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Moore TJ, Rose A, Skipper A, McKnight E. Sexual Sanctification and Relationship Satisfaction in Black Heterosexual Couples. J Sex Marital Ther 2024; 50:527-541. [PMID: 38567544 DOI: 10.1080/0092623x.2024.2329077] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study examines dyadic data from 299 married and 242 cohabiting Black heterosexual couples in the United States (an understudied cross-section of the population) and assesses individual (actor) effects as well as couple (partner) effects of sexual sanctification and relationship satisfaction. Higher levels of sexual sanctification were associated with higher levels of relationship satisfaction for women and men in the actor effects, but no significant associations were found in the partner effects for couples. Additionally, initial findings suggest that sexual sanctification may act as a relational protective factor for Black married and cohabiting couples. Implications for further research as well as practical applications for clergy, therapists, and practitioners working with Black heterosexual couples in sexual relationships are also discussed.
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Affiliation(s)
- T J Moore
- Independent Researcher, The Church of Jesus Christ of Latter-day Saints Church Educational System, Salt Lake City, Utah, USA
| | - Andrew Rose
- Department of Sociology, Texas Tech University College of Arts and Sciences, Lubbock, Texas, USA
| | | | - Emily McKnight
- Independent Researcher, Iowa State University of Science and Technology, Ames, Iowa, USA
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2
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Jones CA, Seilern und Aspang J, Holmes JS, Zamanzadeh RS, Phen HM, Baker JL, Hernandez-Irizarry RC, Moore TJ. Incidence and Risk Factors of Heterotopic Ossification in the Knee After Reamed Tibial Nailing. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00002. [PMID: 38324456 PMCID: PMC10846776 DOI: 10.5435/jaaosglobal-d-23-00258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Heterotopic ossification (HO) in the knee after tibial intramedullary nailing (IMN) has yet to be thoroughly investigated. Our aim was to assess frequency and associated factors for HO in the knee after tibial IMN. METHODS This is a retrospective review at a single level 1 urban trauma center of 213 patients who underwent reamed tibial IMN. Plain radiographs were reviewed postoperatively and on final follow-up (≥6 weeks). Chart review was performed for surgical approach (suprapatellar versus infrapatellar), demographics, injury characteristics, and clinical follow-up. The primary outcome was frequency of HO. RESULTS HO on final follow-up (mean: 41.43 weeks) was recorded in 15% cases. Postsurgical retroinfrapatellar reaming debris (odds ratio [OR], 4.73), Injury Severity Score (OR, 1.05), intensive care unit admission (OR, 2.89), chest injury (OR, 3.4), and ipsilateral retrograde femoral IMN (OR, 5.08) showed a notable association with HO development. No association was observed in HO formation between surgical approach, knee pain, or range-of-motion deficits. DISCUSSION Radiographic evidence of HO in the knee after reamed tibial IMN is not uncommon and is associated with retained reaming debris, Injury Severity Score, chest injury, intensive care unit admission, and ipsilateral retrograde femoral nailing. No differences were noted in HO formation between approaches. HO was not associated with knee pain or range-of-motion deficits.
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Affiliation(s)
- Corey A. Jones
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | | | - Jeffrey S. Holmes
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Ryan S. Zamanzadeh
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Huai M. Phen
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - J.'Lynn L. Baker
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | | | - Thomas J. Moore
- From the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
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3
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Crane MA, DiStefano MJ, Moore TJ. False or Misleading Claims in Online Direct-to-Consumer Ketamine Advertising in Maryland. JAMA Netw Open 2023; 6:e2342210. [PMID: 37934500 PMCID: PMC10630893 DOI: 10.1001/jamanetworkopen.2023.42210] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 11/08/2023] Open
Abstract
This cross-sectional study evaluates the prevalence of false or misleading information in online direct-to-consumer advertising for off-label and unapproved ketamine in Maryland.
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Affiliation(s)
- Matthew A. Crane
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J. DiStefano
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | - Thomas J. Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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4
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Moore TJ, Wirtz PW, Curran JN, Alexander GC. Medical use and combination drug therapy among US adult users of central nervous system stimulants: a cross-sectional analysis. BMJ Open 2023; 13:e069668. [PMID: 37094897 DOI: 10.1136/bmjopen-2022-069668] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Examine patterns of adult medical use of amphetamine and methylphenidate stimulant drugs, classified in the USA as Schedule II controlled substances with a high potential for psychological or physical dependence. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Prescription drug claims for US adults, age 19-64 years, included in a commercial insurance claims database with 9.1 million continuously enrolled adults from 1 October 2019, through 31 December 2020. Stimulant use was defined as adults filling one or more stimulant prescriptions during calendar 2020. OUTCOME MEASURES The primary outcome was an outpatient prescription claim, service date and days' supply for central nervous system (CNS)-active drugs. Combination-2 was defined as 60 days or more of combination treatment with a Schedule II stimulant and one or more additional CNS-active drugs. Combination-3 therapy was defined as the addition of 2 or more additional CNS-active drugs. Using service date and days' supply, we examined the number of stimulant and other CNS-active drugs for each of the 366 days of 2020. RESULTS Among 9 141 877 continuously enrolled adults, the study identified 276 223 individuals (3.0%) using Schedule II stimulants during 2020. They filled a median of 8 (IQR, 4-11) prescriptions for these stimulant drugs that provided 227 (IQR, 110-322) treatment days of exposure. Among this group, 125 781 (45.5%) combined use of one or more additional CNS active drugs for a median of 213 (IQR, 126-301) treatment days. Also, 66 996 (24.3%) stimulant users used two or more additional CNS-active drugs for a median of 182 (IQR, 108-276) days. Among stimulants users, 131 485 (47.6%) were exposed to an antidepressant, 85 166 (30.8%) filled prescriptions for anxiety/sedative/hypnotic medications and 54 035 (19.6%) received opioid prescriptions. CONCLUSION A large proportion of adults using Schedule II stimulants are simultaneously exposed to one or more other CNS-active drugs, many with tolerance, withdrawal effects or potential for non-medical use. There are no approved indications and limited clinical trial testing of these multi-drug combinations, and discontinuation may be challenging.
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Affiliation(s)
- Thomas J Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Phillip W Wirtz
- Department of Decision Sciences, The George Washington University School of Business, Washington, District of Columbia, USA
| | - Jill N Curran
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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5
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Butrovich MA, Reaves AC, Heyward J, Moore TJ, Alexander GC, Inker LA, Nolin TD. Inclusion of Participants with CKD and Other Kidney-Related Considerations during Clinical Drug Development: Landscape Analysis of Anticancer Agents Approved from 2015 to 2019. Clin J Am Soc Nephrol 2023; 18:455-464. [PMID: 36723359 PMCID: PMC10103296 DOI: 10.2215/cjn.0000000000000105] [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: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND The US Food and Drug Administration has prioritized efforts to expand availability of therapies, including anticancer agents, for patients with CKD. US Food and Drug Administration Guidance recommends inclusion of study participants with CKD in clinical trials, improving pharmacokinetic characterization in people with decreased GFR, and using contemporary GFR assessment methods during drug development. We performed a landscape analysis of anticancer agents approved from 2015 to 2019 to evaluate inclusion of study participants with CKD and GFR assessment methods used during drug development and subsequent translation to kidney-related safety and dosing data in product labeling. METHODS Oncology drugs approved from 2015 to 2019 and associated pivotal trials were identified. We evaluated inclusion of study participants with CKD in pivotal trials and pharmacokinetic analyses, investigated GFR assessment methods used for pivotal trial eligibility and renal pharmacokinetic analyses, and identified kidney-related adverse drug event and dosing information. RESULTS A total of 55 drugs and 74 pivotal trials were included. Of the pivotal trials, 95% contained kidney-related eligibility criteria, including 68% with GFR-based eligibility. The median lower limit of GFR required for inclusion was 45 ml/min or ml/min per 1.73 m 2 . Pharmacokinetic analyses were performed in CKD stages 4-5 and hemodialysis for only 29% and 6% of drugs, respectively. Estimated creatinine clearance was used in over 60% and 80% of pivotal trials and pharmacokinetic analyses, respectively. Reporting of kidney-related adverse drug events was highly variable. Product labeling for 49% of drugs contained no kidney dosing information. CONCLUSIONS Study participants with CKD continue to be excluded from anticancer drug development, and GFR estimation in pivotal trials and renal pharmacokinetic analyses remains imprecise and heterogeneous. Furthermore, kidney-related safety and dosing information is scarcely and inconsistently presented.
