ABSTRACT: Many patients with diabetes do not receive recommended standards of care. Diabetes patients were seen by a pharmacist in a diabetes assessment service (DAS) 1 week prior to a physician appointment to complete diabetes standards. Completion rates of American Diabetes Association (ADA) standards were compared between patients of 5 physicians offered the DAS intervention and a concurrent cohort of randomly selected patients of nonparticipating physicians. A total of 94 patients were seen by DAS; 210 patients comprised the controls. DAS patients had a significantly higher proportion of each standard completed (glycosylated hemoglobin, lipids, foot exam, eye referral, pneumococcal and influenza vaccination, and urine microalbumin) compared with the control group (P < .001). An average of 3.3 ± 1.8 diabetes standards per patient were completed. A planned visit with a pharmacist prior to a physician appointment, with the goal of completing ADA standards of care, was feasible and effective in this university-based family medicine center.
American Journal of Medical Quality 06/2012; · 1.64 Impact Factor
ABSTRACT: Limited clinical documentation is suggestive of a drug interaction between warfarin and diuretics.
To evaluate the effect on international normalized ratio (INR) when a daily oral diuretic is started or increased in patients on chronic stable warfarin therapy.
The medical records of all active patients of two hospital-based anticoagulation clinics were retrospectively reviewed to identify patients who were started on or received a dose increase of a daily oral diuretic while on stable warfarin therapy. The primary endpoint was the mean difference between an INR recorded within 30 days prior to the diuretic initiation (pre-INR) and an INR recorded within 30 days after diuretic initiation (post-INR).
A total of 1254 patient charts were screened and a total of 123 patients met the study criteria. The mean difference in pre-INR and post-INR was 0.09 (95% CI -0.03 to 0.21, p = 0.12). Post-INR values were outside of the patient's therapeutic range in 39 patients (32%), but no major bleeding or thromboembolic events were reported.
Based on this retrospective study, diuretics did not result in a significant change in the INR in patients on stable warfarin therapy.
Expert Opinion on Drug Safety 09/2011; 11(3):375-80. · 3.02 Impact Factor
ABSTRACT: To assess whether genetically determined Amerindian ancestry predicts increased presence of risk alleles of known susceptibility genes for systemic lupus erythematosus (SLE).
Single-nucleotide polymorphisms (SNPs) within 16 confirmed genetic susceptibility loci for SLE were genotyped in a set of 804 Mestizo lupus patients and 667 Mestizo healthy controls. In addition, 347 admixture informative markers were genotyped. Individual ancestry proportions were determined using STRUCTURE. Association analysis was performed using PLINK, and correlation between ancestry and the presence of risk alleles was analyzed using linear regression.
A meta-analysis of the genetic association of the 16 SNPs across populations showed that TNFSF4, STAT4, ITGAM, and IRF5 were associated with lupus in a Hispanic Mestizo cohort enriched for European and Amerindian ancestry. In addition, 2 SNPs within the major histocompatibility complex region, previously shown to be associated in a genome-wide association study in Europeans, were also associated in Mestizos. Using linear regression, we predicted an average increase of 2.34 risk alleles when comparing an SLE patient with 100% Amerindian ancestry versus an SLE patient with 0% Amerindian ancestry (P < 0.0001). SLE patients with 43% more Amerindian ancestry were predicted to carry 1 additional risk allele.
Our results demonstrate that Amerindian ancestry is associated with an increased number of risk alleles for SLE.
Arthritis & Rheumatism 12/2010; 62(12):3722-9. · 7.87 Impact Factor