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Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature156445
Source
Am Heart J. 2008 Jul;156(1):148-54
Publication Type
Article
Date
Jul-2008
Author
Lyne Lalonde
Josée Martineau
Normand Blais
Martine Montigny
Jeffrey Ginsberg
Martine Fournier
Djamal Berbiche
Marie-Claude Vanier
Lucie Blais
Sylvie Perreault
Isabel Rodrigues
Author Affiliation
Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. lyne.lalonde@umontreal.ca
Source
Am Heart J. 2008 Jul;156(1):148-54
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Anticoagulants - administration & dosage - blood
Confidence Intervals
Cost-Benefit Analysis
Female
Follow-Up Studies
Humans
International Normalized Ratio
Male
Middle Aged
Monitoring, Physiologic - economics - methods
Ontario
Pharmaceutical Services - economics - statistics & numerical data
Pharmacists
Physician's Practice Patterns - economics
Professional Role
Reference Values
Sensitivity and specificity
Thromboembolism - drug therapy - prevention & control
Time Factors
Total Quality Management
Abstract
Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to patients on oral anticoagulant, who are transferred to their physician once they are stabilized. This may be as effective as and less expensive than long-term PMAS follow-up.
Once PMAS patients were stabilized and ready for discharge, they were randomized to be transferred to their physician or stay with the PMAS. Quality of international normalized ratio (INR) control, incidence of complications, health-related quality of life, use of health care services, and direct incremental cost of PMAS follow-up were evaluated.
One hundred thirty-eight physicians and 250 patients participated. Patients were initially followed at the PMAS for a mean of 11.3 weeks and afterwards were followed by their physician (n = 122) or by the PMAS pharmacists (n = 128) for a mean of 14.9 and 14.5 weeks, respectively. Pharmacist-managed anticoagulation services' and physician's patients were within the exact target range 77.3% and 76.7% of the time (95% CI of the difference -4.9% to 6.0%) and within the extended range 93.0% and 91.6% of the time (95% CI -2.1% to 4.7%), respectively. Pharmacist-managed anticoagulation services patients have seen their family physician less often (95% CI -3.1 to -0.1 visit per year). Number of INR tests, incidence of complications, and health-related quality of life were similar in both groups. The incremental cost of PMAS follow-up was estimated at CAN$123.80 per patient year.
Once PMAS patients are well stabilized, maintaining a PMAS follow-up or transferring them to their physician is associated with excellent INR control. However, long-term PMAS follow-up may be more expensive.
PubMed ID
18585510 View in PubMed
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A systematic review and Canadian consensus recommendations on the use of biomarkers in the treatment of non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature133382
Source
J Thorac Oncol. 2011 Aug;6(8):1379-91
Publication Type
Article
Date
Aug-2011
Author
Peter M Ellis
Normand Blais
Dennis Soulieres
Diana N Ionescu
Meenakshi Kashyap
Geoff Liu
Barb Melosky
Tony Reiman
Phillippe Romeo
Frances A Shepherd
Ming-Sound Tsao
Natasha B Leighl
Author Affiliation
Juravinski Cancer Centre, Hamilton, Ontario, Canada. peter.ellis@jcc.hhsc.ca
Source
J Thorac Oncol. 2011 Aug;6(8):1379-91
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Canada
Carcinoma, Non-Small-Cell Lung - diagnosis - therapy
Clinical Trials as Topic
Consensus
Humans
Lung Neoplasms - diagnosis - therapy
Practice Guidelines as Topic
Tumor Markers, Biological - analysis
Abstract
Greater understanding of molecular pathways important in cell growth and proliferation of thoracic malignancies, particularly non-small cell lung cancer (NSCLC), has resulted in intense clinical and translational research. There is now considerable interest in personalizing treatment based on an understanding of tumor histology and molecular abnormalities. However, there is a multiplicity of data, often with discordant results resulting in confusion and uncertainty among clinicians.
We conducted a systematic review and a consensus meeting of Canadian lung cancer oncologists and pathologists to make recommendations on the use of biomarkers in NSCLC. PubMed covering 2005 to March 2010 was searched using MESH terms for NSCLC and randomized trials, plus text words for the biomarkers of interest. Conference proceedings from 2005 to 2009 ASCO, ESMO, IASLC, and USCAP were also searched. The articles were reviewed by pairs of oncologists and pathologists to determine eligibility for inclusion.
Ten oncologists and pathologists reviewed and summarized the literature at a meeting attended by 37 individuals. Draft recommendations were formulated and agreed upon by consensus process. There is some evidence that histology is prognostic for survival. There is evidence from multiple randomized clinical trials to recommend the following: histologic subtype is predictive of treatment efficacy and for some agents toxicity. Immunohistochemistry testing should be performed on NSCLC specimens that cannot be classified accurately with conventional H&E staining. As EGFR mutations are predictive of benefit from tyrosine kinase inhibitors, diagnostic NSCLC samples should be routinely tested for EGFR-activating mutations. Clinical data on K-RAS mutations are inconsistent, therefore testing is not recommended. There is insufficient evidence to recommend other biomarker testing. No biomarkers to date reliably predict improved efficacy for anti-VEGF therapy. Routine assessment for EML4/ALK mutations is not recommended at present, although emerging data suggest that it may become valuable in the near future.
Assessment of NSCLC biomarkers is becoming increasingly important. Therefore, adequate diagnostic material must be obtained for accurate histologic subtyping and relevant molecular biology assays.
Notes
Comment In: J Thorac Oncol. 2012 Apr;7(4):773-4; author reply 77422425934
PubMed ID
21709590 View in PubMed
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