Intensive Care MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Division of Anaesthesiology Critical Care Emergency and Pain MedicineNîmes University Hospital, University of MontpellierNîmesFrance
| | - David Yeung
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Sepehr Shakib
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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12
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Angley M, Criddle D, Rigby D, Elliott RA, Phillips K, Penm J, Sluggett JK, Gailer J, Thiele H, Page AT, Pauw C, Gillespie S, Shakib S, Yik J. Hospital‐initiated post‐discharge medication reviews in Australia: expert opinion on the barriers and enablers to implementation. Pharmacy Practice and Res 2022. [DOI: 10.1002/jppr.1832] [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: 11/08/2022]
Affiliation(s)
- Manya Angley
- Manya Angley Research and Consulting Adelaide Australia
| | - Deirdre Criddle
- Complex Needs Coordination Team and Sir Charles Gairdner Hospital Pharmacy Department Sir Charles Gairdner Hospital Nedlands Australia
| | | | - Rohan A. Elliott
- Pharmacy Department, Austin Health and Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Melbourne Australia
| | | | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy The University of Sydney Sydney Australia
- Department of Pharmacy Prince of Wales Hospital Randwick Australia
| | - Janet K. Sluggett
- UniSA Allied Health and Human Performance University of South Australia Adelaide Australia
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide Australia
- Centre for Medicine Use and Safety Monash University Parkville Australia
| | - Joy Gailer
- Drug and Therapeutics Information Service Southern Adelaide Local Health Network Adelaide Australia
| | - Horst Thiele
- Hospital in the Home Service (HITH) Northern Sydney Local Health District Sydney Australia
| | - Amy T. Page
- Centre for Optimisation of Medicines, School of Allied Health and WA Centre for Health and Ageing University of Western Australia Perth Australia
| | - Carly Pauw
- Hospital in the Home (HITH), Integrated Community Health Western Sydney Local Health District Sydney Australia
| | - Sarah Gillespie
- Australian Association of Consultant Pharmacy Canberra Australia
| | | | - Jerry Yik
- The Society of Hospital Pharmacists of Australia Melbourne Australia
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13
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Evans TG, Bussey L, Eagling-Vose E, Rutkowski K, Ellis C, Argent C, Griffin P, Kim J, Thackwray S, Shakib S, Doughty J, Gillies J, Wu J, Druce J, Pryor M, Gilbert S. Efficacy and safety of a universal influenza A vaccine (MVA-NP+M1) in adults when given after seasonal quadrivalent influenza vaccine immunisation (FLU009): a phase 2b, randomised, double-blind trial. The Lancet Infectious Diseases 2022; 22:857-866. [DOI: 10.1016/s1473-3099(21)00702-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 10/18/2022]
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14
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Gillam MH, Pratt NL, Inacio MCS, Shakib S, Caughey GE, Sanders P, Lau DH, Roughead EE. Cardiac Implantable Electronic Devices: Reoperations and the Competing Risk of Death. Heart Lung Circ 2021; 31:537-543. [PMID: 34674955 DOI: 10.1016/j.hlc.2021.08.027] [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] [Received: 11/25/2020] [Revised: 07/28/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of cardiac implantable electronic devices (CIED), which includes pacemakers, implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and cardiac resynchronisation therapy defibrillators (CRT-D) has increased over the past 20 years, but there is a lack of real world evidence on the longevity of these devices in the older population which is essential to inform health care delivery and support clinical decisions. METHODS AND RESULTS We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs database. The cohort consisted of people who had a CIED procedure between 2005 and 2015. The cumulative risk of generator replacement/reoperations was estimated accounting for the competing risk of death. A total of 16,662 patients were included. In pacemaker recipients with an average age of 85 years, the 5-year risk of reoperation ranged from 2.8% in single chamber, 3.6% in dual chamber to 7.6% in CRT-P recipients, while the 5-year risk of dying with the index pacemaker in situ was 63% in single chamber, 46% in dual chamber and 56% in CRT-P recipients. In defibrillator recipients with an average age of 80 years, the 5-year risk of reoperation ranged from 11% in single chamber, 13% in dual chamber to 24% in CRT-D recipients, while the 5-year risk of dying with the index defibrillator in situ was 46% in single chamber, 40% in dual chamber and 41% in CRT-D recipients. CONCLUSION In this cohort of older patients the 5-year risk of generator reoperation was low in pacemaker recipients whereas up to one in four CRT-D recipients would have a reoperation within 5 years.
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Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Maria C S Inacio
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Medicine, University of Adelaide, Adelaide, SA, Australia; Australia and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Gillian E Caughey
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
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15
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Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
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Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
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16
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Abstract
Direct oral anticoagulant (DOAC) use for stroke prevention in atrial fibrillation (AF) has dose reduction criteria including age, weight, serum creatinine, and creatinine clearance. There is a paucity of data for rates of inappropriate inpatient DOAC dosing in Australia. The objective was to determine the rates of inappropriate inpatient DOAC dosing in AF and identifying its associated underlying factors. We conducted a retrospective cross-sectional study from December 2013 to November 2019 across six South Australian public hospitals utilising a centralised electronic health record. Multivariate analysis was used to identify factors associated with underdosing of patients prescribed apixaban. Of 1882 inpatients, 544 (28.9 %) were inappropriately dosed. Underdosing was the most common form of inappropriate dosing with rates of 22.9 % (n = 295), 7.1 % (n = 7), and 25.1 % (n = 124) for apixaban, dabigatran, and rivaroxaban, respectively. Independent factors predictive of apixaban underdosing included higher age (adjusted odds ratio (aOR) 1.63 [95 % Confidence Interval (CI): 1.47-1.81]), higher serum creatinine (aOR 1.13 [95 % CI: 1.08-1.19]), higher total number of drugs on discharge (aOR 1.08 [95 % CI: 1.04-1.11]), and being already prescribed a DOAC on admission (aOR 1.63 [95 % CI: 1.12-2.38]). Nearly one quarter of all apixaban prescribing was inappropriately underdosed. Older patients with multimorbidity, frailty and polypharmacy present a challenge for clinicians in balancing risks of thromboembolism and bleeding. It is likely prescribers are more conservative in their apixaban dosing in this population. Clinicians should consider alternative drug regimens to avoid DOAC use at inappropriate doses at unknown safety and efficacy.
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Affiliation(s)
- Ray J Li
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, 5000, Australia.
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, 5000, Adelaide, Australia.
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, 5000, Australia
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, 5000, Adelaide, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Division of Health Sciences, University of South Australia, 5000, Adelaide, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, 5000, Australia
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, 5000, Adelaide, Australia
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17
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Zheng WY, Van Dort B, Marcilly R, Day R, Burke R, Shakib S, Ku Y, Reid-Anderson H, Baysari M. A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment. JMIR Med Inform 2021; 9:e24022. [PMID: 34269680 PMCID: PMC8325080 DOI: 10.2196/24022] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems. OBJECTIVE This study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital's computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems. METHODS The Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability. RESULTS The participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals' knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity. CONCLUSIONS This initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems.
