Validating HERDOO2 - When is it Safe to Stop Therapy After an Unprovoked VTE?

September 22, 2017

According to the 2016 CHEST VTE Guidelines, at least 3 months of therapy is recommended for an unprovoked DVT or PE (Grade 1B). Thereafter, the clinician is expected to weigh the risks and benefits to determine if extended therapy is appropriate. Balancing the risk of mortality from recurrent VTE versus major bleeding has been challenging.  A validated clinical decision tool is sorely needed!  Until recently, no risk assessment tool has been validated and therefore none have been widely adopted in practice.

Guest Author:  Carol Chan, Pharm.D.

Music by Good Talk

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Testing the Limits on Blood Glucose Monitoring: Can We Safely Cut Back?

September 8, 2017

Is self-monitoring of blood glucose (SMBG) cost-effective?  SMBG is often recommended to help guide treatment decisions.  Consumer-oriented advertising often promotes frequent SMBG as means to achieve better glycemic control but current clinical practice guidelines do not provide specific recommendations regarding the frequency of blood glucose monitoring. The lack of conclusive evidence supporting the clinical benefits of routine SMBG combined with the rising costs of healthcare has led some payers to place limits on SMBG testing supplies.  Is this wise policy?  Or does it lead to poor health outcomes?

Guest Authors:  KyAnn Wisse, PharmD, BCACP and Dawn Fuke, Pharm.D, BCPS

Music by Good Talk

 

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Preventing Pediatric Dosing Errors – Is It Time to Dump the Medicine Cup?

December 7, 2016

Children are often given liquid dosage forms for both prescription and over-the-counter medicines.  Several studies have shown that caregivers unintentionally put children at risk by inaccurately measuring the dose of liquid medications.  In 2015, the American Academy of Pediatrics (AAP) adopted a policy statement which recommends exclusively using milliliters for dosing instructions to prevent dosing errors.  Our guest today critically examines a recent study that examined labeling and dosing tools that may contribute to medication errors.

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Pharmacists Patient Care Process

December 1, 2016

Our guest, Dr. Melissa Somma McGivney, describes the Pharmacists Patient Care Process and explains why having a consistent philosophy of practice, a consistent process of care, and a sustainable practice management system are critical for success.

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Opioid Safety and Overdose Prevention

October 21, 2016

While narcotic analgesics remain a mainstay for the treatment of acute and chronic pain, urgent care visits and deaths from opioid overdoses have skyrocketed.   Our panelists are Dr. Lucas Hill from the University of Texas at Austin and Jeffrey Bratberg from the University of Rhode Island. Dr. Hill practices in a primary care setting and maintains the iForumRx  Opioid Safety and Overdose Prevention Resource Page.  Dr. Bratberg helped develop, implement, and expand the Collaborative Pharmacy Practice for Naloxone Partnership in Rhode Island. Drs. Hill and Bratberg describe how healthprofessionals - particularly ambulatory care pharmacists - can take action to improve the safe use of opioids and prevent overdoses.  

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Eleven Things Every Clinician Should Know About the “Egregious Eleven”

September 29, 2016

A recent paper published in Diabetes Care proposing a new classification system for diabetes challenges our existing paradigm and has significant implications for our treatment approach for diabetes.

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Preventing Weight Gain - Recommending Behavior Change in Young Adults

July 15, 2016

We're all aware that there is an obesity epidemic and its linked to dozens of health problems.  But nothing we've done so far — public awareness campaigns, changes in school lunch programs, and approving new drugs for weight loss — has halted this epidemic.  The prevalence of obesity continues to climb in young adults  and most of us keep packing on the pounds as we get older!  Thus preventing weight gain in young adults is critically important to long-term outcomes. The recent results of  the Study of Novel Approaches to Weight Gain Prevention (SNAP) provides evidence to guide recommendations for behavioral change. 

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Crossing the Periprocedural Bridge in Patients with Atrial Fibrillation

March 25, 2016

For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS2 score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS2 score is 5 or higher and not bridging if the CHADS2 score is 2 or lower. But what about patients with a CHADS2 score of 3 or 4?

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Reconsidering Strategies for Insulin Intensification

March 11, 2016

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.

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TEXT ME — Text Messaging to Promote Behavior Change

February 26, 2016
With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes. Several healthcare-related applications and mobile phone text messaging systems have already been designed; yet, very few have undergone rigorous testing to confirm clinical benefit.  The investigators of the Tobacco, Exercise, and Diet Messages (TEXT ME) trial designed a text message-based intervention to encourage lifestyle modifications and evaluated its impact on cardiovascular risk in patients with established CHD. The TEXT ME study provides robust findings to support a simple, inexpensive intervention to modify cardiovascular risk … at least over the short term.
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