Jill T. Johnson

Variation in Anticoagulant Recommendations by the Guidelines and Decision Tools among Patients with Atrial Fibrillation

Published atrial fibrillation (AF) guidelines and decision tools offer oral anticoagulant (OAC) recommendations; however, they consider stroke and bleeding risk differently. The aims of our study are: (i) to compare the variation in OAC recommendations by the 2012 American College of Chest Physicians guidelines, the 2012 European Society of Cardiology (ESC) guidelines, the 2014 American Heart Association (AHA) guidelines and two published decision tools by Casciano and LaHaye; (ii) to compare the concordance with actual OAC use in the overall study population and the population stratified by stroke/bleed risk. A cross-sectional study using the 2001–2013 Lifelink claims data was used to contrast the treatment recommendations by these decision aids. CHA2DS2-VASc and HAS-BLED algorithms were used to stratify 15,129 AF patients into nine stroke/bleed risk groups to study the variation in treatment recommendations and concordance with actual OAC use/non-use. The AHA guidelines which were set to recommend OAC when CHA2DS2-VASc = 1 recommended OAC most often (86.30%) and the LaHaye tool recommended OAC the least often (14.91%). OAC treatment recommendations varied considerably when stroke risk was moderate or high (CHA2DS2-VASc > 0). Actual OAC use/non-use was highly discordant (>40%) with all of the guidelines or decision tools reflecting substantial opportunities to improve AF OAC decisions.

Treatment of metastatic melanoma with pazopanib: A report of five patient cases:

Metastatic melanoma has a median length of survival after diagnosis of 6–9 months. Unfortunately, the National Comprehensive Cancer Network clinical practice guidelines for treating stage IV, unresectable, metastatic melanoma are limited with regard to treatment options. Pazopanib (Votrient™) is FDA-approved for advanced soft tissue sarcoma and advanced renal cell carcinoma. Limited research exists for using pazopanib in the treatment of metastatic melanoma. We present five cases in which pazopanib was used in combination with paclitaxel ± carboplatin for treatment of unresectable, metastatic melanoma.

An Advanced Pharmacy Practice Experience in Application of Evidence-Based Policy

Objective. To determine the impact of an advanced pharmacy practice experience (APPE) to develop skills needed to apply an evidence-based approach to population-level practice decisions. Design. A 4-week evidence-based medicine APPE was implemented that included active-learning techniques and online learning modules, participation in state drug-policy committee meetings, and completion of an evidence-based medicine review for a specific drug agent or class. Assessment. Students’ mean score on application of principles related to biostatistics and information mastery on posttests increased 15.8% from pretest to posttest. Students’ mean score on a 22-question information mastery quiz was 90.8%. Mean scores for course evaluation components ranged from 4.8 to 5.0 on a 5-point Likert scale. All respondents indicated they would recommend the APPE to other students. Conclusions. An APPE that incorporated content from active drug-policy committees increased students’ evidence-based medicine skills and enhanced their understanding of, appreciation for, and confidence in evidence-based practice.