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Affiliation(s)
- Wu Yi Zheng
- Black Dog Institute, Randwick, NSW, Australia.,The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
| | - Bethany Van Dort
- The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
| | - Romaric Marcilly
- Univ Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de santé des Pratiques médicales, Lille, France.,INSERM, CHU Lille, CIC-IT/Evalab 1403, Centre d'Investigation Clinique, Lille, France
| | - Richard Day
- University of New South Wales, Randwick, Australia
| | | | | | - Young Ku
- Hunter New England Local Health District, Newcastle, Australia
| | | | - Melissa Baysari
- The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
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Abstract
INTRODUCTION Drug allergy is commonly reported in patient notes and electronic health records. The prevalence of self-reported drug allergy in the general Australian population has not previously been studied. METHODS We surveyed a representative sample of the South Australian adult population regarding their own perception of drug allergy, including drug type and severity as well as the use of medical alert devices. Data were weighted to correspond to age and sex of the South Australian population. RESULTS 22.2% of adults in South Australia consider themselves allergic to one or more drugs, 9.3% declared themselves to be allergic to penicillin, 5% to an antibiotic other than penicillin, and 13% to one or more antibiotics. Drug allergy and penicillin allergy was significantly more prevalent in females, and increased with age. Thirteen percent of those with an antibiotic allergy reported a severe reaction, of whom 27% wore a medical notification device. Of those allergic to penicillin, 75% had their index reaction more than 10 years ago and did not report severe features. DISCUSSION Self-reported drug allergy is common in the general population, as it is in medical clinic and hospital populations. The majority of those reporting penicillin allergy would be considered low-risk and suitable for delabelling procedures. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Carlo Yuson
- Immunology and Allergy Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Sepehr Shakib
- Clinical Pharmacology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - William Smith
- Immunology and Allergy Department, Royal Adelaide Hospital, Adelaide, Australia
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19
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Luo R, Burke G, Mui C, Shakib S, Ferrara-Cook C, Krasner A, Madan A. Pharmacokinetics and Safety of an Improved Oral Formulation of Paltusotine, a Selective, Non-Peptide Somatostatin Receptor 2 (SST2) Agonist for the Treatment of Acromegaly. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.1068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Depot injection formulations of peptide somatostatin receptor ligands (SRLs) are routinely used to treat acromegaly and neuroendocrine tumors (NETs). Paltusotine (CRN00808), an orally administered small molecule nonpeptide selective somatostatin receptor 2 (SST2) agonist has been shown to maintain GH and IGF-1 levels in acromegaly patients previously on depot SRLs (ACROBAT Edge NCT03789656). In this study, a capsule formulation was used, which did not exhibit dose proportional pharmacokinetics (PK) at doses >40 mg, required a 2-hour post-dose fast in overnight fasted patients, and had the potential for reduced bioavailability when taken with proton-pump inhibitors (PPI). A spray-dried dispersion (SDD) tablet formulation was developed with improved solubility in the physiological pH range and its performance was evaluated in healthy volunteers. Male and female healthy volunteers who met inclusion/exclusion criteria were enrolled in a single-center Phase 1 study (ANZCTR registration ACTRN12619001562167). A Cohort of 12 subjects was administered a single dose of paltusotine in a four-period cross-over design. Periods 1 and 2 assessed the effect of lansoprazole (a PPI) on PK of 20 mg dose of paltusotine SDD tablets. In Period 3, 20 mg dose of paltusotine SDD tablets was co-administered with a high fat, high-calorie meal. In Period 4, a 60 mg dose of paltusotine SDD tablets was administered to assess dose proportionality. In a separate cohort of subjects (n=12; also, a 4-period cross-over design), the relative bioavailability of capsules and SDD tablets was assessed, and the effect of food administration 0.5, 1, and 2 hour post-dose was evaluated. Subsequently, in another cohort of 12 subjects (a 3-period cross-over design), dose proportionality of the SDD tablets was evaluated at 40 mg and 80 mg dose with a 1-hour post-dose fast. A 4 hours post-dose fast was also assessed for the 80 mg dose. Pharmacokinetics and safety of paltusotine were evaluated. Paltusotine was generally well tolerated in this study. SDD tablets exhibited dose proportional increase in total systemic exposure (AUC) up to a dose of 80 mg. Healthy volunteers pretreated with the PPI, lansoprazole (15 mg bid for 3 days), and co-administered with paltusotine SDD tablets exhibited a small decrease (approximately 25%) in systemic exposure to paltusotine compared with the same subjects that had washed out from the PPI-pretreatment. SDD tablets exhibited significant reduction in systemic exposure when co-administered with a high-fat, high-calorie meal. However, the SDD formulation was less sensitive to timing of post-dose food administration compared to the capsule formulation. These data suggest that the SDD tablet formulation of paltusotine improves flexibility in dose administration, can be co-administered with PPIs and other agents that increase stomach pH, and reduces the post-dose fasting requirement.
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Affiliation(s)
- Rosa Luo
- Crinetics Pharmaceuticals, Inc., San Diego, CA, USA
| | - Gerald Burke
- Crinetics Pharmaceuticals, Inc., San Diego, CA, USA
| | - Cosina Mui
- Crinetics Pharmaceuticals, Inc., San Diego, CA, USA
| | | | | | - Alan Krasner
- Crinetics Pharmaceuticals, Inc., San Diego, CA, USA
| | - Ajay Madan
- Crinetics Pharmaceuticals, Inc., San Diego, CA, USA
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Levesque S, Polasek TM, Haan E, Shakib S. Attitudes of healthy volunteers to genetic testing in phase 1 clinical trials. F1000Res 2021; 10:259. [PMID: 35136570 PMCID: PMC8787555 DOI: 10.12688/f1000research.26828.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Genetic testing in clinical trials introduces several ethical and logistical issues to discuss with potential participants when taking informed consent. The aim of this study was to explore the attitudes of healthy volunteers in phase 1 studies to the topics of genetic security, genetic privacy and incidental genetic findings. Methods: Healthy volunteers presenting for screening appointments at a phase 1 clinical trial unit (CMAX Clinical Research, Adelaide, Australia) took an anonymous paper survey about genetic testing. Results: There were 275 respondents to the survey. The mean age was 27 years (range 18-73); 54% were male and 53% were of North/Western European ethnicity. Just over half the healthy volunteers thought genetic security (56%) and genetic privacy (57%) were “important” or “very important”. However, the security of their genetic information was ranked less important than other personal information, including mobile phone number, internet browser search history and email address. Two-thirds of respondents would trade genetic privacy for re-identifiability if information relevant to their health were discovered by genetic testing. Healthy volunteers favoured the return of incidental genetic findings (90% indicated this was “important” or “very important”). A level of risk (10 to 90%) for developing a serious medical condition that would “trigger” the return of incidental genetic findings to participants was not identified. Conclusions: Healthy volunteers screening for phase 1 clinical trials have mixed views about the importance of genetic security and genetic privacy, but they strongly favour the return of incidental genetic findings that could affect their health. These issues should be discussed with potential participants during informed consent for phase 1 clinical trials with genetic testing.
