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Oliveira do Hospital, Portugal

Samson C.M.,Gastroenterology
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

OBJECTIVES:: To utilize pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD. METHODS:: We identified 362 pediatric IBD patients seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts’ member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%. RESULTS:: Among our 362 patients, we matched 228 (63%) within Express Scripts’ eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication. Their mean MPR was 0.63?±?0.31 (SD) and 40% had an MPR ≥ 80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72?±?0.28 vs. 0.51?±?0.32, P?=?0.002) and patients whose MPR were ≥ 80% were more likely to have a PGA of remission than those with whose MPR were < 80% (84% vs. 43%, P?=?<0.001). CONCLUSIONS:: We found a significant association between refill adherence and clinical remission. Nonadherence was common and was more common in adolescents. Use of PBM databases to identify and intervene on patients with poor adherence may improve outcomes in pediatric IBD. © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,


Chen M.,U.S. Food and Drug Administration | Suzuki A.,Gastroenterology | Suzuki A.,University of Arkansas for Medical Sciences | Borlak J.,Hannover Medical School | And 3 more authors.
Journal of Hepatology | Year: 2015

Idiosyncratic drug-induced liver injury (DILI) is a common cause for drug withdrawal from the market and although infrequent, DILI can result in serious clinical outcomes including acute liver failure and the need for liver transplantation. Eliminating the iatrogenic "harm" caused by a therapeutic intent is a priority in patient care. However, identifying culprit drugs and individuals at risk for DILI remains challenging. Apart from genetic factors predisposing individuals at risk, the role of the drugs' physicochemical and toxicological properties and their interactions with host and environmental factors need to be considered. The influence of these factors on mechanisms involved in DILI is multi-layered. In this review, we summarize current knowledge on 1) drug properties associated with hepatotoxicity, 2) host factors considered to modify an individuals' risk for DILI and clinical phenotypes, and 3) drug-host interactions. We aim at clarifying knowledge gaps needed to be filled in as to improve risk stratification in patient care. We therefore broadly discuss relevant areas of future research. Emerging insight will stimulate new investigational approaches to facilitate the discovery of clinical DILI risk modifiers in the context of disease complexity and associated interactions with drug properties, and hence will be able to move towards safety personalized medicine. © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Moayyedi P.,McMaster University | Ford A.C.,McMaster University | Talley N.J.,Gastroenterology | Cremonini F.,Mayo Medical School | And 3 more authors.
Gut | Year: 2010

Introduction: Probiotics may benefit irritable bowel syndrome (IBS) symptoms, but randomised controlled trials (RCTs) have been conflicting; therefore a systematic review was conducted. Methods: MEDLINE (1966 to May 2008), EMBASE (1988 to May 2008) and the Cochrane Controlled Trials Register (2008) electronic databases were searched, as were abstracts from DDW (Digestive Diseases Week) and UEGW (United European Gastroenterology Week), and authors were contacted for extra information. Only parallel group RCTs with at least 1 week of treatment comparing probiotics with placebo or no treatment in adults with IBS according to any acceptable definition were included. Studies had to provide improvement in abdominal pain or global IBS symptoms as an outcome. Eligibility assessment and data extraction were performed by two independent researchers. Data were synthesised using relative risk (RR) of symptoms not improving for dichotomous data and standardised mean difference (SMD) for continuous data using random effects models. Results: 19 RCTs (18 papers) in 1650 patients with IBS were identified. Trial quality was generally good, with nine reporting adequate methods of randomisation and six a method of concealment of allocation. There were 10 RCTs involving 918 patients providing outcomes as a dichotomous variable. Probiotics were statistically significantly better than placebo (RR of IBS not improving = 0.71; 95% CI 0.57 to 0.88) with a number needed to treat (NNT) = 4 (95% CI 3 to 12.5). There was significant heterogeneity (χ2 = 28.3, p = 0.001, I2 = 68%) and possible funnel plot asymmetry. Fifteen trials assessing 1351 patients reported on improvement in IBS score as a continuous outcome (SMD = -0.34; 95% CI -0.60 to -0.07). There was statistically significant heterogeneity (χ2 = 67.04, p<0.001, I2 = 79%), but this was explained by one outlying trial. Conclusion: Probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain.


Dyson J.K.,Gastroenterology | Rutter M.D.,University Hospital of North Tees
World Journal of Gastroenterology | Year: 2012

The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) has been recognised since 1925 and still accounts for 10%-15% of deaths in IBD. IBD-associated CRC (IBD-CRC) affects patients at a younger age than sporadic CRC. The prognosis for sporadic CRC and IBD-CRC is similar, with a 5-year survival of approximately 50%. Identifying at risk patients and implementing appropriate surveillance for these patients is central to managing the CRC risk in IBD. The increased risk of colorectal cancer in association with IBD is thought to be due to genetic and acquired factors. The link between inflammation and cancer is well recognised but the molecular biology, immune pathobiology and genetics of IBD-CRC are areas of much ongoing research. This review examines the literature relating to IBD-CRC, focusing on the incidence of IBD-CRC and examining potential risk factors including age at diagnosis, gender, duration and extent of colitis, severity of inflammation, family history of sporadic CRC and co-existent primary sclerosing cholangitis (PSC). Confirmed risk factors for IBD-CRC are duration, severity and extent of colitis, the presence of co-existent PSC and a family history of CRC. There is insufficient evidence currently to support an increased frequency of surveillance for patients diagnosed with IBD at a younger age. Evidence-based guidelines advise surveillance colonoscopy for patients with colitis 8 to 10 years after diagnosis, with the interval for further surveillance guided by risk factors (extent of disease, family history of CRC, post-inflammatory polyps, concomitant PSC, personal history of colonic dysplasia, colonic strictures). There is a move away from using random colonic biopsies towards targeted biopsies aimed at abnormal areas identified by newer colonoscopic techniques (narrow band imaging, chromoendoscopy, confocal microendoscopy). © 2012 Baishideng.


Akoh J.A.,Gastroenterology
Current Infectious Disease Reports | Year: 2011

Infection is the most challenging and life-threatening complication of vascular access and causes significant morbidity, loss of access, and mortality. The aims of this review are to determine the magnitude of the infection problem, identify possible factors, and provide an update on the management of vascular access infections. Infections account for approximately 15% to 36% of all deaths in dialysis patients (the second leading cause after cardiovascular events) and for about 20% of admissions. Several studies demonstrate a hierarchy of infection risk from temporary catheter, tunnelled cuffed catheter, arteriovenous grafts, to arteriovenous fistula in decreasing order. Suspicion of infection must be followed by appropriate blood cultures, including possible simultaneous sampling from a peripheral vein and the access. The best way to treat vascular access infection is prevention, bearing in mind the idea "fistula first" and "lines last", with the appropriate use of arteriovenous grafts and newer devices sandwiched in between. © 2011 Springer Science+Business Media, LLC.

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