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Affiliation(s)
- Morgan A. Butrovich
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Allison C. Reaves
- William B. Schwartz, MD, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Jamie Heyward
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas J. Moore
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lesley A. Inker
- William B. Schwartz, MD, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Thomas D. Nolin
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Lunati MP, Aspang JSU, Baker JL, Wilson JM, Moore TJ. Radiographic Prediction of Soft Tissue Injury Associated with Tibial Plateau Fractures: The Direction of Articular Depression Matters. J Surg Orthop Adv 2023; 32:270-275. [PMID: 38551237] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
This investigation aimed to evaluate the impact of coronal articular fragment displacement of Schatzker type II tibial plateau fractures on concomitant soft tissue knee injuries. One hundred consecutively treated patients were included. Depression depth and coronal articular fragment displacement were measured radiographically, and medial collateral ligament (MCL) and lateral meniscus (LM) injury, and pain and range of motion (ROM) on final follow up, were recorded. Multivariable regression was then performed. Coronal articular fragment displacement was medially and laterally hinged in 74% and 26% of patients, respectively. MCL injuries were significantly higher in the lateral hinge group (odds ratio [OR]: 3.25; confidence interval [CI]: 1.07 to 9.84; p = 0.03). No difference was found in LM injury incidence and amount of articular depression between groups. At final follow-up, average pain and ROM was similar between groups. Findings demonstrate a significant correlation between laterally hinged articular depression in Schatzker II tibial plateau fractures and concomitant MCL injury. (Journal of Surgical Orthopaedic Advances 32(4):270-275, 2023).
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Affiliation(s)
- Matthew P Lunati
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, Georgia
| | | | - J'Lynn L Baker
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, Georgia
| | - Jacob M Wilson
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, Georgia
| | - Thomas J Moore
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, Georgia
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Moore TJ, Alami A, Alexander GC, Mattison DR. Safety and effectiveness of
NMDA
receptor antagonists for depression: A multidisciplinary review. Pharmacotherapy 2022; 42:567-579. [PMID: 35665948 PMCID: PMC9540857 DOI: 10.1002/phar.2707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/18/2022]
Abstract
Ketamine, an anesthetic available since 1970, and esketamine, its newer S‐enantiomer, provide a novel approach for the treatment of depression and other psychiatric disorders. At subanesthetic doses, the two drugs, along with their older congener, phencyclidine (PCP), induce a transient, altered mental state by blocking the N‐methyl‐D‐aspartate (NMDA) receptor for glutamate, the primary excitatory neurotransmitter in the mammalian central nervous system. This multidisciplinary review examines the pharmacology/direct effects on consciousness, effectiveness in depression and acute suicidality, and safety of these fast‐acting NMDA antagonists. To capture the essence of 60 years of peer‐reviewed literature, we used a semi‐structured approach to the subtopics, each of which required a different search strategy. We review the evidence for the three primary reported benefits of the two clinical drugs when used for depression: success in difficult‐to‐treat patients, rapid onset of action within a day, and immediate effects on suicidality. Key safety issues include the evidence—and lack thereof—for the effects of repeatedly inducing this altered mental state, and whether an adequate safety margin exists to rule out the neurotoxic effects seen in animal studies. This review includes evidence from multiple sources that raise substantial questions about both safety and effectiveness of ketamine and esketamine for psychiatric disorders.
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Affiliation(s)
- Thomas J. Moore
- Center for Drug Safety and Effectiveness, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of EpidemiologyMilken Institute School of Public Health, The George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Abdallah Alami
- McLaughlin Centre for Population Health Risk AssessmentUniversity of OttawaOttawaOntarioCanada
- School of Mathematics and StatisticsCarleton UniversityOttawaOntarioCanada
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Division of General Internal MedicineJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Donald R. Mattison
- McLaughlin Centre for Population Health Risk AssessmentUniversity of OttawaOttawaOntarioCanada
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
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8
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Hwang YJ, Alexander GC, Moore TJ, Mehta HB. Author Response: Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease. Neurology 2022; 98:49-50. [PMID: 34965990 PMCID: PMC10501790 DOI: 10.1212/wnl.0000000000013043] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Affiliation(s)
- Jeromie Ballreich
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charles Bennet
- The University of South Carolina College of Pharmacy, Columbia.,The Center for Comparative Effectiveness, The City of Hope Comprehensive Cancer Center, Duarte, California
| | - Thomas J Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - G Caleb Alexander
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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10
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Hwang YJ, Alexander GC, An H, Moore TJ, Mehta HB. Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease. Neurology 2021; 97:e1266-e1275. [PMID: 34389652 DOI: 10.1212/wnl.0000000000012601] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the risk of hospitalization and death associated with pimavanserin use. METHODS We conducted a retrospective cohort study of adults 65 years and older with Parkinson's disease between November 1, 2015 and December 31, 2018 using an administrative dataset on residents of Medicare-certified long-term care facilities and linked Medicare claims data. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance pimavanserin users and nonusers on 24 baseline characteristics. Fine-Gray competing risk and Cox proportional hazards regression models were used to estimate the risk of hospitalization and death up to one year, respectively. RESULTS The study cohort included 2,186 pimavanserin users and 18,212 nonusers. There was a higher risk of 30-day hospitalization with pimavanserin use vs. nonuse (IPTW adjusted hazard ratio [aHR] 1.24, 95% confidence intervals [CI] 1.06-1.43). There was no association of pimavanserin use with 90-day hospitalization (aHR 1.10, CI 0.99-1.24) nor with 30-day mortality (aHR 0.76, CI 0.56-1.03). Pimavanserin use vs. nonuse was associated with an increased 90-day mortality (aHR 1.20, CI 1.02-1.41) that persisted after 180 days (aHR 1.28, CI 1.13-1.45) and 1 year (aHR 1.56, CI 1.42-1.72). CONCLUSIONS Pimavanserin use vs. nonuse in older adults was associated with an increased risk of hospitalization at one month of initiation and a higher risk of death for up to one year following initiation. These findings, in a large real-world cohort within long-term care facilities, may help to inform decisions regarding its risk-benefit balance among patients with Parkinson's disease. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with Parkinson's disease who are 65 or older and residing in Medicare-certified long-term care facilities, pimavanserin prescribing is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and, 365-day mortality.
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Affiliation(s)
- Y Joseph Hwang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD .,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD
| | - G Caleb Alexander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Huijun An
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas J Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Institute for Safe Medication Practices, Alexandria, VA.,Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Moore TJ, Wirtz PW, Kruszewski SP, Alexander GC. Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study. BMJ Open 2021; 11:e048528. [PMID: 34389573 PMCID: PMC8365816 DOI: 10.1136/bmjopen-2020-048528] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their medical and/or neurological conditions. DESIGN Cross-sectional study. SETTING Annual US Medical Expenditure Panel Survey, a stratified random sample of approximately 30 000 persons designed to produce national population estimates. It focuses on reported medical spending, medical services used, health status and prescription medications. PARTICIPANTS Adults age 19 years and older who reported obtaining one or more prescriptions for amphetamine or methylphenidate products during two survey years, 2013 and 2018. MAIN OUTCOMES MEASURES Prescriptions obtained, the specific stimulant product and annual treatment days of drug supplied. RESULTS In 2018, an estimated 4.1 million US adults (95% CI 3.4 million to 4.8 million) reported prescriptions for CNS stimulants, having filled a mean of 7.3 (95% CI 6.8 to 7.8) prescriptions with a mean of 226 (95% CI 210 to 242) days' supply. Compared with 2013, the estimated number of adults reporting using CNS stimulants in 2018 increased by 1.8 million (95% CI 1.0 million to 2.7 million) or 79.8%. Most 2018 adult stimulant users reported taking psychoactive medication for one or more mental, behavioural or neurodevelopment disorders. Overall, 77.8% (95% CI 72.6% to 83.0%) reported some medication for adult attention deficit disorder, 26.8% (95% CI 22.2% to 31.5%) took medication for anxiety, 25.1% (95% CI 19.9% to 30.3%) for depression and 15.3% (95% CI 9.8% to 20.8%) indicated drug treatment for other mental or neurological disorders. Adult CNS stimulant use was higher in females, in younger age cohorts and among individuals of white race/ethnicity. CONCLUSIONS Adult medical use of prescription stimulants increased markedly in 5 years and occurred in a population often reporting multiple mental or neurological disorders. Further action is needed to understand and manage this new resurgence in drugs with high risks of dependence.