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Affiliation(s)
- Sebastian Levesque
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Discipline of Pharmacology, The University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Thomas M. Polasek
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Centre for Medicines Use and Safety, Monash University, Melbourne, Victoria, 3052, Australia
- Certara, Princeton, New Jersey, 08540, USA
| | - Eric Haan
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Faculty of Health and Medical Science, The University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, 5000, Australia
- Discipline of Pharmacology, The University of Adelaide, Adelaide, South Australia, 5000, Australia
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Parajuli DR, Shakib S, Eng-Frost J, McKinnon RA, Caughey GE, Whitehead D. Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients. BMC Cardiovasc Disord 2021; 21:104. [PMID: 33602125 PMCID: PMC7893887 DOI: 10.1186/s12872-021-01868-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics-with and without the direct involvement of a pharmacist. METHODS A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. RESULTS MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression. CONCLUSIONS Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.
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Affiliation(s)
- Daya Ram Parajuli
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
- Flinders Rural Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, PO Box 852, Renmark, SA, 5341, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Eng-Frost
- Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Cardiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Ross A McKinnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Dean Whitehead
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
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22
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Li RJ, Caughey GE, Shakib S. Concomitant inpatient prescribing of strong opioids with sedatives: Associations with comorbid conditions. Pharmacol Res Perspect 2021; 9:e00717. [PMID: 33550717 PMCID: PMC7868063 DOI: 10.1002/prp2.717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
Co-prescribing of opioids and sedatives is a known risk factor for opioid-induced ventilatory impairment (OIVI). Prevalence data for sedative and opioid co-prescription in inpatients in Australia are unknown. Our objective was to determine the prevalence of inpatient sedative and opioid co-prescribing and to identify factors associated with co-prescription. We conducted a retrospective cross-sectional study from July 2017 to October 2017 across four South Australian hospitals utilizing a centralized electronic health record. Multivariate analysis was used to identify characteristics predictive of co-prescribing of a strong opioid (fentanyl, hydromorphone, morphine, and oxycodone) and sedative medications (benzodiazepines, antiepileptics, antipsychotics, and tricyclic antidepressants). Of the 6170 inpatients, 2795 (45.3%) were prescribed a strong opioid and of those, 1889 (30.6% of all inpatients) were co-prescribed a sedative. Of those prescribed a strong opioid, five (0.18%) developed OIVI. Patients prescribed a strong opioid had a 27-77% increased likelihood of being prescribed a sedative. Factors predictive of sedative co-prescribing included the presence of disease of the central nervous system adjusted OR (aOR) 8.66 [95% CI 5.83-12.9] and respiratory disease aOR 1.42 [95% CI 1.17-1.72]. Nearly, one third of all hospital inpatients were co-prescribed a strong opioid and a sedative medication. Patients with comorbidities resulting in increased risk of respiratory depression/OIVI were more likely to have sedative co-prescription. Clinicians should be aware of the effects of high-risk medications and ensure that systems and monitoring are in place that help mitigate adverse outcomes.
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Affiliation(s)
- Ray J. Li
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
- Discipline of PharmacologyAdelaide Medical SchoolThe University of AdelaideAdelaideAustralia
| | - Gillian E. Caughey
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
- Discipline of PharmacologyAdelaide Medical SchoolThe University of AdelaideAdelaideAustralia
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideAustralia
- Division of Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Sepehr Shakib
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
- Discipline of PharmacologyAdelaide Medical SchoolThe University of AdelaideAdelaideAustralia
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23
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Selby PR, Shakib S, Peake SL, Warner MS, Yeung D, Hahn U, Roberts JA. A Systematic Review of the Clinical Pharmacokinetics, Pharmacodynamics and Toxicodynamics of Ganciclovir/Valganciclovir in Allogeneic Haematopoietic Stem Cell Transplant Patients. Clin Pharmacokinet 2021; 60:727-739. [PMID: 33515202 DOI: 10.1007/s40262-020-00982-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ganciclovir (GCV) and valganciclovir (VGCV) are the first-line agents used to prevent and treat cytomegalovirus (CMV) infection in allogeneic haematopoietic stem cell transplant (alloHCT) patients. OBJECTIVE The aim of this work was to describe available data for the clinical pharmacokinetics, pharmacodynamics and toxicodynamics of GCV and VGCV and the potential of a therapeutic drug monitoring strategy to improve outcomes in the alloHCT population. METHODS We systematically reviewed the pharmacokinetics (dose-exposure), pharmacodynamics (exposure-efficacy) and toxicodynamics (exposure-toxicity) of GCV and VGCV in alloHCT patients with CMV infection. Studies including alloHCT patients treated for CMV infection reporting the pharmacokinetics, pharmacodynamics and toxicodynamics of GCV or VGCV were searched for using the PUBMED and EMBASE databases from 1946 to 2019. Only studies involving participants > 12 years of age and available in the English language were included. RESULTS A total of 179 patients were included in the 14 studies that met the inclusion criteria, of which 6 examined GCV pharmacokinetics only, while 8 also examined GCV pharmacodynamics and toxicodynamics. Reported pharmacokinetic parameters showed considerable interpatient variability and were different from other populations, such as solid organ transplant and human immunodeficiency virus-infected patients. Only one study found a correlation between neutropenia and elevated peak and trough GCV concentrations, with no other significant pharmacodynamic and toxicodynamic relationships identified. While therapeutic drug monitoring of GCV is performed in some institutions, no association between GCV therapeutic drug monitoring and clinical outcomes was identified. CONCLUSION Further studies of the pharmacokinetics, pharmacodynamics and toxicodynamics of GCV/VGCV in alloHCT patients are required to identify a more robust therapeutic range and to subsequently quantify the potential value of therapeutic drug monitoring of GCV/VGCV in the alloHCT population.
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Affiliation(s)
- Philip Roland Selby
- School of Medicine, University of Adelaide, Adelaide, SA, Australia. .,Pharmacy Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Sepehr Shakib
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sandra L Peake
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Morgyn S Warner
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Infectious Diseases Unit, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,SA Pathology, Adelaide, SA, Australia
| | - David Yeung
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,SA Pathology, Adelaide, SA, Australia.,Haematology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Uwe Hahn
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,SA Pathology, Adelaide, SA, Australia.,Haematology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jason A Roberts
- Faculty of Medicine and Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, St Lucia, QLD, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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24
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Inglis JM, Caughey GE, Smith W, Shakib S. Documentation of adverse drug reactions to opioids in an electronic health record. Intern Med J 2021; 51:1490-1496. [PMID: 33465262 DOI: 10.1111/imj.15209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Allergy to opioids is the second most common drug allergy label in electronic health records (EHR). Adverse drug reactions (ADR) to opioids cause significant morbidity and contribute to healthcare costs, while incorrect opioid allergy labels may unnecessarily complicate patient management. AIMS To examine the documentation of opioid ADR in a large-scale hospital-based EHR. METHODS A cross-sectional retrospective review of EHR documentation of opioid ADR at four public hospitals in South Australia was conducted. Data were extracted from all ADR entries including the reported allergen, ADR category (allergy or intolerance) and reaction details. Expert criteria were used to determine consistency of ADR categorisation as allergy or intolerance. RESULTS Of 86 727 unique ADR reports, there were 13 781 ADR to opioids with most being entered as allergy (n = 8913, 64.7%) rather than intolerance (n = 4868, 35.3%). The most commonly documented reactions were nausea/vomiting (n = 3912, 28%), rash (n = 647, 5%), itch (n = 642, 5%) and hallucinations (n = 527, 4%). There were 362 (3%) ADR labels of anaphylaxis. Of those ADR containing a reaction description (n = 11 868), 89% of reports entered as allergy had a reaction description that was consistent with intolerance and 8% of the entered intolerances had descriptions consistent with allergy when assessed using predefined criteria. CONCLUSIONS This large EHR-based study demonstrates the high rate of opioid ADR labels in EHR. The majority of these labels were for symptoms suggestive of pharmacological intolerance. Reactions consistent with true allergy were uncommon. Systematic review of ADR by a dedicated clinical service would improve the accuracy of documentation.
