Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

2021 ◽  
pp. 001857872110375
Author(s):  
Frank A. Fanizza ◽  
Jennifer Loucks ◽  
Angelica Berni ◽  
Meera Shah ◽  
Dennis Grauer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Medication Adherence ◽  
Hcv Treatment ◽  
Clinical Pharmacists ◽  
The Mean ◽  
Group 2 ◽  
Cure Rates ◽  
The Impact ◽  
Mean Time ◽  
Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

scholarly journals Revisiting conventional adenoidectomy using technology

2020 ◽  
Vol 6 (7) ◽  
pp. 1232
Author(s):  
Kiran Gangadhar S. ◽  
Sonee Thingujam ◽  
Jayita Poduval
Keyword(s):  
Blood Loss ◽  
Paediatric Population ◽  
Lateral View ◽  
Respiratory Pathogens ◽  
Moderate Degree ◽  
Ventilation Tubes ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Adenoidectomy is one of the most frequently applied surgical procedures in the paediatric population, either alone or in conjunction with tonsillectomy and/or insertion of ventilation tubes. The main purpose of the adenoidectomy is to eliminate the nasopharyngeal respiratory pathogens and to remove nasal airway obstruction. Aim of the study was to compare the outcomes of conventional and endoscopic assisted curettage adenoidectomy.</p><p class="abstract"><strong>Methods:</strong> In this comparative study, 50 patients were divided into 2 groups. Group 1 (25 patients) underwent endoscopic curettage adenoidectomy and group 2 (25 patients) underwent conventional curettage adenoidectomy. Intraoperative time, complications and postoperative pain were recorded.  </p><p class="abstract"><strong>Results:</strong> 72% in group 1 and 64% in group 2 had grade 2 adenoid hypertrophy. 68% in group 1 and 64% in group 2 had a moderate degree of obstruction in lateral view of soft tissue X-ray nasopharynx. The mean time taken for surgery in group 1 was 13.29±3.28 minutes, and in group 2,6.28±2.31 minutes. Minimal loss of blood was recorded in group 1 with less than 20 ml, whereas in group 2, the blood loss was high; 30% of patients had blood loss more than 30 ml. In group 1, the mean VAS was 3.25 and 2.55 in group 2 2.55. In group 1, 4% of patients had primary haemorrhage and in group 2, 8% of patients had primary haemorrhage. No patient had velopharyngeal dysfunction in either group.</p><p class="abstract"><strong>Conclusions:</strong> More operative time but less blood loss were noted in endoscopic adenoidectomy. Intraoperative visualisation of the nasopharynx in endoscopic procedures showed no significant advantage over conventional adenoidectomy.</p>

scholarly journals Performance of Venous Port Catheter Insertion by a General Surgeon: A Prospective Study

2015 ◽  
Vol 100 (5) ◽  
pp. 827-835 ◽  
Author(s):  
Mehmet Aziret ◽  
Oktay İrkörücü ◽  
Cihan Gökler ◽  
Enver Reyhan ◽  
Süleyman Çetinkünar ◽  
...  
Keyword(s):  
Vascular Access ◽  
Catheter Insertion ◽  
Port Catheter ◽  
Insertion Procedure ◽  
Venous Port ◽  
Stay Time ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

As part of the vascular access procedures, venous ports, commonly referred to as catheters, are placed under the skin to enable safe and easy vascular access for administration of repeated drug treatments. 122 patients who had received a venous port catheter insertion procedure in the general surgery department between January 1012 and January 2014 were involved in this study. Patients were divided into two groups: those who had undergone a fluoroscopy (group 1) and those who had not undergone a fluoroscopy (group 2). Complications that emerged during and after the port catheter insertion procedure and successful insertion rates were recorded in the database. Data of these patients were presented in a prospective manner. There were 92 to 30 patients in groups 1 and 2, respectively. In group 1, the mean age was approximately 56.8, total catheter stay time was 20,631 days, and mean time of port use was 224.2 days. In group 2, the mean age was approximately 61.2, total catheter stay time was 13,575 days, and mean time of port use was 452.5 days. Successful insertion rate was 100% and 90% in groups 1 and 2, respectively (P &lt; 0.05). The proper insertion of the port catheter accompanied by monitoring methods can decrease procedure-related complications. Statistical comparisons between the two groups in terms of malposition and successful insertion rates also support this view (P &lt; 0.05). The findings support the view that in cancer patients, a venous port catheter insertion accompanied by a fluoroscopy can be safely performed by general surgeons.

scholarly journals Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

2021 ◽  
Author(s):  
Can Öztürk ◽  
Kim Sprenger ◽  
Noriaki Tabata ◽  
Atsushi Sugiura ◽  
Marcel Weber ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Independent Predictor ◽  
Time Varying ◽  
Severe Mitral Regurgitation ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

Comparison of power-free-chop and phaco-chop techniques for moderate nucleus

2020 ◽  
Author(s):  
Haiqing Bai ◽  
Lin Yao
Keyword(s):  
Healing Process ◽  
Corneal Thickness ◽  
Dissipated Energy ◽  
Thickness Variation ◽  
Negative Effects ◽  
Chi Square ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