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Affiliation(s)
- Thomas J Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Phillip W Wirtz
- Department of Decision Sciences, The George Washington University School of Business, Washington, DC, USA
| | - Stefan P Kruszewski
- Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Divison of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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12
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Moore TJ, Morrow RL, Dormuth CR, Mintzes B. US Food and Drug Administration Safety Advisories and Reporting to the Adverse Event Reporting System (FAERS). Pharmaceut Med 2021; 34:135-140. [PMID: 32180152 DOI: 10.1007/s40290-020-00329-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) and other major regulators regularly issue safety advisories about licensed drugs with new adverse effects that have been documented through observational studies, clinical trials, and spontaneously reported adverse drug events. OBJECTIVE To assess the possible effects of a representative group of FDA Drug Safety Communications on the reporting of the specific adverse effect featured in the advisory on new cases reported to the FDA Adverse Event Reporting System (FAERS). METHODS We examined 16 FDA Drug Safety Communications issued from 2010 to 2015 that had not previously been the focus of advisories from regulators in the UK, Canada, or Australia. We compared the reports of the adverse effect in the 8 calendar quarters preceding the advisory and in the 4 quarters following. We measured change in reporting frequency by calculating the event reporting odds ratio (ROR) for the post-warning compared to the pre-warning periods. We defined a credible association of the advisory with increased reporting as a ROR ≥ 2.0 and p value of < 0.05 by Fisher's Exact Test. RESULTS We found statistically significant increased reporting for 4/16 advisories with RORs that ranged from 3.9 to 40.6. Three advisories had smaller but still statistically significant increases that were less than the ROR ≥ 2.0 threshold. For 7 advisories, we found no statistically significant changes in reporting. CONCLUSIONS No consistent pattern or effect was found on spontaneous reporting following these safety advisories. After results were available, we observed that some cases with the largest reporting increase also involved substantial numbers of legal claims. Changes in adverse event reporting following a warning need to be evaluated on a case-by-case basis.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 916 Prince Street, Suite 102, Alexandria, VA, 22314, USA.
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Faculty of Medicine and Health, University of Sidney Charles Perkins Center and School of Pharmacy, Sydney, Australia
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Silber GK, Weller DW, Reeves RR, Adams JD, Moore TJ. Co-occurrence of gray whales and vessel traffic in the North Pacific Ocean. ENDANGER SPECIES RES 2021. [DOI: 10.3354/esr01093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
All species of large whales are susceptible to vessel strikes, but the true scale and geographical extent of such strikes is not known. This paper provides a qualitative assessment of the range-wide risks posed to gray whales Eschrichtius robustus by vessels, by comparing patterns of whale distribution with the density of vessel traffic seasonally throughout the North Pacific in 2019. Areas of very high vessel density were evident year-round near many coastlines, along inter-continental trade routes, and at hubs of commercial shipping near port entrances. Gray whales were exposed to vessel strikes throughout their range and in their feeding, southbound migration, wintering, and northbound migration periods. Areas of apparently high risk were in the Russian Far East (Kamchatka peninsula and Okhotsk Sea), Bering Sea (including the Aleutian Islands), Gulf of Alaska, and along the entire west coast of North America. Risk appeared greatest during south- and northbound migration when much of the gray whale population is moving through waters near shore. Tanker, container, and bulk-carrier ships represent considerable risk to whales in the North Pacific Ocean, but the large geographical extent of commercial fishing activities suggests that fisheries are also a substantial source of risk. Vessel-strike risk maps indicate the relative extent of exposure of gray (and other) whales to underwater vessel noise. The number of gray whales killed by ship strikes each year may be in the tens, or perhaps the low hundreds. Additional analyses, including quantitative assessments, are warranted to further clarify the risk of vessel strikes to gray whales.
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Affiliation(s)
- GK Silber
- Smultea Environmental Sciences, Washington Grove, MD 20880, USA
| | - DW Weller
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, NOAA, La Jolla, CA 92037, USA
| | - RR Reeves
- Okapi Wildlife Associates, Hudson, Quebec J0P1H0, Canada
| | - JD Adams
- Office of Protected Resources, National Marine Fisheries Service, NOAA, Silver Spring, MD 20910, USA
| | - TJ Moore
- Independent Researcher, Seattle, WA, USA
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Abstract
OBJECTIVE This study aimed to quantify the association between pharmaceutical industry payments to physicians for pimavanserin and both pimavanserin prescription volume and Medicare expenditures. METHODS This retrospective cross-sectional study used 2016 and 2017 data from Open Payments and the Medicare Part D Prescriber Public Use Files. The authors used Poisson regression models to quantify the association between physician payments for pimavanserin and pimavanserin prescription volume and linear regression models to quantify the association with Medicare expenditures for pimavanserin. RESULTS Of 1,609 physicians who prescribed pimavanserin, 45% received payments, which totaled to $6,369,922. Each $10,000 in physician payments was associated with a 14% increase in pimavanserin prescription volume (incident rate ratio=1.14, 95% confidence interval [CI]=1.13-1.14). Every $100 in physician payments was associated with a $175.84 increase in Medicare pimavanserin expenditures (95% CI=$161.55-$190.13). CONCLUSIONS Extensive physician payments have been associated with increased pimavanserin prescription volume and Medicare expenditures.
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Affiliation(s)
- Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (Mehta, Alexander); Institute for Safe Medication Practices, Alexandria, Virginia, and Department of Epidemiology, Milken Institute of Public Health, George Washington University, Washington, D.C. (Moore); Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore (Alexander)
| | - Thomas J Moore
- Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (Mehta, Alexander); Institute for Safe Medication Practices, Alexandria, Virginia, and Department of Epidemiology, Milken Institute of Public Health, George Washington University, Washington, D.C. (Moore); Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore (Alexander)
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (Mehta, Alexander); Institute for Safe Medication Practices, Alexandria, Virginia, and Department of Epidemiology, Milken Institute of Public Health, George Washington University, Washington, D.C. (Moore); Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore (Alexander)
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15
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Moore TJ, Mouslim MC, Blunt JL, Alexander GC, Shermock KM. Assessment of Availability, Clinical Testing, and US Food and Drug Administration Review of Biosimilar Biologic Products. JAMA Intern Med 2021; 181:52-60. [PMID: 33031559 PMCID: PMC7536628 DOI: 10.1001/jamainternmed.2020.3997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/14/2022]
Abstract
IMPORTANCE Biosimilar biologic products were authorized in 2010, after the US Congress established an expedited pathway for approval of clinically similar versions of approved biologic products. Unlike for most small-molecule generic drugs, approval requirements for a biosimilar included animal studies and a comparative efficacy clinical trial. OBJECTIVE To analyze the evidence required to support a biosimilarity license application, examine the US Food and Drug Administration (FDA) evaluation process, and estimate the costs of the key clinical trial evidence. DESIGN This study evaluated all biosimilar biologic products approved from January 2010 through October 2019, using the publicly available FDA review documents, disclosures from ClinicalTrials.gov, and the published peer-reviewed literature. The costs of efficacy clinical trials were estimated using licensed proprietary software. MAIN OUTCOMES AND MEASURES The following elements of each approved biosimilar were evaluated: the extent of human clinical testing to establish that the biosimilar had no clinically meaningful differences with the reference product, results of comparative animal studies, and FDA-cited application deficiencies. The cited deficiencies included the following categories: (1) facility inspection, (2) manufacturing or product quality, (3) animal studies, (4) laboratory analytical studies, (5) phase 1 and/or immunogenicity studies, and (6) phase 3 comparative efficacy trials. RESULTS As of October 2019, the FDA had approved 23 biosimilar biologics for 9 reference products. The 29 clinical trials that established that the efficacy of the biosimilar products was comparable to that of the reference products enrolled a median (interquartile range [IQR]) of 504 (258-612) patients, had a median (IQR) estimated cost of $20.8 ($13.8-$35.3) million, and had a median (IQR) treatment duration of 52 (28-68) weeks. Substantial deficiencies temporarily halted the review of 9 applications, and the most frequent deficits were failed facilities inspections (n = 5) and manufacturing process quality problems (n = 6). The approved biosimilar submissions included 51 animal studies on species that included mice, rats, rabbits, dogs, and cynomolgus monkeys. Negative outcomes in 2 animal studies were attributed to differences between human and test species. The FDA generally met the standard 12-month review deadlines or stopped the review clock when serious deficiencies were identified. CONCLUSIONS AND RELEVANCE This study found that most comparative efficacy trials supporting the FDA approval of biosimilars appeared to be as rigorous as and often larger, longer, and more costly than pivotal trials for new molecular entities. Further research is needed into whether less costly comparative efficacy trials could provide adequate evidence of biosimilarity and whether animal studies contribute useful scientific evidence.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia.,Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC
| | - Morgane C Mouslim
- The Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jenna L Blunt
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
| | - G Caleb Alexander
- The Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kenneth M Shermock
- The Center for Drug Safety and Effectiveness and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Pharmacy, Johns Hopkins Health System, Baltimore, Maryland
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16
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Heyward J, Moore TJ, Chen J, Meek K, Lurie P, Alexander GC. Key Evidence Supporting Prescription Opioids Approved by the U.S. Food and Drug Administration, 1997 to 2018. Ann Intern Med 2020; 173:956-963. [PMID: 32986486 DOI: 10.7326/m20-0274] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about the evidence required by the U.S. Food and Drug Administration (FDA) for new approvals of opioid analgesics. OBJECTIVE To characterize the quality of safety and efficacy data in new drug applications (NDAs) for opioid analgesics approved by the FDA between 1997 and 2018. DESIGN Cross-sectional analysis. SETTING Data from ClinicalTrials.gov, FDA reviews, and peer-reviewed publications. PARTICIPANTS Patients with pain who participated in phase 3 pivotal trials. INTERVENTION FDA-approved opioid analgesics. MEASUREMENTS Key characteristics of each NDA, including the number, size, and duration of pivotal trials; trial control groups; the use of enriched trial populations; and systematically measured safety outcomes. RESULTS Most of the 48 NDAs evaluated were for new dosage forms (n = 25 [52.1%]) or new formulations (n = 9 [18.8%]); only 1 (2.1%) was for a new molecular entity. Of 39 NDAs approved for treating chronic pain, only 21 products were supported by at least 1 pivotal trial; these trials (n = 28) had a median duration of 84 days (interquartile range [IQR], 25 to 84 days) and enrolled a median of 299 patients (IQR, 174 to 525 patients). Seventeen (81%) of these products were approved on the basis of designs that excluded patients who could not tolerate the drugs, had early adverse effects, or reported few immediate benefits. Among NDAs for chronic pain, 8 (20.5%) included pooled safety reviews that reported systematic assessment of diversion, 7 (17.9%) reported systematic measurement of nonmedical use, and 15 (38.5%) assessed development of tolerance. Eight of 9 products for acute pain were supported by at least 1 pivotal trial; the pivotal trials (n = 19) had a median duration of 1 day (IQR, 1 to 2 days) and enrolled a median of 329 patients (IQR, 199 to 456 patients). Although all but 1 of the 48 approved NDAs were for previously approved moieties, analysis of available NDAs for referent products yielded similar findings. LIMITATIONS The analysis was limited to approved opioids. Animal studies and nonpivotal trials were excluded. Evidence for safety in NDAs was presented for chronic pain only. CONCLUSION Between 1997 and 2018, the FDA approved opioids on the basis of pivotal trials of short or intermediate duration, often in narrowly defined pain populations of patients who could tolerate the drug. Systematic collation of certain important safety outcomes was rare. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- James Heyward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.H., J.C., K.M.)
| | - Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia, and George Washington University, Washington, DC (T.J.M.)
| | - Jennifer Chen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.H., J.C., K.M.)
| | - Kristin Meek
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.H., J.C., K.M.)
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC (P.L.)
| | - G Caleb Alexander
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Medicine, Baltimore, Maryland (G.C.A.)
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17
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Moore TJ, Heyward J, Anderson G, Alexander GC. Variation in the estimated costs of pivotal clinical benefit trials supporting the US approval of new therapeutic agents, 2015-2017: a cross-sectional study. BMJ Open 2020; 10:e038863. [PMID: 32532786 PMCID: PMC7295430 DOI: 10.1136/bmjopen-2020-038863] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Little is routinely disclosed about the costs of the pivotal clinical trials that provide the key scientific evidence of the treatment benefits of new therapeutic agents. We expand our earlier research to examine why the estimated costs may vary 100-fold. DESIGN A cross-sectional study of the estimated costs of the pivotal clinical trials supporting the approval of 101 new therapeutic agents approved by the US Food and Drug Administration from 2015 to 2017. METHODS We licensed a software tool used by the pharmaceutical industry to estimate the likely costs of clinical trials to be conducted by contract research organisations. For each trial we collected 52 study characteristics. Linear regression was used to assess the most important factors affecting costs. PRIMARY AND SECONDARY OUTCOME MEASURES The mean and 95% CI of 225 pivotal clinical trials using varying assumptions. We also assessed median estimated costs per patient, per clinic visit and per drug. RESULTS Measured as pivotal trials cost per approved drug, the 101 new molecular entities had an estimated median cost of US$48 million (IQR US$20 million-US$102 million). The 225 individual clinical trials had a median estimate of US$19 million (IQR US$12 million-US$33 million) per trial and US$41 413 (IQR, US$29 894-US$75 047) per patient. The largest single factor driving cost was the number of patients required to establish the treatment effects and varied from 4 patients to 8442. Next was the number of trial clinic visits, which ranged from 2 to 166. Our statistical model showed trial costs rose exponentially with these two variables (R2=0.696, F=257.9, p<0.01). CONCLUSIONS The estimated costs are modest for measuring the benefits of new therapeutic agents but rise exponentially as more patients and clinic visits are required to establish a drug effect.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia, USA
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - James Heyward
- Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gerard Anderson
- Department of Heath Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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18
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Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has prompted many initiatives to identify safe and efficacious treatments, yet little is known regarding where early efforts have focused. We aimed to characterise registered clinical trials assessing drugs or plasma treatments for COVID-19. DESIGN, SETTING AND PARTICIPANTS Cross-sectional analysis of clinical trials for the treatment of COVID-19 that were registered in the USA or in countries contributing to the WHO's International Clinical Trials Registry Platform. Relevant trial entries of drugs or plasma were downloaded on 26 March 2020, deduplicated, verified with reviews of major medical journals and WHO websites and independently analysed by two reviewers. MAIN OUTCOMES Trial intervention, sponsorship, critical design elements and specified outcomes RESULTS: Overall, 201 clinical trials were registered for testing the therapeutic benefits of 92 drugs or plasma, including 64 in monotherapy and 28 different combinations. Only eight (8.7%) products or combinations involved new molecular entities. The other test therapies had a wide range of prior medical uses, including as antivirals, antimalarials, immunosuppressants and oncology treatments. In 152 trials (75.7%), patients were randomised to treatment or comparator, including 55 trials with some form of blinding and 97 open-label studies. The 49 (24.4%) of trials without a randomised design included 29 single armed studies and 20 trials with some comparison group. Most trial designs featured multiple endpoints. Clinical endpoints were identified in 134 (66.7%) of trials and included COVID-19 symptoms, death, recovery, required intensive care and hospital discharge. Clinical scales were being used in 33 (16.4%) trials, most often measures of oxygenation and critical illness. Surrogate endpoints or biomarkers were studied in 88 (42.3%) of trials, primarily assays of viral load. Although the trials were initiated in more than 17 countries or regions, 100 (49.8%) were registered in China and 78 (37.8%) in the USA. Registered trials increased rapidly, with the number of registered trials doubling from 1 March to 26 March 2020. CONCLUSIONS While accelerating morbidity and mortality from the COVID-19 pandemic has been paralleled by early and rapid clinical investigation, many trials lack features to optimise their scientific value. Global coordination and increased funding of high-quality research may help to maximise scientific progress in rapidly discovering safe and effective treatments.
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Affiliation(s)
- Hemalkumar B Mehta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia, USA
| | - Jodi B Segal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Schwartz AM, Wilson JM, Boden SD, Moore TJ, Bradbury TL, Fletcher ND. Managing Resident Workforce and Education During the COVID-19 Pandemic: Evolving Strategies and Lessons Learned. JB JS Open Access 2020; 5:e0045. [PMID: 33117955 PMCID: PMC7408274 DOI: 10.2106/jbjs.oa.20.00045] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: The novel coronavirus and associated Coronavirus Disease 2019 (COVID-19) is
rapidly spreading throughout the world, with robust growth in the United
States. Its drastic impact on the global population and international health
care is swift, evolving, and unpredictable. The effects on orthopaedic
surgery departments are predominantly indirect, with widespread cessation of
all nonessential orthopaedic care. Although this is vital to the
system-sustaining measures of isolation and resource reallocation, there is
profound detriment to orthopaedic training programs. Methods: In the face of new pressures on the finite timeline on an orthopaedic
residency, the Emory University School of Medicine Department of
Orthopaedics has devised a 5-pronged strategy based on the following: (1)
patient and provider safety, (2) uninterrupted necessary care, (3) system
sustainability, (4) adaptability, and (5) preservation of vital leadership
structures. Results: Our 5 tenants support a 2-team system, whereby the residents are divided into
cycling “active-duty” and “working remotely”
factions. In observation of the potential incubation period of viral
symptoms, phase transitions occur every 2 weeks with strict adherence to
team assignments. Intrateam redundancy can accommodate potential illness to
ensure a stable unit of able residents. Active duty residents participate in
in-person surgical encounters and virtual ambulatory encounters, whereas
remotely working residents participate in daily video-conferenced
faculty-lead, case-based didactics and pursue academic investigation, grant
writing, and quality improvement projects. To sustain this, faculty and
administrative 2-team systems are also in place to protect the leadership
and decision-making components of the department. Conclusions: The novel coronavirus has decimated the United States healthcare system, with
an unpredictable duration, magnitude, and variability. As collateral damage,
orthopaedic residencies are faced with new challenges to provide care and
educate residents in the face of safety, resource redistribution, and
erosion of classic learning opportunities. Our adaptive approach aims to be
a generalizable tactic to optimize our current landscape.