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Affiliation(s)
- Joshua M Inglis
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Clinical Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - William Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Clinical Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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25
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Abstract
Background Underrepresentation of older people in clinical trials remains. This study aimed to examine the inclusion of older people and associated safety and efficacy reports from clinical trials of new molecular entities for cardiovascular disease indications since commencement of the US Food and Drug Administration Drug Trial Snapshot (DTS) Program. The DTS provides concise information on participants included in clinical trials supporting US Food and Drug Administration approval of new drugs. Methods and Results A cross‐sectional analysis between January 1, 2015 and April 30, 2019 of DTS data including approval date, indication, number of trials and participants, age distribution, efficacy, and safety statements was conducted. Participation‐to‐prevalence ratio (PPR) was used to describe representation of older participants in trials relative to disease population. Efficacy and safety statements regarding age were compared with drug prescribing information. A total of 72 079 participants from 10 DTS reports were identified and 39 625 (55.0%) were aged ≥65 years old. Overall, 63.6% of cardiovascular disease DTS reports were representative of people aged ≥65 years old for specific cardiovascular disease conditions. Underrepresentation was observed in 4 DTS: 2 for heart failure (PPR 0.48 and 0.62), 1 for pulmonary arterial hypertension (PPR 0.72), and 1 for venous thromboembolism (PPR 0.38). Participants in clinical trials for new drugs for the treatment of atrial fibrillation (PPR 0.99 and 1.21) and hypercholesterolemia (PPR 0.84 and 0.97) were reflective of the older population for these diseases. An increased risk of adverse events in older participants was reported in 40% DTS safety statements but no differences were reported in the drug product information. Conclusions Despite the fact that >60% of cardiovascular disease trial participants for new molecular entities included in the DTS program were representative of the older population in real‐world clinical practice, concerns remain for conditions including heart failure or venous thromboembolism. Drug product information safety statements regarding age differences in adverse events were not reflective of trial findings. An increased directive is needed to facilitate the generation of real‐world evidence and appropriate reporting within drug product information for these potentially at‐risk patient populations.
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Affiliation(s)
- Gillian E Caughey
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute Adelaide South Australia Australia.,Division of Health Sciences University of South Australia Adelaide Australia.,Discipline of Pharmacology Adelaide Medical School The University of Adelaide Australia.,Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
| | - Maria C Inacio
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute Adelaide South Australia Australia.,Division of Health Sciences University of South Australia Adelaide Australia
| | - J Simon Bell
- Division of Health Sciences University of South Australia Adelaide Australia.,Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Agnes I Vitry
- Division of Health Sciences University of South Australia Adelaide Australia
| | - Sepehr Shakib
- Discipline of Pharmacology Adelaide Medical School The University of Adelaide Australia.,Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
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26
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Hauta-Aho M, Teperi S, Korhonen MJ, Bell JS, Farinola N, Johns S, Shakib S, Huupponen R. Frailty and Co-Prescribing of Potentially Interacting Drugs in New Users of Warfarin. Drugs Aging 2020; 37:373-382. [PMID: 32147805 PMCID: PMC7190596 DOI: 10.1007/s40266-020-00755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Warfarin is underutilised in frail older people because of the fear of bleeding complications. Drug interactions are an independent bleeding risk factor. However, the extent to which potential drug interactions are taken into account at warfarin therapy initiation in frail patients is not known. Objective The objective of this study was to investigate the use of potentially interacting drugs increasing the bleeding risk before and after warfarin initiation in frail and non-frail patients. Methods We conducted an observational study including inpatients aged ≥ 60 years initiated on warfarin in a tertiary hospital in Adelaide, South Australia. Frailty status was assessed with the Reported Edmonton Frail Scale. Medication charts were reviewed before and after warfarin initiation. Results In total, 151 patients (102 non-frail and 49 frail) were included. Before warfarin initiation, the use of clopidogrel and acetaminophen was more common in frail patients compared with non-frail patients (25.5% vs 10.2%, p = 0.0135, 63.8% vs 35.7% p = 0.0014, respectively). The use of non-steroidal anti-inflammatory drugs, 9.2% in non-frail patients and 6.4% in frail patients before warfarin initiation, was completely stopped after warfarin initiation in both groups. The use of antiplatelet drugs decreased from 56.1% in non-frail patients and 66.0 % in frail patients to 12.2% and 14.9%, respectively. Instead, the use of drugs affecting the metabolism of warfarin or vitamin K increased in both groups. No statistically significant difference was seen in the exposure to interacting drugs between study groups after warfarin initiation. Acetaminophen, senna glycosides and cytochrome P450 2C9 inhibiting drugs were the most common interacting drugs at discharge used in 49.0%, 18.4% and 20.4% of non-frail patients and 53.2%, 29.8% and 19.1% of frail patients, respectively. Conclusions The overall frequency of potential drug interactions was moderate and frail patients were not exposed to warfarin drug interactions more often than non-frail patients. Further studies in larger study populations are required to verify these results. Electronic supplementary material The online version of this article (10.1007/s40266-020-00755-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milka Hauta-Aho
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland. .,Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland. .,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Simo Teperi
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Maarit J Korhonen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland.,Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Nicholas Farinola
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally Johns
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Faculty of Health Science, University of Adelaide, Adelaide, SA, Australia
| | - Risto Huupponen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland.,Clinical Pharmacology Unit, Turku University Hospital, Turku, Finland
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27
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Davis KM, Eckert M, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey G. Continuity of care for people with multimorbidity: the development of a model for a nurse-led care coordination service. AUST J ADV NURS 2020. [DOI: 10.37464/2020.374.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Zhang B, Zhao R, Liang R, Gao Y, Liu R, Chen X, Lu Z, Wang Z, Yu L, Shakib S, Cui J. Abstract CT132: Orelabrutinib, a potent and selective Bruton's tyrosine kinase inhibitor with superior safety profile and excellent PK/PD properties. Tumour Biol 2020. [DOI: 10.1158/1538-7445.am2020-ct132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Foreman C, Smith WB, Caughey GE, Shakib S. Categorization of adverse drug reactions in electronic health records. Pharmacol Res Perspect 2020; 8:e00550. [PMID: 32302059 PMCID: PMC7164405 DOI: 10.1002/prp2.550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate the quality of adverse drug reaction (ADR) documentation in a state-wide electronic health record (EHR), and to assess the impact of the interface design on documentation accuracy and ability to provide decision support. Data were extracted from 43 011 unique records in a state-wide electronic health record in South Australia, Australia. Information obtained included ADR coding as allergy or intolerance, allergen name, reaction, and occupation of those entering data. Categorization into drug allergy or intolerance was assessed for accuracy. Reactions were entered predominantly by nurses (60.1%), also by doctors (31.0%) and pharmacists (6.1%). Of 27 314 reactions, 86.5% were coded as allergy and 13.5% as intolerance. The majority (78.2%) described reactions to drugs (as opposed to food, environmental or contact allergens), predominantly chosen from the drug database (96.4%). Many entries used free text for the reaction description (27.4%). Terms found in the predefined list under the allergy heading were more likely to be categorized as allergy, even when the mechanism was pharmacological intolerance. Only 45.1% (n = 1671/3705) of reactions consistent with intolerance (eg, "nausea," "diarrhea") were correctly categorized as such, although categorization by pharmacists was more accurate (P < .0001). These data suggest that ADR categorization as allergy or intolerance is influenced by the EHR design. The obligatory classification of ADRs into allergy or intolerance was not well understood and does not appear to have practical benefit.
