Long-term safety and disease control with ruxolitinib cream among patients with atopic dermatitis based on previous medication history: Pooled results from two phase 3 studies

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Digital Medical Record System using Blockchain Technology: A Survey

In these modern times where diseases, viral flu, and infections are too common for the human being, to tackle this problem sometimes it gets hard, as the patient has incomplete documents of their diagnostics in case the document get lost for certain reason or patient left some important reports at home, and carrying a file every single time when patients visit a doctor is quite a burden, and some doctors give fake medication to the patients, and as patient migrate to a new place and visits a doctor then that particular doctor would need all patients previous medication and hereditary diseases information if any, doctor has to go through the whole check-up in order to get any allergies for certain medication or any lab reports if there are missing any. Keywords: Blockchain, Hyperledger Fabric, Medical Records, Orderers, Radiologist, Tester, Patient, Doctor

Acute Hepatitis in Pregnancy – Diagnostic Challenges

A 35-year-old nulliparous woman, 22 weeks of gestation, with no relevant personal or family history, on Doxylamine Succinate+ Dicyclomine Hydrochloride + Pyridoxine Hydrochloride and Chlorpromazine, was admitted in the Obstetric Department for hyperemesis gravidarum. Physical examination was unremarkable. After stopping her previous medication, she was started on ondansetron. Blood analysis revealed INR 1.0; AST 525U/L; ALT 952U/L, GGT 55U/L, FA 72U/L, total bilirubin (TB) 2.05mg/dL, with direct of 1.37mg/dL. Abdominal ultrasound only revealed vesicular microlithiasis. Choledocholithiasis or hyperemesis gravidarum were the preliminary diagnostic hypotheses.

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Background With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. Methods We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. Results We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. Conclusions We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.

P645 Mental health, work presenteeism and exercise in IBD patients

Background IBD has been shown to increase the rates of anxiety and depression amongst diagnosed individuals, with a prevalence rate of approximately 15- 20%. Chronic diseases such as IBD can have a significant impact on productivity at work (presenteeism). This can lead to emotional distress, poor quality of life and cost effects on employers. The primary aim of the study was to assess the prevalence of psychological problems, exercise levels and presenteeism at work among IBD patients. Methods This was a multicentre international study whereby IBD patients (>18 years) in clinical remission over the last year, were asked to answer an anonymous questionnaire. Demographic data, type of IBD, current and previous medication, admissions to hospital, history of psychiatric referrals, Stanford Presenteeism Scale (SPS-6), Godin Score (exercise related score) were collected. Exclusion criteria included patients with IBD flares requiring corticosteroids in the previous 12 months. Results 573 patients (CD: n=318) from 8 European Centres and Israel participated in the study. The mean patient age was 39.9 years (SD+/- 13.0). 21.6% were smokers and 48.5% were non-smokers. The rest were ex-smokers. 10.9% of patients had a diagnosis of depression/anxiety prior to the diagnosis of IBD, whereas this increased to 20.6% post-IBD diagnosis, this being significantly commoner in the CD cohort (23.0%, p<0.05) and in females (55.8%, p<0.05). 37.7% of patients had been to a psychiatrist or a psychologist (41% of CD, p<0.05) with 11.7% of patients being on psychiatric medication (14.5% of CD, p<0.05). Low presenteeism at work was evident in 34.7%, with no statistically significant difference between UC and CD patients (p=0.5). 39.9% had a Godin Exercise Score being in the active range, 38.8% had a sedentary/insufficient exercise score. The rest were moderately active. Patients diagnosed with depression/anxiety had a more sedentary lifestyle. Conclusion In our study 37.7% of patients were referred for psychological help. This can have several effects including poor presenteeism at work (34.7%) and reduced efficiency. These issues are commoner in patients with CD than in UC. Active involvement of a psychologist/ psychiatrist as part of the IBD team should be routine as to improve the patient’s quality of life.