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Affiliation(s)
- Andrew M Schwartz
- Emory University School of Medicine, Atlanta, Georgia.,Emory University Orthopaedics & Spine Hospital, Tucker, Georgia
| | - Jacob M Wilson
- Emory University School of Medicine, Atlanta, Georgia.,Emory University Orthopaedics & Spine Hospital, Tucker, Georgia
| | - Scott D Boden
- Emory University School of Medicine, Atlanta, Georgia.,Emory University Orthopaedics & Spine Hospital, Tucker, Georgia
| | - Thomas J Moore
- Emory University School of Medicine, Atlanta, Georgia.,Emory University Orthopaedics & Spine Hospital, Tucker, Georgia
| | - Thomas L Bradbury
- Emory University School of Medicine, Atlanta, Georgia.,Emory University Orthopaedics & Spine Hospital, Tucker, Georgia
| | - Nicholas D Fletcher
- Emory University School of Medicine, Atlanta, Georgia.,Children's Healthcare of Atlanta, Egelston Campus, Atlanta, Georgia
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20
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Abstract
BACKGROUND Pivotal clinical trials provide critical evidence to regulators regarding a product's suitability for marketing approval. The objectives of this study are (1) to characterize select features of trials for oncology products approved by the U.S. Food and Drug Administration between 2015 and 2017; and (2) to quantify the costs of these trials and how such costs varied based on trial characteristics. METHODS We identified novel oncology therapeutic drugs, and their respective pivotal trials, approved between 2015 and 2017 using annual summary reports from the Food and Drug Administration. Cost estimates for each pivotal trial were calculated using IQVIA's CostPro, a clinical trial cost estimating tool based on executed contracts between pharmaceutical manufacturers and contract research organizations. Measures of drug and trial characteristics included trial design, end point, patient enrollment, and regulatory pathway. We also performed sensitivity analyses that varied assumptions regarding how efficiently each trial was conducted. RESULTS A total of 39 pivotal clinical trials provided the basis for Food and Drug Administration approval of 30 new oncology drugs from 2015 to 2017. Among these trials, primary end points were objective response rate in 20 (51.3%), progression-free survival in 13 (33.3%), and overall survival in 6 (15.4%). Twenty trials (51.3%) were single-arm studies. The median estimated cost of oncology pivotal trials was $31.7 million (interquartile range = $17.0-$60.4 million). Trials with objective response rate as primary end point had a median estimate of $17.7 million (interquartile range = $11.9-$27.1 million), compared with trials examining progression-free survival ($42.3 million, interquartile range = $34.6-$101.2 million) or overall survival ($79.4 million, interquartile range = $56.9-$97.7 million) (p < 0.001). Estimated costs for single-arm trials ($17.7 million, interquartile range = $11.9-$23.7 million) were less than for trials with a placebo-controlled ($56.7 million, interquartile range = $40.9-$103.9 million) or active control arm ($67.6 million, IQR = $35.5-$93.5 million) (p < 0.001). CONCLUSIONS Relative to the estimated costs of drug development, the costs of these oncology pivotal trials were modest, with trials that produced more valuable scientific information costing more than their counterparts.
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Affiliation(s)
- Emily Han-Chung Hsiue
- Cellular and Molecular Medicine Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, VA, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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21
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Redfern JV, Moore TJ, Becker EA, Calambokidis J, Hastings SP, Irvine LM, Mate BR, Palacios DM. Evaluating stakeholder‐derived strategies to reduce the risk of ships striking whales. DIVERS DISTRIB 2019. [DOI: 10.1111/ddi.12958] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jessica V. Redfern
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration La Jolla California
| | - Thomas J. Moore
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration La Jolla California
| | - Elizabeth A. Becker
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration contracted by ManTech International Corporation Solana Beach California
| | | | - Sean P. Hastings
- Channel Islands National Marine Sanctuary Office of National Marine Sanctuaries, National Oceanic and Atmospheric Administration Santa Barbara California
| | - Ladd M. Irvine
- Marine Mammal Institute and Department of Fisheries and Wildlife, Hatfield Marine Science Center Oregon State University Newport Oregon
| | - Bruce R. Mate
- Marine Mammal Institute and Department of Fisheries and Wildlife, Hatfield Marine Science Center Oregon State University Newport Oregon
| | - Daniel M. Palacios
- Marine Mammal Institute and Department of Fisheries and Wildlife, Hatfield Marine Science Center Oregon State University Newport Oregon
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22
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Singer AD, Huynh T, Wong P, Sharma GB, Gonzalez F, Umpierrez M, Schenker ML, Moore TJ. CT can stratify patients as low risk for tibial neuropathy following a talus fracture. Emerg Radiol 2019; 26:541-548. [PMID: 31286323 DOI: 10.1007/s10140-019-01706-y] [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: 05/17/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Determine the incidence of tibial neuropathy following talus fractures and CT's ability to stratify patients at risk for developing post-traumatic neuropathy. MATERIALS AND METHODS In this IRB-approved retrospective analysis, 71 talus fractures and 8 contralateral control ankle CTs were reviewed by one observer blinded to clinical information. CT evidence suggestive of tibial neurovascular bundle injury included nerve displacement, perineural fat effacement/edema, and bone touching nerve. The association between these CT findings and clinically evident tibial neuropathy was analyzed. A semi-quantitative likelihood score was assigned based on the degree of the CT findings around the nerve. Interobserver agreement was calculated between 2 other readers. RESULTS Twenty-five percent of patients in this cohort had clinical evidence of tibial neuropathy. There was a high specificity (0.87-0.93) and negative predictive value (0.83-0.87), a moderate accuracy (0.80-0.82), but a lower sensitivity (0.33-0.56) associated with the CT findings. Among the CT findings, nerve displacement (p < 0.0001) and bone touching nerve (p = 0.01) were associated with tibial neuropathy. A likelihood score of 2-5 was associated (p = 0.007-0.015) with tibial neuropathy. The presence of tibial neuropathy and nerve recovery were not associated with hospital length of stay, while CT findings were. There was substantial agreement between the three readers: likelihood scores 2+ (k = 0.78) and 3+ (k = 0.72). CONCLUSIONS Tibial neuropathy occurs following talus fractures, and CT findings may help surgeons narrow down the number of patients requiring close neurological follow-up.
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Affiliation(s)
- Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| | - Tony Huynh
- School of Medicine, Augusta State University, Augusta, GA, USA
| | - Phil Wong
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | | | - Felix Gonzalez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Mara L Schenker
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Thomas J Moore
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
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23
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Aizpuru M, Farley KX, Rojas JC, Crawford RS, Moore TJ, Wagner ER. Motorized scooter injuries in the era of scooter-shares: A review of the national electronic surveillance system. Am J Emerg Med 2019; 37:1133-1138. [PMID: 30952603 DOI: 10.1016/j.ajem.2019.03.049] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [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: 12/24/2018] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There has been a spike in recent news regarding motorized scooter injuries due to the expansion of scooter sharing companies. Given the paucity of literature on this topic, the purpose of our study was to describe and quantify emergency department encounters associated with motorized scooter related injuries. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for motorized scooter related injuries from 2013 to 2017. Patient demographics, diagnosis, injury location, narrative description of incident, and disposition data were collected from emergency department encounters. RESULTS There were an estimated 32,400 motorized scooter injuries from 2013 to 2017. The estimated incidence did not change significantly over time with 1.9 cases per 100,000 in 2013 and 2.6 cases per 100,000 in 2017. A 77.0% increase in scooter injuries was noted for millennials from 2016 to 2017. Head injuries were the most common body area injured (27.6%). Fractures or dislocations (25.9%) were the most common diagnosis. The most common site of fracture was the wrist and lower arm (35.4%). There were no deaths. Major orthopaedic injury and concussion were the strongest independent predictors of hospital admission. CONCLUSIONS Head injuries were the most commonly injured body part, while fractures or dislocations were the most common diagnosis. These results highlight the importance of using protective equipment while riding motorized scooters, and lay a foundation for future policies requiring helmet use.
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Affiliation(s)
- Matthew Aizpuru
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kevin X Farley
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America
| | - Jaimie C Rojas
- New York Medical College, Valhalla, NY, United States of America
| | - Robert S Crawford
- Emory University School of Medicine, Department of Surgery, Vascular Division, Atlanta, GA, United States of America
| | - Thomas J Moore
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America
| | - Eric R Wagner
- Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, United States of America.
