Scott Martin Vouri

Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis

INTRODUCTION Antimuscarinics should be used with caution in older adults with overactive bladder (OAB) due to anticholinergic adverse events (AEs). Systematic reviews and meta-analyses (SRMAs) have analyzed safety-related outcomes but have not specified risk in the elderly, the population at highest risk for AEs. The aim of this review is to explore and evaluate AEs and treatment discontinuations in adults 65 or older taking antimuscarinics for OAB. METHODS Keywords were searched in MEDLINE, EMBASE, SCOPUS, and Cochrane Central Register for Controlled Trials. Randomized controlled trials (RCTs) along with sub-analyses and pooled analyses that compared antimuscarinics to placebo or another antimuscarinic were performed in February 2015. Studies assessing AEs or treatment discontinuations in a population of adults 65 or older were included. The Jadad Criteria and McHarm Tool were used to assess the quality of the trials. RESULTS A total of 16 studies met the inclusion criteria. Eighty AEs and 27 reasons for treatment discontinuation were described in the included studies and further explored. Anticholinergic AEs were more common in antimuscarinics compared to placebo. Incidence of dizziness, dyspepsia, and urinary retention with fesoterodine, headache with darifenacin, and urinary tract infections with solifenacin were significantly higher compared to placebo. Treatment discontinuation due to AEs and dry mouth were higher in the antimuscarinics when compared to placebo in older adults. CONCLUSIONS Treatment for overactive bladder using antimuscarinics in adults aged 65 or older resulted in significant increases in risk for several AEs compared to placebo including anticholinergic and non-anticholinergic AEs.

Tadalafil: A Phosphodiesterase-5 Inhibitor for Benign Prostatic Hyperplasia

Tadalafil is a phosphodisesterase (PDE)‐5 inhibitor recently approved by the United States Food and Drug Administration for lower urinary tracts symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). The mechanism for improved LUTS is thought to be related to three principal theories: alterations in nitric oxide levels, Rho‐associated protein kinase deactivation, and reductions in pelvic atherosclerosis. The efficacy of PDE‐5 inhibitors for the treatment of LUTS associated with BPH has been demonstrated in several randomized placebo‐controlled trials. Tadalafil is thought to be superior based on an extended half‐life; however, other PDE‐5 inhibitors have positive results in BPH and have not been proved to be inferior to tadalafil. Before administration, concomitant use of medications such as nonselective α‐adrenergic antagonists, nitrates, and cytochrome P450 inhibitors should be assessed for possible drug interactions. Potential adverse drug events seen in Food and Drug Administration–approved tadalafil include back pain, dyspepsia, headache, and dizziness. Given the efficacy and safety data currently available, the PDE‐5 inhibitor tadalafil represents a reasonable alternative for selected male patients with LUTS associated with BPH, especially with concomitant erectile dysfunction.

A review of cardiovascular and renal function monitoring: a consideration of older adults with HIV

The prevalence of human immunodeficiency virus (HIV) infection in older and elderly adults is significant worldwide. This population poses new challenges and opportunities in the management of HIV. In addition to the risks affecting HIV patients of all ages, including risk of opportunistic infection and medication resistance, age-related changes in physiology, higher comorbidity burdens, increased use of medications, and potential adverse drug reactions to HIV medications all factor into the care of older adults with HIV. The risk and progression of cardiovascular and renal comorbidities may be higher in the older adult HIV population and in patients taking specific HIV medications. Understanding these risks is essential when managing a new type of patient: the older adult with HIV.

Immunosuppressants and risk of Parkinson disease

We performed a population‐based case–control study of United States Medicare beneficiaries age 60–90 in 2009 with prescription data (48,295 incident Parkinson disease cases and 52,324 controls) to examine the risk of Parkinson disease in relation to use of immunosuppressants. Inosine monophosphate dehydrogenase inhibitors (relative risk = 0.64; 95% confidence interval 0.51–0.79) and corticosteroids (relative risk = 0.80; 95% confidence interval 0.77–0.83) were both associated with a lower risk of Parkinson disease. Inverse associations for both remained after applying a 12‐month exposure lag. Overall, this study provides evidence that use of corticosteroids and inosine monophosphate dehydrogenase inhibitors might lower the risk of Parkinson disease.