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Affiliation(s)
| | | | - Gillian E. Caughey
- Discipline of PharmacologyAdelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
- School of Pharmacy and Medical SciencesDivision of Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Sepehr Shakib
- Discipline of PharmacologyAdelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideAustralia
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30
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Masnoon N, Shakib S, Kalisch Ellett L, Caughey GE. Predictors of unplanned hospitalisation in the older population: The role of polypharmacy and other medication and chronic disease-related factors. Australas J Ageing 2020; 39:e436-e446. [PMID: 32056359 DOI: 10.1111/ajag.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify demographic and medication-related predictors of unplanned hospitalisation and combine them into a hospitalisation risk score. METHODS Patients aged ≥65 years from an outpatient multimorbidity clinic were included. Hospitalisation predictors within a year of clinic discharge were identified using logistic regression. A risk score was developed. The area under the curve (AUC) was used to assess its predictive ability, compared to that of the medicines count (definition of polypharmacy). RESULTS A total of 598 patients were included (median age of 80.0 years). 58.0% (n = 347) were hospitalised within a year of clinic discharge. The AUC for the risk score incorporating age, medicines count, heart failure (HF), atherosclerotic disease and systemic steroids was 0.67 [95% CI 0.62-0.71], compared to 0.62 [95% CI 0.58-0.67] for the medicines count. CONCLUSION A hospitalisation risk score incorporating demographics, medicines, namely steroids, and diseases such as HF had increased predictive ability compared to the medicines count, providing guidance for developing future polypharmacy tools.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,Department of Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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31
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Molga A, Wall M, Wee LYA, Chhetri R, Singhal D, Singhal N, To LB, Shakib S, To T, Hiwase D. Screening for deficits using the G8 and VES-13 in older patients with Myelodysplastic syndromes. J Geriatr Oncol 2020; 11:128-130. [DOI: 10.1016/j.jgo.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/02/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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32
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Molga A, Wall M, Chhetri R, Wee LY, Singhal D, Edwards S, Singhal N, Ross D, To LB, Caughey G, Shakib S, Germing U, To T, Hiwase D. Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes. J Geriatr Oncol 2020; 11:114-120. [DOI: 10.1016/j.jgo.2019.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/31/2018] [Accepted: 02/04/2019] [Indexed: 12/27/2022]
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33
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Davis KM, Eckert MC, Shakib S, Harmon J, Hutchinson AD, Sharplin G, Caughey GE. Development and Implementation of a Nurse-Led Model of Care Coordination to Provide Health-Sector Continuity of Care for People With Multimorbidity: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e15006. [PMID: 31815675 PMCID: PMC6928704 DOI: 10.2196/15006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background Innovative strategies are required to reduce care fragmentation for people with multimorbidity. Coordinated models of health care delivery need to be adopted to deliver consumer-centered continuity of care. Nurse-led services have emerged over the past 20 years as evidence-based structured models of care delivery, providing a range of positive and coordinated health care outcomes. Although nurse-led services are effective in a range of clinical settings, strategies to improve continuity of care across the secondary and primary health care sectors for people with multimorbidity have not been examined. Objective To implement a nurse-led model of care coordination from a multidisciplinary outpatient setting and provide continuity of care between the secondary and primary health care sectors for people with multimorbidity. Methods This action research mixed methods study will have two phases. Phase 1 includes a systematic review, stakeholder forums, and validation workshop to collaboratively develop a model of care for a nurse-led care coordination service. Phase 2, through a series of iterative action research cycles, will implement a nurse-led model of care coordination in a multidisciplinary outpatient setting. Three to five iterative action research cycles will allow the model to be refined and further developed with multiple data collection points throughout. Results Pilot implementation of the model of care coordination commenced in October 2018. Formal study recruitment commenced in May 2019 and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by March 2020. Conclusions Nursing, clinician, and patient outcomes and experiences with the nurse-led model of care coordination will provide a template to improve continuity of care between the secondary and primary health care systems. The model template may provide a future pathway for implementation of nurse-led services both nationally and internationally. International Registered Report Identifier (IRRID) DERR1-10.2196/15006
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Affiliation(s)
- Kate M Davis
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Marion C Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, Faculty of Health Science, University of Adelaide, Adelaide, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Joanne Harmon
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Amanda D Hutchinson
- School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | - Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, Faculty of Health Science, University of Adelaide, Adelaide, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
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Masnoon N, Shakib S, Kalisch Ellett L, Caughey GE. Rationalisation of polypharmacy in practice: a survey of physicians and pharmacists. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
- Department of Pharmacy Royal Adelaide Hospital Adelaide Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School University of Adelaide Adelaide Australia
- Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
- Discipline of Pharmacology, Adelaide Medical School University of Adelaide Adelaide Australia
- Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
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Caughey GE, Shakib S, Barratt JD, Roughead EE. Use of Medicines that May Exacerbate Heart Failure in Older Adults: Therapeutic Complexity of Multimorbidity. Drugs Aging 2019; 36:471-479. [PMID: 30875020 DOI: 10.1007/s40266-019-00645-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multimorbidity is common in older patients with heart failure (HF), complicating therapeutic management and increasing the risk of harm. OBJECTIVE This study sought to examine the prevalence of medicines for the treatment of comorbid conditions potentially associated with harm in older people, before and after HF hospitalization. METHODS A retrospective cohort study of older people hospitalized with a primary diagnosis of HF over a 12-month period was conducted using administrative health claims data from the Department of Veterans' Affairs (DVA) Australia. We examined the prevalence of medicines that may exacerbate or worsen HF as defined by the American Heart Association (AHA) and Australian HF clinical guidelines, in the 30 days prior and 120 days before and after discharge for HF. RESULTS A total of 4069 older adults were hospitalized for HF during the study period; almost 60% (n = 2435) received at least one medicine associated with an increased risk of harm before hospitalization, with the majority (66.7%, n = 1623) dispensed in the 30 days prior. A small but significant reduction after hospitalization was observed, but 56% (n = 1638) received at least one of these medicines after hospitalization (p = 0.001). Over one-quarter received two or more medicines before hospitalization, and this only reduced to 22% post-hospitalization (p < 0.0001). CONCLUSIONS Little change in the prescribing of potentially harmful medicines for HF was observed; 56% of older adults received at least one following hospitalization for HF, highlighting the therapeutic complexity of multimorbidity in HF. Use of the AHA list to facilitate identification of potentially harmful medicines, followed by prioritization of treatment goals and appropriate risk mitigation are needed to facilitate reduction in hospitalization for patients with HF with multimorbidity.