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24
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Abstract
BACKGROUND/AIMS Despite the increasing globalization of clinical trials, little is known regarding how the trial site costs vary around the world. We quantified the geographical distribution and regional cost differences for the clinical trials that established the benefits for new therapeutic drugs approved by the US Food and Drug Administration in 2015 and 2016. METHODS We included all pivotal clinical trials for 59 new molecular entities approved by the US Food and Drug Administration in 2015 and 2016 that included at least one site in North America. We derived cost estimates from IQVIA's CostPro, a global clinical trial cost-estimating tool used by pharmaceutical sponsors. We assessed the patient and site allocation of these trials across eight geographic regions. To quantify the region-specific cost differences, we conducted a within-trial comparison by expressing the estimated regional costs associated with the sites in each global region as a percent of the same costs in North America. We also estimated the percentage breakdown of regional cost components (pass-through, site management, regulatory, and study conduct costs) for each trial and for all endpoints reported the median and interquartile range. RESULTS Overall, 127 pivotal clinical trials enrolled 91,415 patients from 13,264 sites. Most patients (60.3%) and sites (57.3%) were outside North America. A median of 66% of the total estimated trial costs (interquartile range: 60%-72%) were spent on regional tasks, with the largest share (53.3%) going directly to trial sites and the remainder going to other regional trial management tasks. Differences were greatest in four lower cost regions: Africa, with an estimated regional cost per site of 49% of North America (interquartile range: 44%-56%), Central Europe 50% (interquartile range: 41%-63%), Middle East 53% (interquartile range: 42%-64%) and Latin America 59% (interquartile range: 50%-70%). Overall, 90 (71%) of the 127 pivotal trials had a total of 3160 sites in these lower cost regions. In contrast, savings were more limited in Western Europe, Oceania, and Asia, where estimated regional costs were 78% of North America (interquartile range: 67%-89%). One-quarter of the trials with sites in Asia and Oceana did not achieve cost savings in those regions relative to North America. CONCLUSION Among this sample of pivotal trials for recently approved US Food and Drug Administration products, most patients and sites enrolled were outside of North America, with selection of regional sites having a significant impact on total trial costs.
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Affiliation(s)
- Yao Qiao
- 1 Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Caleb Alexander
- 1 Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,3 Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Thomas J Moore
- 4 Institute for Safe Medication Practices, Alexandria, VA, USA.,5 Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Rafael Arceo S, Runner RP, Huynh TD, Gottschalk MB, Schenker ML, Moore TJ. Disparities in follow-up care for ballistic and non-ballistic long bone lower extremity fractures. Injury 2018; 49:2193-2197. [PMID: 30314632 DOI: 10.1016/j.injury.2018.09.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe differences in follow-up compliance and emergency department (ED) visits between ballistic and non-ballistic operative lower extremity fracture patients. DESIGN Retrospective study. SETTING Urban level 1 trauma center. PATIENTS/PARTICIPANTS Patients age ≥18 years with ≥1 tibia or femur fractures treated with ORIF or intramedullary nailing (IMN) between September 1, 2013 and August 31, 2015. MAIN OUTCOME MEASURE A compliance fraction calculated as ([number of attended follow-up visits] / [number of attended follow-up visits + number of missed follow-up visits]) and ED visits in the post-operative period. RESULTS 612 patients were studied. Patients with ballistic lower extremity fractures had a younger mean age (30.8 years v. 41.6 years; p < 0.0001); a shorter length of stay (5.00 days v. 8.00 days; p < 0.0001); and were more likely to be male (92.6% v. 68%; p < 0.0001) and African-American (90.1% v. 63.1%; p < 0.0001) when compared to non-ballistic long bone injuries. Increased follow-up compliance (defined as a compliance fraction ≥0.75) was associated with having a non-ballistic fracture (OR 1.73, 1.13-2.64; p = 0.01), not having an ED visit (OR 2.08, 1.30-3.33; p = 0.002), and being female (OR 1.82, 1.27-2.61; p = 0.001). Increased ED utilization (≥ 1 ED visit) was associated with ballistic mechanism (OR 1.95, 1.20-3.16; p = 0.006), a low follow-up compliance fraction (OR 2.08, 1.30-3.33; p = 0.0019), homelessness (OR 3.91, 1.53-9.98; p = 0.006), and African-American race (OR 2.26, 1.26-4.05; p = 0.05). Scheduling a specific follow-up visit on the discharge summary did not predict higher compliance (OR 1.51, 0.98-2.33; p = 0.06). Conversely, the lack of a specific follow-up visit scheduled on the discharge summary did not predict ED utilization (OR 0.63, 0.34-1.17; p = 0.14). CONCLUSION The results of this study demonstrate that increased utilization of the ED was associated with ballistic fractures, homelessness, decreased clinic compliance, and African American race. Furthermore, patients with non-ballistic injuries, women, and those without any ED visit were more likely to have higher outpatient clinic compliance.
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Affiliation(s)
- S Rafael Arceo
- Emory University School of Medicine, Department of Medicine, United States
| | - Robert P Runner
- Emory University School of Medicine, Department of Orthopaedics, United States
| | | | | | - Mara L Schenker
- Emory University School of Medicine, Department of Orthopaedics, United States
| | - Thomas J Moore
- Emory University School of Medicine, Department of Orthopaedics, United States.
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Moore TJ, Zhang H, Anderson G, Alexander GC. Estimated Costs of Pivotal Trials for Novel Therapeutic Agents Approved by the US Food and Drug Administration, 2015-2016. JAMA Intern Med 2018; 178:1451-1457. [PMID: 30264133 PMCID: PMC6248200 DOI: 10.1001/jamainternmed.2018.3931] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [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: 12/16/2022]
Abstract
IMPORTANCE A critical question in health care is the extent of scientific evidence that should be required to establish that a new therapeutic agent has benefits that outweigh its risks. Estimating the costs of this evidence of efficacy provides an important perspective. OBJECTIVE To estimate costs and assess scientific characteristics of pivotal efficacy trials that supported the approval of new therapeutic agents by the US Food and Drug Administration (FDA) from 2015 to 2016. DESIGN AND SETTING This study identified 59 novel therapeutic drugs using the annual summary reports from the FDA Center for Drug Evaluation and Research. ClinicalTrials.gov, FDA reviews, and peer-reviewed publications that were publicly available in 2017 were used to identify 52 characteristics of each efficacy trial. Costs were calculated with a global clinical trial cost assessment tool available to contract research organizations and pharmaceutical sponsors. MAIN OUTCOMES AND MEASURES Estimated mean cost and 95% CIs based on industry benchmark data from 60 countries. Measures of trials' scientific characteristics included trial design (no control group, placebo, and active drug), end point (surrogate outcome, clinical scale, and clinical outcome), patient enrollment, and treatment duration. RESULTS A total of 138 pivotal clinical trials provided the basis for approval of 59 new therapeutic agents by the FDA from 2015 to 2016, with a median estimated cost of $19.0 million (interquartile range, $12.2 million-$33.1 million). Estimated costs ranged from less than $5 million for trials without a control group for 3 orphan drugs with fewer than 15 patients each to $346.8 million (95% CI, $252.0 million-$441.5 million) for a noninferiority trial with end points assessing clinical benefit. Twenty-six of 138 trials (18.8%) were uncontrolled, with a mean estimated cost of $13.5 million (95% CI, $10.1 million-$16.9 million). Trials designed with placebo or active drug comparators had an estimated mean cost of $35.1 million (95% CI, $25.4 million-$44.8 million). Costs also varied by trial end point, treatment duration, patient enrollment, and therapeutic area. CONCLUSIONS AND RELEVANCE The highest-cost trials were those in which the new agent had to be proved to be noninferior with clinical benefit end points compared with an agent already available or those that required larger patient populations to achieve statistical power to document smaller treatment effects or accrue infrequently occurring end points.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia.,Department of Epidemiology and Biostatistics, Milken Institute of Public Health, George Washington University, Washington, DC
| | - Hanzhe Zhang
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerard Anderson
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Fleming AH, Yack T, Redfern JV, Becker EA, Moore TJ, Barlow J. Combining acoustic and visual detections in habitat models of Dall’s porpoise. Ecol Modell 2018. [DOI: 10.1016/j.ecolmodel.2018.06.014] [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: 10/28/2022]
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Abstract
This study evaluates data from the US Medical Expenditure Panel Survey to determine the extent of unsafe use of zolpidem.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia.,Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, Washington, DC
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Abstract
SummaryWe examined the effect of angiotensin II (AII) on platelet activation in 15 normotensive volunteers. By measuring the initial phase of platelet aggregation on the optical density aggregation tracing and generation of thromboxane production, we demonstrated that AII enhances collagen-induced platelet activation. This enhancement in platelet activation is significantly greater when subjects are on a high salt than on a low salt diet. Furthermore, the increase in platelet activation parallels an increase in platelet AII receptor number. These parallel changes in platelet activation and platelet AII receptors provide a possible mechanism through which AII may affect platelet function.