Impact of co-investigators on pharmacy resident research publication

Objective: To explore influences of co-investigators on the successful publication of a pharmacy residency project. Methods: We analyzed published and non-published research presented at a regional pharmacy conference. Abstracts were matched 1:1 based on state and abstract year. We assessed university affiliation, number, degree, and H-Index of co-investigators on the abstract. Descriptive and inferential analyses were used to identify variables associated with resident publication. Results: University-affiliated programs (p=0.015), highest H-Index of a non-physician co-investigator (p=0.002), and positive H-Index (≥1) of a non-physician co-investigator (p=0.017) were significant predictors of resident publication on univariate analyses. There were no differences in the number of co-investigators (p=0.051), projects with physician co-investigators (p=1.000), or projects with Doctor of Philosophy (PhD) or Master of Science (MS) co-investigators (p=0.536) between published and non-published projects. Multivariate analysis found that the highest H-index of non-physician co-investigator remained significant as a predictor to resident publication (odds ratio (OR) 1.09, 95% Confidence Interval (CI) 1.01-1.17). Conclusions: The quality of co-investigators, as measured by an increasing H-Index, is associated with the successful publication of residency projects. More emphasis may need to be placed on resident research co-investigator selection and training to prepare pharmacy residents for research and scholarly activity.

Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report

A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient.

Antimuscarinic Use in Men Treated With Bladder Outlet Obstruction Medication Therapy

OBJECTIVE To assess changes over time in the use of antimuscarinics (AM) among visits in adult men treated with bladder outlet obstruction (BOO) medication therapy (ie, alpha blocker and 5-alpha reductase inhibitors). METHODS We used the National Ambulatory Medicare Care Survey database (2006-2014) to identify men aged 40 or older, who initiated or continued on BOO medication therapy. Among these visits, we assessed the percentage of AM and evaluated trends of AM use across between 2006 and 2014 using multivariable logistic regression. RESULTS Overall, there were 7561 patient visits in men aged 40 or older, who were treated with BOO medication therapy between 2006 and 2014 which equates to approximately 158 million visits in the United States after incorporating National Ambulatory Medicare Care Survey weights. Overall, AM was used in 3.7% of visits, among those who were treated with BOO medication therapy; use of AM increased with age. In the multivariable analysis, there was no increasing trend in the use of AM in 2006 relative to subsequent years through 2014 (P = .8104). CONCLUSION Despite a previous study that showed an increasing trend in antimuscarinic use among patients coded for lower urinary tract symptoms or benign prostatic hyperplasia between 1993 and 2010, several recent randomized-controlled trials, and a recommendation in a clinical practice guideline in 2010, we found no increasing trend in antimuscarinic use among visits in men who were treated with BOO medication therapy in 2006 compared to subsequent years. This suggests the potential undertreatment of antimuscarinics and an area for improved prescribing.

Antidiabetic medication de-escalation following bariatric surgery: 减肥手术之后可以降级使用降糖药物

Approximately 216,000 bariatric surgery (BS) procedures were performed in 2016; an increase from 158,000 in 2011.1 This increase may be attributable to the rising awareness of beneficial effects on health and the improving safety profile of BS. According to the National Institutes of Health consensus criteria, patients qualify for bariatric surgery if they have a body mass index (BMI) ≥35 kg/m2 but <40 kg/m2 along with at least one obesity-related comorbidity or have a BMI ≥40 kg/m2 .

Treated-and-released urinary catheterization in the emergency department by sex

HighlightsUrinary catheterization was assessed in emergency department visits.Prevalence of urinary catheterization was 4.3 per 1,000 treated‐and‐released visits.Differences in appropriate urinary catheter use were found between sexes.Further quality improvement projects in treated‐and‐released visits are needed. Background The prevalence and difference in likely indications of urinary catheterization (UC) in treated‐and‐released emergency department (ED) visits between men and women are currently unknown. Methods This was a cross‐sectional analysis using the 2013 National Emergency Department Sample for all treated‐and‐released visits in persons aged ≥18 years. The prevalence of conditions associated with UC visits in men and women were identified. A hierarchical ranking was used to categorize diagnosis codes identified during ED visits into clinically meaningful categories to assess conditions for UC. Results In 2013, there were 87,797,062 treated‐and‐released ED visits in adults. The rate of UC in treated‐and‐released ED visits in adults was 4.3 per 1,000 visits, with 6.5 per 1,000 visits in men and 2.7 per 1,000 visits in women. Using the hierarchal ranking, a higher proportion of UC visits in men were coded for acute urinary retention, and a higher proportion of UC visits in women were coded for neurologic, cognitive, and psychiatric conditions. Conclusions The rate of UC in treated‐and‐released ED visits was higher in men than women, and UC rate increased with age. The heterogeneity of conditions coded in UC visits in women compared with men may suggest more potentially avoidable UC in women in the treated‐and‐released ED population. If confirmed, this would suggest opportunities for quality improvement in the ED to prevent overutilization of urinary catheters.