Abstract Background: To compare intraoperative and postoperative effects of power-free-chop and phaco-chop techniques for moderate nucleus in phacoemulsification sugery. Methods: Sixty patients were evaluated in 2 groups prospectively. The power-free-chop technique was performed in Group 1 (30 eyes) and the phaco-chop technique in Group 2 (30 eyes). There were no significant differerces between these 2 groups. The cumulative dissipated energy (CDE), time to achieve maximum vision, corneal thickness variation, and time to return to the preoperative values were collected. All parameters were statistically compared in these 2 groups by using the chi-square test and the independent-sample t test. Results: The CDE was 5.53±1.92J in Group 1 and 7.02±1.77J in Group 2. After the operation, the mean time to recover to the maximum vision was 2.80±1.42 days in Group 1 and 3.80±1.92 days in Group 2 respectively. The mean postoperative corneal thickness increased 36.9±14.74μm in Group1 and 46.20±20.67μm in Group 2. And the mean time to return to preoperative pachymetry values were 3.73±1.70 days and 4.83±2.11 days, in Group 1 and Group 2 respectively. There were significant differences in these parameters between both groups. Conclusions: The power-free-chop technique had fewer negative effects on the corneal endothelium as less ultrasound power was used for moderate nucleus cases. This can accelerate the functional healing process and the return to preoperative physiologic values.

Value-based neurosurgery: the example of microvascular decompression surgery

2014 ◽  
Vol 120 (2) ◽  
pp. 462-472 ◽  
Author(s):  
Nancy McLaughlin ◽  
Farzad Buxey ◽  
Karen Chaw ◽  
Neil A. Martin
Keyword(s):  
Trigeminal Neuralgia ◽  
Outcome Measures ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Care ◽  
Decompression Surgery ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

The impact of different preventive counseling programs on medication adherence in patients with paroxysmal atrial fibrillation after catheter ablation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Pogosova ◽  
AI Ovchinnikova ◽  
YM Yufereva ◽  
OY Sokolova ◽  
KV Davtyan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Catheter Ablation ◽  
Group Support ◽  
Counseling Programs ◽  
Preventive Counseling ◽  
Group 2 ◽  
The Impact ◽  
E Mail ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background Poor medication adherence is a major contributor to suboptimal health outcomes and increased costs in cardiovascular (CV) diseases including atrial fibrillation (AF). Purpose To assess the impact of different preventive counseling programs on medication adherence in AF patients (pts) after catheter ablation (CA). Methods A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. Medication adherence was assessed using the 4-item Morisky-Green scale at baseline and at 12 months.  Results A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features. Baseline levels of non-adherenсe and partial adherence were high in all groups (53.4%, 71.1% and 73.3% respectively). At 1 year of follow-up pts from both intervention groups demonstrated a significant improvement of medication adherence vs control (table).  Conclusions Preventive counseling programs with remote support via phone or e-mail improve medication adherence in AF pts after CA. Мedication adherence 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 months P for Group 2 vs. control at 12 months Baseline After 12 months Baseline After 12 months Baseline After 12 months Adherence,% 46.7 60 28.9 60 26.7 31.1 &lt;0.01 &lt;0.01 Partial adherence ,% 17.8 20 31.1 20 24.4 33.3 n/s n/s Non-adherence,% 35.6 60 40 20 48.9 35.6 n/s n/s

scholarly journals Evaluation of Metachronous Breast and Endometrial Cancers: Preroutine and Postroutine Adjuvant Tamoxifen Use

2016 ◽  
Vol 26 (8) ◽  
pp. 1440-1447 ◽  
Author(s):  
Kassondra S. Grzankowski ◽  
J. Brian Szender ◽  
Chandra L. Spring-Robinson ◽  
Shashikant B. Lele ◽  
Kunle O. Odunsi ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Adjuvant Tamoxifen ◽  
Time Interval ◽  
Primary Tumors ◽  
Previous Diagnosis ◽  
Clinicopathologic Factors ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

BackgroundThe time interval between diagnoses of breast cancer (BC) and endometrial cancer (EC) is not well established in women with metachronous primary tumors. We sought to examine this interval and identify associations with treatment-related and clinicopathologic factors.MethodsWe identified 141 patients who developed both cancers during 1966 to 2013. Patients were divided into 2 groups: group 1, BC first, and group 2, EC first. Subanalysis performed of group 1 (59 patients) stratified around adjuvant tamoxifen use: pre-1990 BC diagnosis and post.ResultsFifty-nine and 82 patients were in groups 1 and 2, respectively. The mean time interval was comparable (76 vs 74 months,P= 0.861). Subanalysis divided group 1 into pre- (n = 27) and post- (n = 32) 1990 and resulted in different mean time intervals between diagnosis of metachronous cancers (106 vs 50 months, respectively [P= 0.042]). Median progression-free survival (PFS) and overall survival (OS) for EC were longer in the pre group (PFS, 51 vs 26 months [P= 0.169]; OS, 59 vs 27 months [P= 0.190]). Median PFS and OS for BC were also longer in this group (PFS, 147 vs 109 months [P= 0.005]; OS, 166 vs 114 months [P< 0.001]).ConclusionsOur data indicate the mean time interval between the diagnosis of EC and BC was approximately 6 years. Disease-specific EC survival was worse for patients with a previous diagnosis of BC. Stratification around implementation of tamoxifen use shows comparable grade and stage but different time interval and survival, suggesting resulting effects from adjuvant therapy for BC. These results are useful in counseling women at risk.