P642 Effects of Covid-19 on employment in IBD patients

Background There is an ongoing concern over the impact of COVID-19 on IBD patients. A significant proportion of IBD patients are treated with immunosuppressive medications and their effects on COVID-19 susceptibility and outcomes remain of concern to patients and physicians alike. Apart from the clinical outcome, the pandemic may have other psychosocial effects on this vulnerable cohort such as employment stability. The primary aim of this study was to analyze the percentage of COVID-19 patients who tested themselves for COVID-19 and the outcome of those who tested positive. A secondary aim was to assess their employment status. Methods This was a multicentre international study whereby IBD patients (>18 years) in clinical remission over the last year, were asked to answer an anonymous questionnaire. Demographic data, type of IBD, current and previous medication, admissions to hospital, were collected. Exclusion criteria included patients with IBD flares requiring corticosteroids in the previous 12 months. Results 573 patients (CD: 55.5%) from 8 European Centres and Israel participated in the study. The mean patient age was 39.9 years (SD+/- 13.0). 21.6% were current smokers and 48.5% were non-smokers. The rest were ex-smokers. 44.5% (n=255 ) of patients were tested for Covid-19 and 5.1% (n=13) were positive. The majority were treated at home (92.3%) with only one patient requiring hospital admission. This was a 33 year old female smoker with UC (E3 disease activity) on anti-TNF therapy. 66.7% of positive cases were on anti-TNF medication and 22.2% were on thiopurines. None of the positive cases were on dual antiTNF/thiopurine therapy. 7.2% of patients had family members who also tested positive for Covid-19. Almost half of all patients (45.2%) had their job affected during the pandemic and this was more prevalent in the UC cohort (P<0.05). 70% of patients switched to remote work from home and 21.4% became unemployed. The average age of patients becoming unemployed was 39.3years (SD+/- 11.9). Conclusion Nearly half of our cohort (45.2%) underwent testing and the majority (92.3%) were treated at home even though two thirds of them were on Anti-TNF medication. Unemployment rates affected 1 in 5 individuals and measures promoting remote work have been taken up wisely by IBD patients. Though the clinical outcomes were excellent, the psychological effects of unemployment have yet to be considered.

Discussion on the Effect of Introducing Clinical Pharmacists to Guide Clinical Medication in ICU

<p>Objective: to investigate the effect of clinical pharmacists in ICU. Methods: 108 ICU patients from January 2018 to March 2020 were divided into the control group and the observation group, with 54 cases in each group. The control group used the previous medication route, while the observation group introduced clinical pharmacists to guide clinical medication. The infection rate and adverse reaction rate of the two groups were compared. Results: the infection rate of the observation group was 3.70%, and that of the control group was 14.81%, which was significantly lower than that of the control group (P&lt;0.05). The adverse reaction rate of the observation group was 5.56%, and that of the control group was 18.52%, which was significantly lower than that of the control group (P&lt;0.05). Conclusion: the introduction of clinical pharmacists to guide clinical medication in ICU can effectively control the infection, and reduce various adverse reactions during drug use, so as to realize the scientific and standardized use of drugs, and improve the efficiency and safety of drug use.</p>

Bleeding predictors in acute coronary syndrome: does the age or clinical presentation matters?

Funding Acknowledgements Type of funding sources: None. INTRODUCTION Bleeding is a quite common non-cardiac complication of acute coronary syndrome (ACS) and is associated with a negative prognosis impact. AIMS To determine the predictors of inhospital major bleeding (IHMB) in ACS and to evaluate whether they differ according to age and clinical presentation. METHODS A multicentric retrospective study which analysed 25524 patients(pts) with ACS, 25141 without and 383 with IHMB. By multivariate analysis, we determined IHMB predictors and evaluated the differences between age groups (&lt;80 years; ≥80 years) and clinical presentation- ST elevation myocardial infarction (STEMI) or non-ST elevation ACS (NSTEACS). RESULTS By multivariate analysis we found 15 significant IHMB predictors (pvalue &lt; 0,05): age≥75years, hypertension, previous angina, pulmonary disease, previous bleeding, atypical presentation (without pain), cardiac arrest, admission heart rate (HR)&gt;100bpm, Killip4 at admission, ST-elevation, admission haemoglobin (Hb)&lt;10g/dL, aspirin or Vitamin K antagonist (VKA) or ivabradine as previous medication and glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa) use. Then, we made a sub-analysis in STEMI pts which revealed that IHMB predictors of pts &lt;80 years were: female gender, age≥75years, chronic kidney disease (CKD), active neoplasm, previous bleeding, atypical presentation, cardiac arrest, admission HR &gt; 100bpm, Killip IV on admission and GPIIb/IIIa use. By contrast, IHMB predictors of pts with ≥80 years were: valvular disease, atypical presentation, aspirin as previous medication and GPIIb/IIIa use. Finally, we made a sub-analysis in NSTACS pts which revealed that IHMB predictors of pts &lt;80years were: previous angina, CKD, previous bleeding, cardiac arrest, Killip≥2 at admission, admission Hb &lt; 10g/dL and VKA as previous medication. Conversely, IHMB predictors of pts with ≥80 years were previous bleeding, cardiac arrest and absence of normal QRS. In addition, by multivariate analysis we found that IHMB had an impact on inhospital mortality (OR = 2,2;pvalue &lt; 0,001), however, by Cox regression there wasn’t an impact on 1-year mortality. CONCLUSION This study suggests that IHMB has impact on inhospital mortality and that its predictors differ with age and clinical presentation. The most powerful predictor was previous bleeding. Considering the importance of IHMB, increased efforts are needed to tailor antithrombotic therapy according to age, renal function and other comorbidities.

Implementation of a pharmacist-provided pharmacogenomics service in an executive health program

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. Summary As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient’s current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. Conclusion The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.