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Affiliation(s)
- Stephen L Swartz
- The Department of Endocrinology/Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - Thomas J Moore
- The Department of Endocrinology/Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
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Affiliation(s)
- Lisa M Schwartz
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Steven Woloshin
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Affiliation(s)
- Steven Woloshin
- From the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (S.W., L.M.S.); AtlantiCare Regional Medical Center, Pomona, NJ (B.W.) ; the Institute for Safe Medication Practices, Alexandria, VA (T.J.M.); and the Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC (T.J.M.)
| | - Lisa M Schwartz
- From the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (S.W., L.M.S.); AtlantiCare Regional Medical Center, Pomona, NJ (B.W.) ; the Institute for Safe Medication Practices, Alexandria, VA (T.J.M.); and the Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC (T.J.M.)
| | - Brian White
- From the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (S.W., L.M.S.); AtlantiCare Regional Medical Center, Pomona, NJ (B.W.) ; the Institute for Safe Medication Practices, Alexandria, VA (T.J.M.); and the Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC (T.J.M.)
| | - Thomas J Moore
- From the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (S.W., L.M.S.); AtlantiCare Regional Medical Center, Pomona, NJ (B.W.) ; the Institute for Safe Medication Practices, Alexandria, VA (T.J.M.); and the Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC (T.J.M.)
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Fitzgerald CA, Moore TJ, Morse BC, Subramanian A, Dente CJ, Patel DC, Reisman WM, Schenker ML, Gelbard RB. The Role of Diverting Colostomy in Traumatic Blunt Open Pelvic Fractures. Am Surg 2017; 83:e280-e282. [PMID: 28822360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Fitzgerald CA, Moore TJ, Morse BC, Subramanian A, Dente CJ, Patel DC, Reisman WM, Schenker ML, Gelbard RB. The Role of Diverting Colostomy in Traumatic Blunt Open Pelvic Fractures. Am Surg 2017. [DOI: 10.1177/000313481708300805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Thomas J. Moore
- Department of Orthopedic Surgery Emory University Atlanta, Georgia
| | | | | | | | | | | | - Mara L. Schenker
- Department of Orthopedic Surgery Emory University Atlanta, Georgia
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Redfern JV, Moore TJ, Fiedler PC, de Vos A, Brownell RL, Forney KA, Becker EA, Ballance LT. Front Cover. DIVERS DISTRIB 2017. [DOI: 10.1111/ddi.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Redfern JV, Hatch LT, Caldow C, DeAngelis ML, Gedamke J, Hastings S, Henderson L, McKenna MF, Moore TJ, Porter MB. Assessing the risk of chronic shipping noise to baleen whales off Southern California, USA. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00797] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Redfern JV, Moore TJ, Fiedler PC, de Vos A, Brownell RL, Forney KA, Becker EA, Ballance LT. Predicting cetacean distributions in data-poor marine ecosystems. DIVERS DISTRIB 2017. [DOI: 10.1111/ddi.12537] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jessica V. Redfern
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 8901 La Jolla Shores Drive La Jolla CA 92037 USA
| | - Thomas J. Moore
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 8901 La Jolla Shores Drive La Jolla CA 92037 USA
| | - Paul C. Fiedler
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 8901 La Jolla Shores Drive La Jolla CA 92037 USA
| | - Asha de Vos
- Department of Ecology and Evolutionary Biology; Centre for Ocean Health; University of California, Santa Cruz; 115 McAllister Way Santa Cruz CA 95060 USA
- The Sri Lankan Blue Whale Project; 131 W.A.D. Ramanayake Mawatha Colombo 2 Sri Lanka
| | - Robert L. Brownell
- Granite Canyon Laboratory; Southwest Fisheries Science Center; NOAA Fisheries; 34500 Highway 1 Monterey CA 93940 USA
| | - Karin A. Forney
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 110 McAllister Way Santa Cruz CA 95060 USA
| | - Elizabeth A. Becker
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 110 McAllister Way Santa Cruz CA 95060 USA
| | - Lisa T. Ballance
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; NOAA Fisheries; 8901 La Jolla Shores Drive La Jolla CA 92037 USA
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia
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Abstract
This safety assessment provides a detailed analysis of key studies and focuses on the six most widely used antipsychotic drugs. Lines of evidence include mechanisms of action, short-term treatment of psychosis, relapse prevention, early intervention in schizophrenia, long-term comparisons between first- and second-generation agents, and flexible treatment algorithms. Despite the diversity of study settings, several common features were seen. All the agents obstruct normal signaling through widely dispersed dopamine D2 receptors. Treatment failure or psychosis relapse was the most frequent outcome in most key studies, ranging from 38 to 93%. High discontinuation rates caused most trials to fail to demonstrate a substantial treatment benefit, or difference from an active comparator. Assessment of harm to the extrapyramidal motor system was confounded because of extensive neurological impairment from previous antipsychotic drug treatment measured at baseline, abrupt discontinuation effects, and high rates of concomitant medications to manage drug adverse effects. Claims that second-generation antipsychotic drugs have safety advantages over classical neuroleptic drugs and prevent relapse were not supported in these key studies. The extent of injury to and impairment of multiple body systems caused by antipsychotic drugs shows the need for a scientific, clinical, and regulatory reappraisal of the appropriate use of these agents.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 101 N. Columbus St, Suite 410, Alexandria, VA, 22314, USA. .,Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Curt D Furberg
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 101 N Columbus St, Suite 410, Alexandria, VA 22314, USA
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Abstract
What has been learned about electronic health data as a primary data source for regulatory decisions regarding the harms of drugs? Observational studies with electronic health data for postmarket risk assessment can now be conducted in Europe and the US in patient populations numbering in the tens of millions compared with a few hundred patients in a typical clinical trial. With standard protocols, results can be obtained in a few months; however, extensive research published by scores of investigators has illuminated the many obstacles that prevent obtaining robust, reproducible results that are reliable enough to be a primary source for drug safety decisions involving the health and safety of millions of patients. The most widely used terminology for coding patient interactions with medical providers for payment has proved ill-suited to identifying the adverse effects of drugs. Directly conflicting results were reported in otherwise similar patient health databases, even using identical event definitions and research methods. Evaluation of some accepted statistical methods revealed systematic bias, while others appeared to be unreliable. When electronic health data studies detected no drug risk, there were no robust and accepted standards to judge whether the drug was unlikely to cause the adverse effect or whether the study was incapable of detecting it. Substantial investment and careful thinking is needed to improve the reliability of risk assessments based on electronic health data, and current limitations need to be fully understood.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 101 N. Columbus St, Suite 410, Alexandria, VA, 22214, USA,
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Moore TJ, Furberg CD, Mattison DR, Cohen MR. Completeness of serious adverse drug event reports received by the US Food and Drug Administration in 2014. Pharmacoepidemiol Drug Saf 2016; 25:713-8. [DOI: 10.1002/pds.3979] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas J. Moore
- Institute for Safe Medication Practices; Horsham PA USA
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health; George Washington University; Washington DC USA
| | - Curt D. Furberg
- Division of Public Health Sciences; Wake Forest University School of Medicine; Winston-Salem NC USA
| | - Donald R. Mattison
- University of Ottawa and Risk Sciences International; Ottawa Ontario Canada
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Edwards EF, Hall C, Moore TJ, Sheredy C, Redfern JV. Global distribution of fin whales B
alaenoptera physalus
in the post-whaling era (1980-2012). Mamm Rev 2015. [DOI: 10.1111/mam.12048] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth F. Edwards
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; National Marine Fisheries Service; National Oceanic and Atmospheric Administration; 8901 La Jolla Shores Dr. La Jolla CA 92037 USA
| | - Candice Hall
- Roffers Ocean Fishing Forecasting Service, Inc.; 60 Westover Drive West Melbourne FL 32904 USA
| | - Thomas J. Moore
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; National Marine Fisheries Service; National Oceanic and Atmospheric Administration; 8901 La Jolla Shores Dr. La Jolla CA 92037 USA
| | - Corey Sheredy
- Amec Earth and Environmental; 9210 Sky Park Ct San Diego CA 92123 USA
| | - Jessica V. Redfern
- Marine Mammal and Turtle Division; Southwest Fisheries Science Center; National Marine Fisheries Service; National Oceanic and Atmospheric Administration; 8901 La Jolla Shores Dr. La Jolla CA 92037 USA
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Roginskaya M, Moore TJ, Ampadu-Boateng D, Razskazovskiy Y. Efficacy and site specificity of hydrogen abstraction from DNA 2-deoxyribose by carbonate radicals. Free Radic Res 2015; 49:1431-7. [PMID: 26271311 DOI: 10.3109/10715762.2015.1081187] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The carbonate radical anion CO(3)(•-) is a potent reactive oxygen species (ROS) produced in vivo through enzymatic one-electron oxidation of bicarbonate or, mostly, via the reaction of CO(2) with peroxynitrite. Due to the vitally essential role of the carbon dioxide/bicarbonate buffer system in regulation of physiological pH, CO(3)(•-) is arguably one of the most important ROS in biological systems. So far, the studies of reactions of CO(3)(•-) with DNA have been focused on the pathways initiated by oxidation of guanines in DNA. In this study, low-molecular products of attack of CO(3)(•-) on the sugar-phosphate backbone in vitro were analyzed by reversed phase HPLC. The selectivity of damage in double-stranded DNA (dsDNA) was found to follow the same pattern C4' > C1' > C5' for both CO(3)(•-) and the hydroxyl radical, though the relative contribution of the C1' damage induced by CO(3)(•-) is substantially higher. In single-stranded DNA (ssDNA) oxidation at C1' by CO3(•-) prevails over all other sugar damages. An approximately 2000-fold preference for 8-oxoguanine (8oxoG) formation over sugar damage found in our study identifies CO(3)(•-) primarily as a one-electron oxidant with fairly low reactivity toward the sugar-phosphate backbone.