Comments on Validity and Reliability of a Systematic Database Search Strategy to Identify Publications Resulting From Pharmacy Residency Research Projects

We would like to respond to the article entitled ‘‘Validity and reliability of a systematic database search strategy to identify publications resulting from pharmacy residency research projects.’’ We agree with the authors’ novel approach to confirm publication via a survey and to identify resident publications via a systematic approach to validate the utility of the database. The authors suggest that this approach can be used to compare publication success between residency programs. Additionally, this information can be used for marketing purposes for the individual residency program. One limitation noted by the authors was the use of only PubMed and EMBASE as the search engines to identify resident publications in the study and suggest other search engines, such as International Pharmaceutical Abstracts (IPA) and Google Scholar, may be used as alternatives. We aim to describe the methods and results of our project in which we assessed the utility of 5 different search engines to identify resident publications. Briefly, we identified the publication rate of abstracts presented at the 2003 (n 1⁄4 171), 2005 (n 1⁄4 221), and 2007 (n 1⁄4 273) Great Lakes Pharmacy Resident Conference (GLPRC) was 11.4% (n 1⁄4 76). We used a similar search strategy in Kwak et al to identify resident publication using the search engines (1) Scopus, (2) IPA, and (3) MEDLINE (PubMed). For this project, we used information from the abstracts that were previously confirmed for publications (n 1⁄4 76) to identify the proportion of these publications found in each of the following search engines: (1) Scopus, (2) IPA, (3) MEDLINE (PubMed), (4) EMBASE, and (5) Google Scholar. Two investigators (SMV and PMS) identified published research projects, and any disagreement between investigators was reviewed for consensus. A kappa statistic was calculated to determine interrater reliability for each search engine. The proportion of the published research was compared for each of the 5 search engines. Additionally, all pairs of search engines were assessed to determine the proportion published using combinations of searches. The proportions of published works were identified in the following search engines: Scopus (90.8%), IPA (75%), MEDLINE (PubMed; 80.3%), EMBASE (88.2%), and Google Scholar (90.8%; Table 1). Additionally, a higher proportion of nonpharmacy journals were identified using the search strategy compared to pharmacy journals (Table 1) in each individual search engine. After assessing various combinations, only Scopus plus IPA or Google Scholar plus IPA identified all 76 publications (Table 2). Based on our results, no single search engine was able to identify all publications. All 9 potential pairs were assessed. Only the combination use of either Scopus and IPA or Google Scholar and IPA resulted in identifying all 76 publications. The use of MEDLINE (PubMed) and EMBASE resulted in the poorest combination of search engines, as it only identified 88.2% (n 1⁄4 67) of publications. Kwak et al used the combination of MEDLINE (PubMed) and EMBASE with great success; however, the utility of this combination may differ in a general population of residency programs. Residents of certain geographic areas may submit to journals indexed to different search engines which may have contributed to the differences between our study and Kwak et al, as we assessed abstracts from the Great Lakes region. Additionally, confirmed publications in our previous search strategy used Scopus, IPA, and MEDLINE (PubMed) and not a validated measure which may have influenced our results. In conclusion, we affirm that a validated measure approach, as used by Kwak et al, is the gold standard for confirming the utility of various search engines; however, it may be difficult to replicate in a larger, generalized population of residents. The use of a single search engine is likely not adequate to identify all published residents’ studies. Regional differences may exist in the use of search engines, as the combination of MEDLINE (PubMed) and EMBASE resulted in a high sensitivity in Kwak