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Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5001, Australia. .,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 5001, Australia. .,Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, 5001, Australia.
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5001, Australia.,Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, 5001, Australia
| | - John D Barratt
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 5001, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, 5001, Australia
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Marshall HS, Baber J, Richmond P, Nissen M, Shakib S, Kreiswirth BN, Zito ET, Severs J, Eiden J, Gruber W, Jansen KU, Jones CH, Anderson AS. S. aureus colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine. J Infect 2019; 79:582-592. [PMID: 31585191 DOI: 10.1016/j.jinf.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/23/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Assess Staphylococcus aureus (S. aureus) colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine (SA3Ag). METHODS In this phase 1, double-blind, sponsor-unblinded study, participants were randomized to receive a single dose (1 of 3 dose levels) of SA3Ag or placebo and a booster dose or placebo at 6 months. S. aureus isolates from nasal, perineal, and oropharyngeal swabs before and through 12 months post-vaccination were identified. RESULTS Baseline S. aureus colonization prevalence was 30.6% (any site), with nasal carriage (27.0%) more common than oropharyngeal/perineal (3.2% each). Following initial vaccination (low-dose: 102; mid-dose: 101; high-dose: 101; placebo: 102) and booster (low-dose: 45; mid-dose: 44; high-dose: 27; placebo: 181), placebo and SA3Ag groups showed similar S. aureus carriage through 12 months. Most colonized participants (74.0%) were colonized by single spa types. Placebo and SA3Ag groups had similar persistence of colonization, with 19.6-30.7% due to single spa types. Acquisition was observed in mid- and high-dose recipients (∼20%) and low-dose and placebo recipients (∼12%). Vaccination resulted in substantial increases in antibodies to all 3 antigens, irrespective of carriage status. CONCLUSIONS Based on descriptive analyses of this small study, SA3Ag vaccination did not impact S. aureus acquisition or carriage. Carriage status did not impact antibody responses to SA3Ag.
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Affiliation(s)
- Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital and Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
| | - James Baber
- Pfizer Australia Pty Ltd, Sydney, NSW, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia Division of Paediatrics & Vaccine Trials Group, Perth, WA, Australia
| | - Michael Nissen
- Queensland Paediatric Infectious Diseases Laboratory, Children's Health Research Centre, University of Queensland, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, University of Adelaide, Adelaide, SA, Australia
| | | | - Edward T Zito
- Pfizer Vaccine Research and Development, Collegeville, PA, USA
| | - Joseph Severs
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | - Joseph Eiden
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | - William Gruber
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | | | - C Hal Jones
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
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Abstract
Novel technologies labelled as ‘precision medicine’ are targeting all aspects of clinical care. Whilst some technological advances are undeniably exciting, many doctors at the frontline of healthcare view precision medicine as being out of reach for their patients. Computer-guided dosing is a precision medicine technology that predicts drug concentrations and drug responses based on individual patient characteristics. In this opinion piece, the example of computer-guided dosing is used to illustrate eight features of a precision medicine technology less likely to be hyperbole and more likely to improve patient care. Positive features in this regard include: (1) fitting the definition of ‘precision medicine’; (2) addressing a major clinical problem that negatively impacts patient care; (3) a track record of high-quality medical science published via peer-reviewed literature; (4) well-defined clinical cases for application; (5) quality evidence of benefits measured by various clinical, patient and health economic endpoints; (6) strong economic drivers; (7) user friendliness, including easy integration into clinical workflow, and (8) recognition of importance by patients and their endorsement for broader clinical use. Barriers raised by critics of the approach are given to balance the view. The value of computer-guided dosing will be decided ultimately by the extent to which it can improve cost-effective patient care.
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Affiliation(s)
- Thomas M Polasek
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA.,Centre for Medicines Use and Safety, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Amin Rostami-Hodjegan
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA.,Centre for Applied Pharmacokinetic Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Caughey GE, Shakib S, Inglis JM, Le TT, Yuson CL, Smith WB. External validation of beta-lactam antibiotic allergy assessment tools: implications for clinical practice and workforce capacity. J Allergy Clin Immunol Pract 2019; 7:2094-2095. [PMID: 31279471 DOI: 10.1016/j.jaip.2019.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Thanh-Thao Le
- Clinical Immunology and Allergy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - Carlo L Yuson
- Clinical Immunology and Allergy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - William B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
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Russell P, Laubscher S, Roberts GW, Mangoni AA, McDonald C, Hendrix I, Hewage U, Hofmann D, Michell S, Taeuber L, Woodman RJ, Shakib S, Crawford GB, Maddison J, Thompson C. A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital. Ther Adv Drug Saf 2019; 10:2042098619854876. [PMID: 31210924 PMCID: PMC6552337 DOI: 10.1177/2042098619854876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/02/2018] [Accepted: 05/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Patients from residential aged care facilities are commonly exposed to inappropriate polypharmacy. Unplanned inpatient admissions can provide an opportunity for review of complex medical regimens and deprescribing of inappropriate or nonbeneficial medications. The aim of this study was to assess the efficacy, safety and sustainability of in-hospital deprescribing. Methods: We followed a prospective, multi-centre, cohort study design, with enrolment of 106 medical inpatients age 75 years and older (mean age was 88.8 years) who were exposed to polypharmacy prior to admission and with a planned discharge to a nursing home for permanent placement. Descriptive statistics were calculated for relevant variables. The Short Form-8 (SF-8) health survey was used to assess changes in health-related quality of life (HRQOL) at 90-day follow up, in comparison with SF-8 results at day 30. Results: Deprescribing occurred in most, but not all patients. There were no differences between the groups in principal diagnosis, Charlson index, number of medications on admission or number of Beers list medications on admission. At 90 days, mortality and readmissions were similar, though the deprescribed group had significantly higher odds of better emotional wellbeing than the nondeprescribed group [odds ratio (OR) = 5.08, 95% confidence interval (CI): 1.93, 13.39; p = 0.001]. In the deprescribing group, 31% of the patients still alive at 90 days had medications restarted in primary care. One-year mortality rates were similar. Conclusions: Deprescribing medications during an unplanned hospital admission was not associated with mortality, readmissions, or overall HRQOL.