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Affiliation(s)
- M Roginskaya
- a Department of Chemistry , East Tennessee State University , Johnson City , USA
| | - T J Moore
- a Department of Chemistry , East Tennessee State University , Johnson City , USA
| | - D Ampadu-Boateng
- a Department of Chemistry , East Tennessee State University , Johnson City , USA
| | - Y Razskazovskiy
- b Department of Physics and Astronomy , East Tennessee State University , Johnson City , USA
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia2Department of Epidemiology and Biostatics, George Washington University Milken Institute School of Public Health, Washington, DC
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Mansour A, Sridhar MS, Jamieson S, Moore TJ. Iatrogenic Femoral Neck Fracture After Closed Reduction of Anterior Hip Dislocation in the Emergency Department. Am J Orthop (Belle Mead NJ) 2015; 44:E278-E282. [PMID: 26251944] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case report detailing an iatrogenic femoral neck fracture (FNF) after closed reduction of an anterior hip dislocation. While iatrogenic FNF is a known complication of closed reduction, there are few published reports of the circumstances surrounding these fractures, and there has been no discussion of possible risk factors predisposing to this injury. This case report and review of the literature identifies the current incidence of FNF with closed reduction of anterior dislocations of the hip, as well as possible antecedent risk factors for this complication. As a result of this case report, we have changed our protocol for treatment of these injuries.
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Affiliation(s)
- Ashton Mansour
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
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Cook CE, Moore TJ, Learman K, Showalter C, Snodgrass SJ. Can experienced physiotherapists identify which patients are likely to succeed with physical therapy treatment? Arch Physiother 2015; 5:3. [PMID: 29340172 PMCID: PMC5721702 DOI: 10.1186/s40945-015-0003-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/28/2015] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of the study was to determine if clinician predicted prognosis is associated with patient outcomes. Methods The study was a secondary analysis of data that were collected in 8 physiotherapy outpatient clinics. Nine physiotherapists with post-graduate training in manual therapy (mean 20.3 years of experience) were asked at baseline to project the outcome of the patients evaluated. In total, 112 patients with low back (74 %) or neck (26 %) pain were treated pragmatically with interventions consisting of manual therapy, strengthening, and patient-specific education. Outcomes measures consisted of percent change in disability (Oswestry or Neck Disability Index), self-reported rate of recovery (0–100 %), and percent change in pain (numerical pain rating scale). Hierarchical logistic regression determined potential factors (clinician predicted prognosis score (1–10) at baseline, dichotomised as poor (1–6) and good (7–10); symptom duration categorised as acute, subacute or chronic; same previous injury (yes/no); baseline pain and disability scores; within-session improvement at initial visit (yes/no); and presence of ≥ one psychological factor) associated with meaningful changes in each of the three outcomes at discharge (disability and pain > 50 % improvement, rate of recovery ≥82.5 % improvement). Results Clinician predicted prognosis (OR 4.15, 95%CI = 1.31, 13.19, p = 0.02) and duration of symptoms (OR subacute 0.24, 95%CI = 0.07, 0.89, p = 0.03; chronic 0.21, 95%CI = 0.05, 0.90, p = 0.04) were associated with rate of recovery, whereas only clinician predicted prognosis was associated with disability improvement (OR 4.28, 95 % CI 1.37, 13.37, p = 0.01). No variables were associated with pain improvement. Conclusions Clinician predicted prognosis is potentially valuable for patients, as a good predicted prognosis is associated with improvements in disability and rate of recovery.
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Affiliation(s)
- Chad E Cook
- Department of Orthopaedics, Duke University, 2200 Main Street, 27705 Durham, NC USA
| | - Thomas J Moore
- Department of Physical and Occupational Therapy, Duke University Medical Center, Clinic 1E, Trent Drive and Erwin Road, 27710 Durham, NC USA
| | - Kenneth Learman
- Department of Physical Therapy, One University Plaza, 44555 Youngstown, Ohio USA
| | | | - Suzanne J Snodgrass
- Department of Physiotherapy, University Drive, 2308 Callaghan, NSW Australia
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Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med 2014; 174:1930-3. [PMID: 25329919 DOI: 10.1001/jamainternmed.2014.5262] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [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: 12/16/2022]
Abstract
IMPORTANCE Severe impulse control disorders involving pathological gambling, hypersexuality, and compulsive shopping have been reported in association with the use of dopamine receptor agonist drugs in case series and retrospective patient surveys. These agents are used to treat Parkinson disease, restless leg syndrome, and hyperprolactinemia. OBJECTIVES To analyze serious adverse drug event reports about these impulse control disorders received by the US Food and Drug Administration (FDA) and to assess the relationship of these case reports with the 6 FDA-approved dopamine receptor agonist drugs. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective disproportionality analysis based on the 2.7 million serious domestic and foreign adverse drug event reports from 2003 to 2012 extracted from the FDA Adverse Event Reporting System. MAIN OUTCOMES AND MEASURES Cases were selected if they contained any of 10 preferred terms in the Medical Dictionary for Regulatory Activities (MedDRA) that described the abnormal behaviors. We used the proportional reporting ratio (PRR) to compare the proportion of target events to all serious events for the study drugs with a similar proportion for all other drugs. RESULTS We identified 1580 events indicating impulse control disorders from the United States and 21 other countries:710 fordopamine receptor agonist drugs and 870 for other drugs. The dopamine receptor agonist drugs had a strong signal associated with these impulse control disorders (n = 710; PRR = 277.6, P < .001). The association was strongest for the dopamine agonists pramipexole (n = 410; PRR = 455.9, P < .001) and ropinirole (n = 188; PRR = 152.5, P < .001), with preferential affinity for the dopamine D3 receptor. A signal was also seen for aripiprazole, an antipsychotic classified as a partial agonist of the D3 receptor (n = 37; PRR = 8.6, P < .001). CONCLUSIONS AND RELEVANCE Our findings confirm and extend the evidence that dopamine receptor agonist drugs are associated with these specific impulse control disorders. At present, none of the dopamine receptor agonist drugs approved by the FDA have boxed warnings as part of their prescribing information. Our data, and data from prior studies, show the need for more prominent warnings.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, Virginia2Department of Epidemiology and Biostatistics, The George Washington University Milken Institute School of Public Health, Washington, DC
| | - Joseph Glenmullen
- Department of Psychiatry, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Donald R Mattison
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, and Risk Sciences International, Ottawa, Ontario, Canada
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, Alexandria, VA 22314, USA
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 200 Lakeside Drive, Suite 200, Horsham, PA 19044, USA
| | - Michael R Cohen
- Institute for Safe Medication Practices, 200 Lakeside Drive, Suite 200, Horsham, PA 19044, USA
| | - Donald R Mattison
- Risk Sciences International, Ottawa, ON, Canada University of Ottawa, Ottawa
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Becker EA, Forney KA, Foley DG, Smith RC, Moore TJ, Barlow J. Predicting seasonal density patterns of California cetaceans based on habitat models. ENDANGER SPECIES RES 2014. [DOI: 10.3354/esr00548] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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