scholarly journals Comparison of power-free-chop and phaco-chop techniques for moderate nuclei

2020 ◽  
Author(s):  
Lin Yao ◽  
Haiqing Bai
Keyword(s):  
Healing Process ◽  
Corneal Thickness ◽  
Dissipated Energy ◽  
Thickness Variation ◽  
Negative Effects ◽  
Chi Square ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

Abstract Background: To compare the intraoperative and postoperative effects of power-free-chop and phaco-chop techniques for moderate nuclei in phacoemulsification surgery. Methods: Sixty patients were evaluated in 2 groups prospectively. The power-free-chop technique was performed in Group 1 (30 eyes), and the phaco-chop technique was performed in Group 2 (30 eyes). There were no significant differences between these 2 groups. The cumulative dissipated energy (CDE), time to achieve maximum vision, corneal thickness variation, and time to return to the preoperative values were collected. All parameters were statistically compared in these 2 groups by using the chi-square test and the independent-sample t -test. Results: The CDE was 5.53±1.92 J in Group 1 and 7.02±1.77 J in Group 2. After the operation, the mean time to recover to the maximum vision was 2.80±1.42 days in Group 1 and 3.80±1.92 days in Group 2. The mean postoperative corneal thickness increased 36.9±14.74 μm in Group 1 and 46.20±20.67 μm in Group 2. The mean time to return to preoperative pachymetry values was 3.73±1.70 days and 4.83±2.11 days in Group 1 and Group 2, respectively. There were significant differences in these parameters between the groups. Conclusions: The power-free-chop technique had fewer negative effects on the corneal endothelium, as less ultrasound power was used for moderate nucleus cases. This can accelerate the functional healing process and the return to preoperative physiologic values.

scholarly journals RATIONAITY AND INTERVENTION EFFICIENCY OF CLINICAL PHARMACIST IN USAGE PAINKILLERS AFTER OPERATION

2021 ◽  
Vol 62 (3) ◽  
Author(s):  
Bui Dang Phuong Chi ◽  
Bui Dang Minh Tri ◽  
Bui Tung Hiep ◽  
Tran Nhat Anh
Keyword(s):  
Adverse Effects ◽  
General Surgery ◽  
Pain Treatment ◽  
Pain Scores ◽  
Post Operative Pain ◽  
The Mean ◽  
Group 2 ◽  
Surgery Department ◽  
Mean Time ◽  
Group 1

Objectives: To evaluate the rationality and effectiveness of clinical pharmacist’s intervention in the use of painkillers for post-operative pain treatment at the General Surgery Department of Cai Nuoc General Hospital. Objects and methods: Cross-sectional descriptive study on 172 patients (patients) undergoing surgery at General Surgery Department, Cai Nuoc General Hospital. Results: There were 38.95% of patients studied with adverse effects when using painkillers. The average duration of painkiller use after surgery was 5.6 ± 4.0 days. The differences in the mean time to take the drug between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. On 2 research groups, in general, the average VAS score after 1 day surgery was 4.2 ± 1.9 points and after 7 days was 1.1 ± 0.8 points. Increase the reasonable rate in choosing drugs group 2 with reasonable rate was had a reasonable rate of 68.18%, much higher than group 1 with 46.43%. Conclusion: The incidence of adverse effects was low. The differences in the mean time to take the drug 70.45%, much higher than group 1 with 42.86%; drug dose, group 2 had reasonable rate was 82.95%, much higher than group 1 with 55.95%; the rationality of drug use, group 2 between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. Increase the rationality of drug selection, drug dosage, and general rationality of post-operative pain treatment.

scholarly journals The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions.

2015 ◽  
Vol 17 (2) ◽  
pp. 175
Author(s):  
Esin Yencilek ◽  
Aysegul Sarsılmaz ◽  
Ozgur Kilickesmez ◽  
Hakan Koyuncu ◽  
Bilal Eryildirim ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Resistive Index ◽  
Optimal Time ◽  
Time Interval ◽  
Index Measurement ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Aims: To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. Material and methods: Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2±3.9 years) and group 2 (≥40 years, mean age 55.4±6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. Results: The mean stone size was 2 8.97±3.62 in group 1 and 10.08±4.67 mm in group 2 (p=0.077). Following SWL, the  RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). Conclusions: RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL. 

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