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Affiliation(s)
- Patrick Russell
- School of Medicine, Flinders University, Royal Adelaide Hospital, Adelaide, Australia
| | - Sara Laubscher
- Southern Adelaide Local Health Network, Adelaide, Australia
| | | | | | | | - Ivanka Hendrix
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Udul Hewage
- School of Medicine, Flinders University, Adelaide, Australia
| | - Dirk Hofmann
- School of Medicine, Flinders University, Adelaide, Australia
| | - Sophie Michell
- Southern Adelaide Local Health Network, Adelaide, Australia
| | - Lauren Taeuber
- Southern Adelaide Local Health Network, Adelaide, Australia
| | | | - Sepehr Shakib
- Discipline of Medicine, University of Adelaide, Australia
| | | | - John Maddison
- Discipline of Medicine, University of Adelaide, Australia
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Pratt NL, Ramsay E, Kalisch Ellett LM, Duszynski K, Shakib S, Kerr M, Caughey G, Roughead EE. Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin: a sequential cohort study. BMJ Open 2019; 9:e026486. [PMID: 31061039 PMCID: PMC6501958 DOI: 10.1136/bmjopen-2018-026486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population. DESIGN Sequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators. SETTING Australian Government Department of Veterans' Affairs claims database. PARTICIPANTS 4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively. MAIN OUTCOME MEASURES One-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death. RESULTS Using the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding. CONCLUSION We found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding.
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Affiliation(s)
- Nicole L Pratt
- School of Pharmacy and Medical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Emmae Ramsay
- School of Pharmacy and Medical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- School of Pharmacy and Medical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Katherine Duszynski
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, University of Adelaide, Adelaide, South Australia, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mhairi Kerr
- School of Pharmacy and Medical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Gillian Caughey
- Discipline of Pharmacology, University of Adelaide, Adelaide, South Australia, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Elizabeth Ellen Roughead
- School of Pharmacy and Medical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey G. How do clinicians and pharmacists assess polypharmacy in a case-based setting? Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.03.102] [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: 10/26/2022]
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Shakib S, Caughey GE, Fok JS, Smith WB. Adverse drug reaction classification by health professionals: appropriate discrimination between allergy and intolerance? Clin Transl Allergy 2019; 9:18. [PMID: 30923609 PMCID: PMC6423864 DOI: 10.1186/s13601-019-0259-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/08/2019] [Indexed: 01/24/2023] Open
Abstract
Background The correct classification of an adverse drug reaction (ADR) as allergy (immunological) or intolerance (non-immunological) has important clinical implications. The aim of this study was to examine the ability of health professionals to discriminate between allergy and intolerance, classify the severity of the ADR and degree of contraindication. Methods Health professionals were presented ten ‘real-life’ ADR scenarios using an online questionnaire and asked to: categorise the reaction as allergy or intolerance, rate the severity of the reaction and judge the level of contraindication of the causative drug. The number and proportion of responses were calculated for each of the cases presented and associations between classification of reaction type, severity and level of contraindication were examined. Results A total of 394 responses were received. Overall 59.0% (SD 28.9) correctly categorised the cases, 60.8% (SD 16.8) classified the severity correct, and less than half (44.7%, SD 28.6) correctly identified the level of contraindication. The proportion of health professionals correctly answering the type, severity and level of contraindication for the allergy case was significantly higher (p < 0.0001) by comparison to the intolerance cases (type: 56.6% ± 33.1; severity: 57.3 ± 11.9; level of contraindication: 38.5 ± 19.9). Conclusions Health professionals have suboptimal understanding of classification of ADRs. Strategies are required to strictly avoid re-exposure of patients to drugs which carry an increased risk of inducing a dangerous reaction, whilst minimising the avoidance of drugs which are of minimal risk or allowing the use of low-risk drugs where the benefits may be significant.
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Affiliation(s)
- Sepehr Shakib
- 1Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA Australia.,2Discipline of Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia
| | - Gillian E Caughey
- 1Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA Australia.,2Discipline of Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA Australia.,3School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA Australia
| | - Jie Shen Fok
- 4Clinical Immunology and Allergy, Royal Adelaide Hospital, North Terrace, Adelaide, SA Australia
| | - William B Smith
- 4Clinical Immunology and Allergy, Royal Adelaide Hospital, North Terrace, Adelaide, SA Australia
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Frey SE, Shakib S, Chanthavanich P, Richmond P, Smith T, Tantawichien T, Kittel C, Jaehnig P, Mojares Z, Verma B, Kanesa-Thasan N, Hohenboken M. Safety and Immunogenicity of MF59-Adjuvanted Cell Culture-Derived A/H5N1 Subunit Influenza Virus Vaccine: Dose-Finding Clinical Trials in Adults and the Elderly. Open Forum Infect Dis 2019; 6:ofz107. [PMID: 30968056 PMCID: PMC6446137 DOI: 10.1093/ofid/ofz107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/26/2018] [Accepted: 02/26/2019] [Indexed: 01/29/2023] Open
Abstract
Background A/H5N1 influenza viruses have high pandemic potential; consequently, vaccines need to be produced rapidly. MF59® adjuvant reduces the antigen required per dose, allowing for dose sparing and more rapid vaccine availability. Methods Two multicenter, phase II trials were conducted to evaluate the safety and immunogenicity of an MF59-adjuvanted, cell culture–derived, A/H5N1 vaccine (aH5N1c) among 979 adult (18–64 years old) and 1393 elderly (≥65 years old) subjects. Participants were equally randomized to receive 2 full-dose (7.5 μg of hemagglutinin antigen per dose) or 2 half-dose aH5N1c vaccinations 3 weeks apart. Outcomes were based on Center for Biologics Evaluation Research and Review (CBER) and Committee for Medicinal Products for Human Use (CHMP) licensure criteria (titers ≥1:40 and seroconversions on day 43). Solicited reactions and adverse events were assessed (www.clinicaltrials.gov: NCT01776541 and NCT01766921). Results CBER and CHMP criteria were met by both age groups. CBER criteria for hemagglutination titers were met for the full-dose formulation. Solicited reaction frequencies tended to be higher in the full-dose group and were of mild to moderate intensity. No vaccine-related serious adverse events occurred. Conclusions In adult and elderly participants, the full-dose aH5N1c vaccine formulation was well tolerated and met US and European licensure criteria for pandemic vaccines.
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Affiliation(s)
- Sharon E Frey
- School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Sepehr Shakib
- CMAX Clinical Research Pty Ltd., Adelaide, SA, Australia
| | - Pornthep Chanthavanich
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, University of Western Australia, and Vaccine Trials Group, Telethon Kids Institute, Subiaco, WA, Australia
| | | | - Terapong Tantawichien
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and Queen Saovabha Memorial Institute, Bangkok, Thailand
| | | | | | | | - Bikash Verma
- GlaxoSmithKline Vaccines LLC, Rockville, Maryland
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Al-Sarawi F, Polasek TM, Caughey GE, Shakib S. Prescribing errors and adverse drug reaction documentation before and after implementation of e-prescribing using the Enterprise Patient Administration System. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fares Al-Sarawi
- Pharmacy Department; Royal Adelaide Hospital; SA Pharmacy; Adelaide Australia
| | - Thomas M. Polasek
- Discipline of Pharmacology; School of Medicine; Faculty of Health and Medical Sciences; University of Adelaide; Adelaide Australia
- Department of Clinical Pharmacology; Royal Adelaide Hospital; Adelaide Australia
| | - Gillian E. Caughey
- Discipline of Pharmacology; School of Medicine; Faculty of Health and Medical Sciences; University of Adelaide; Adelaide Australia
- Department of Clinical Pharmacology; Royal Adelaide Hospital; Adelaide Australia
- School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide Australia
| | - Sepehr Shakib
- Discipline of Pharmacology; School of Medicine; Faculty of Health and Medical Sciences; University of Adelaide; Adelaide Australia
- Department of Clinical Pharmacology; Royal Adelaide Hospital; Adelaide Australia
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Brigandi RA, Zhu J, Murnane AA, Reedy BA, Shakib S. A Phase 1 Randomized, Placebo-Controlled Trial With a Topical Inhibitor of Stearoyl-Coenzyme A Desaturase 1 Under Occluded and Nonoccluded Conditions. Clin Pharmacol Drug Dev 2019; 8:270-280. [PMID: 30650256 PMCID: PMC6590436 DOI: 10.1002/cpdd.644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2017] [Accepted: 11/28/2018] [Indexed: 02/04/2023]
Abstract
Stearoyl‐coenzyme A desaturase 1 (SCD‐1) in sebaceous glands is a key enzyme in the synthesis of monounsaturated fatty acids essential for acne development. GSK1940029 gel, a novel SCD‐1 inhibitor, is being developed as a potential treatment for acne. To assess the irritation potential, pharmacokinetics (PK), and safety of topical GSK1940029 to the skin of healthy adults, two interdependent studies were conducted in parallel. Study 1 (n = 54) investigated the irritation potential of GSK1940029 (0.3% and 1%, occluded application) to allow for its application to larger surface areas in study 2 (n = 39), which investigated the safety, tolerability, and PK of GSK1940029 after single and repeat doses as occluded and nonoccluded applications. GSK1940029 was not a primary or cumulative irritant after 2 and 21 days of dosing in study 1. In study 2, single and repeat applications of GSK1940029 (0.1% to 1%) doses were well tolerated with little or no influence on AUC and Cmax under occluded or unoccluded conditions. Systemic exposure increased proportionally with surface area and was higher in occluded conditions. Design of these interdependent studies allowed for the assessment of the irritation potential for topical GSK1940029 in parallel with the investigation of PK and safety profiles.
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Affiliation(s)
- Richard A Brigandi
- Virtual Proof of Concept Discovery Performance Unit, GlaxoSmithKline, King of Prussia, PA, USA
| | - John Zhu
- Clinical Pharmacology Modeling and Simulation, GlaxoSmithKline, King of Prussia, PA, USA
| | - Amy A Murnane
- Virtual Proof of Concept Discovery Performance Unit, GlaxoSmithKline, King of Prussia, PA, USA
| | - Beth Ann Reedy
- Virtual Proof of Concept Discovery Performance Unit, GlaxoSmithKline, King of Prussia, PA, USA
| | - Sepehr Shakib
- CMAX, a division of IDT Australia Limited, Adelaide, South Australia, Australia.,Department of Clinical Pharmacology, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Caughey GE, Gadzhanova S, Shakib S, Roughead EE. Concomitant prescribing of opioids and benzodiazepines in Australia, 2012-2017. Med J Aust 2018; 210:39-40. [PMID: 30636298 DOI: 10.5694/mja2.12026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/24/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Gillian E Caughey
- Adelaide Medical School, University of Adelaide, Adelaide, SA.,Royal Adelaide Hospital, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | - Sepehr Shakib
- Adelaide Medical School, University of Adelaide, Adelaide, SA.,Royal Adelaide Hospital, Adelaide, SA
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Gillam MH, Pratt NL, Inacio MCS, Shakib S, Sanders P, Lau DH, Roughead EE. Rehospitalizations for complications and mortality following pacemaker implantation: A retrospective cohort study in an older population. Clin Cardiol 2018; 41:1480-1486. [PMID: 30294784 DOI: 10.1002/clc.23091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION A large number of older people receive pacemakers each year but broad population-based studies that describe complications following pacemaker implantation in this population are lacking. METHODS We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs database. The cohort consisted of patients who received a pacemaker from 2005 to 2014. The outcomes were subsequent rehospitalizations for infections, procedure-related complications, thromboembolism, cardiovascular events (heart failure, myocardial infarction, and atrial fibrillation), and reoperation of pacemaker, and mortality. RESULTS There were 10 883 pacemakers recipients, the median age was 86 years (interquartile range 83-89), 61% were males, and 74% received a dual-chamber pacemaker. Within 90 days postdischarge, rehospitalizations were occasioned by pacemaker infection in 0.5%, device-related complications in 1.5%, cerebral infarction in 0.7%, and heart failure in 6% of single-chamber pacemaker recipients. In dual-chamber pacemaker recipients rehospitalizations were occasioned by pacemaker infection in 0.4%, septicemia in 0.4%, device-related complications in 1.2%, cerebral infarction in 0.3%, and heart failure in 3%. Rehospitalizations for pacemaker adjustment occurred in 1.5% of patients. The 90-day postdischarge mortality was 5% and 3% in patients with single- and dual-chamber pacemaker, respectively. CONCLUSION Rehospitalizations for infection, procedure-related complications, or thromboembolism occurred in 1% to 2% of patients within 90 days postdischarge, while 10% of single chamber and 7% of dual-chamber recipients experienced a rehospitalization for a cardiovascular event.
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Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Maria C S Inacio
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Cooper M, O'Connor‐Semmes R, Reedy BA, Hacquoil K, Gorycki P, Pannullo K, Verticelli A, Shakib S. First‐in‐Human Studies for a Selective RET Tyrosine Kinase Inhibitor, GSK3179106, to Investigate the Safety, Tolerability, and Pharmacokinetics in Healthy Volunteers. Clin Pharmacol Drug Dev 2018; 8:234-245. [DOI: 10.1002/cpdd.600] [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] [Received: 12/12/2017] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Sepehr Shakib
- CMAX Clinical Research Pty LtdRoyal Adelaide Hospital Adelaide South Australia
- Department of Clinical PharmacologySchool of MedicineUniversity of Adelaide Adelaide South Australia
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018; 35:43-60. [PMID: 29350335 DOI: 10.1007/s40266-018-0516-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice. OBJECTIVES The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity). METHODS A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting. RESULTS After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%). CONCLUSION The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia.
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
| | - Gillian E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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Parajuli DR, Kourbelis C, Franzon J, Newman P, McKinnon RA, Shakib S, Whitehead D, Clark RA. 207Effectiveness of the pharmacist-involved multidisciplinary management of heart failure to improve readmission and mortality rates: systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D R Parajuli
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - C Kourbelis
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - J Franzon
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - P Newman
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - R A McKinnon
- Flinders Medical Centre and Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - S Shakib
- Royal Adelaide Hospital, Department of Clinical Pharmacology, Adelaide, Australia
| | - D Whitehead
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - R A Clark
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
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