Effect of Acetazolamide vs Placebo on Duration of Invasive Mechanical Ventilation Among Patients With Chronic Obstructive Pulmonary Disease A Randomized Clinical Trial

Chronic Obstructive Pulmonary disease(COPD) is a series of lung diseases that make it extremely difficult for persons affected with this disease to breath properly. It is a frequent cause of ICU admissions. Treatment requires invasive mechanical ventilation because noninvasive ventilation methods often are not successful at alleviating the effects of this disease.

Acetalzolamide is a medication used as a noninvasive method of relieving COPD symptoms. However this medication does not have the FDA indication to treat COPD and no studies were done to see if this medication was even effective in doing such. This article is a double blind study that had patients taking 500-1ooo mg of Acetazolamide to test its effectiveness as a COPD treating agent.

The results of the study actually found that there was NO difference in symptoms when Acetazolamide was administered. However, it is important to note that the researchers conducting the study, said that certain aspects of the study could have been underpowered to establish statistical significance.

Why was this drug allowed to be used for so long to treat a condition it was not FDA approved to treat without first having thorough research done proving its efficacy? What does this mean or how does this change the ways in which we introduce a new drug therapy?

Citation:

Faisy C, Meziani F, Planquette B, et al. Effect of Acetazolamide vs Placebo on Duration of Invasive Mechanical Ventilation Among Patients With Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. JAMA. 2016;315(5):480-488. doi:10.1001/jama.2016.0019.

Integrating Predictive Analytics Into High-Value Care The Dawn of Precision Delivery

The United States spends twice as much on healthcare than most of the other industrialized countries around the world. This is obviously a negative as it can prevent the U.S. population from being able to afford adequate patient care due to its high prices. Electronic Health Records have become ubiquitously used in the health system of the United States, and this study was used to examine if “precision delivery” can be used to help lower the total cost of healthcare. “Precision delivery” gets is a concept similar to “precision medication” [which involves using a patients genetic information to create medications fine tuned for their specific genetic makeup], precision delivery involves using a patients electronic health record to limit the use of costly healthcare practices and systems.

Predictive analysis can be used on the EHRs to help eliminate wasteful spending. In the acute care setting, parts of northern California have used this algorithm to prevent antibiotic overuse in newborns. Additionally it was used in the Parkland Health and Hospital system to lower the number of patient readmission, of patients with heart failure whom were deemed at a high risk of 30 day readmission.

Some health professionals have raised concerns about predictive analysis, most particularly in the fact that it diminishes the physicians, or medical professionals, role in managing clinical uncertainty.  However some argue that the physician is still required to exercise his clinical judgement in managing his findings from the information he is receiving from the computer analysis. Regardless, many professionals feel that the time for predictive analysis is now.

Do you feel like the implementation of predictive analysis or “precision delivery” is what the U.S. needs to cut the cost of their healthcare? How effective will these methods be in the future or on a larger scale? Are there any other potential ways to help cut the healthcare cost? Does the machine analysis diminish the role of the physician? Why or why not?

Citation:

Parikh RB, Kakad M, Bates DW. Integrating Predictive Analytics Into High-Value Care: The Dawn of Precision Delivery. JAMA.2016;315(7):651-652. doi:10.1001/jama.2015.19417.

Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazi

The Zika Virus is a arbovirus that is named after a forest in Uganda. It is primarily transmitted through mosquito bites and other methods of blood transmission but has also been known to be transferred through sexual contact. The only current methodology of diagnosing the Zika Virus is through real time polymerase chain reaction however this method is not effective in detecting the virus in newborns.

Since 2015 an epidemic of the Zika Virus has been plaguing the country of Brazil. 6 months after the first onset it has shown that 1248 new cases were reported. In January of 2016 it was reported that 3,174 newborns had been infected with the virus. Through this great abundance of newborn infections it was noted that newborns with the disease had developed ocular lesions on their eyes. This article provides a study that was done on 29 infants to evaluate whether or not ophthalmologic evaluations should be done in areas with high rates of Zika Virus transmission as a means to diagnose newborns with the infection.

The findings showed that 10 of the 29 newborns or about 35% had ocular abnormalities. The study believes that this information can provide valuable clinical analysis insight on diagnosing the Zika Virus. Newborns should be continually given ocular examinations in order to constantly screen for this condition. This can help lower the spread of the virus in high transmission areas.

Do you feel that this information will help stop or at least halt the transmission of the Zika Virus? Is 10 out of 29 enough evidence to be used as sufficient clinical analysis? Why or Why Not?

Citation:

de Paula Freitas B, de Oliveira Dias J, Prazeres J, et al. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol.Published online February 09, 2016. doi:10.1001/jamaophthalmol.2016.0267.

Machine Learning and the Profession of Medicine

This article asks the question must the physician( or any medical professional for that matter) be human? The Institute for Creative Technologies developed a new computer they named “Ellie” that is able to analyze patient facial expressions and vocal tones, intonations and responses. Through this analysis it was even able to detect signs of PTSD. In the study, a group of 239 patients were told that “Ellie” was either controlled by a person or operating autonomously. It was actually found that the latter option produced more personal and intimate responses to the computer program.

The article then talks about how technology needs to continue to develop within the walls of technology. It discusses how the electronic medical record is just starting to be embraced but this should for no reason be the end of what they refer to as a “digital revolution.” It is believed that technology has tremendous potential and practical implementation in the practice of patient care.

How do you feel about the use of technology as a means to patient care? Does it make the medical professional obsolete and no longer necessary? Why have a human surgeon when you can have a computer operate on you? How will this kind of technology impact the field of pharmacy? Why will their still be a need for pharmacists if a computer can provide MTM services to patients? Will patients trust a computer to provide information to them….what about in subsequent generations?

Citation:

Darcy AM, Louie AK, Roberts L. Machine Learning and the Profession of Medicine.JAMA. 2016;315(6):551-552. doi:10.1001/jama.2015.18421.

Assessment of the effeCt of lIfestyle iNtervention plus water-soluble ciNnAMon extract On loweriNg blood glucose in pre-diabetics, a randomized, double-blind, multicenter, placebo controlled trial: study protocol for a randomized controlled trial

It is predicted that in the year 2030, diabetes will be the seventh leading cause of death worldwide. Cinnamon has shown the potential to be used an a potentially effective means of treating diabetes as it makes ones cells more sensitive to insulin  as well as has shown other potential treatment benefits in patents with type 2 diabetes such as lowering their blood pressure.  This study was to see whether or not water soluble cinnamon extract could be used to prevent pre-diabetes from progressing to diabetes.

The study was a double blind study in which 428 patients divided into two groups spread along 10 sites for each group, would be given either a placebo or 500 mg of cinnamon extract. These were to be taken two capsules a day for 12 months. The follow up for these patients after the results were collected would be for 2 years. Both men and women were studied in this trial and women for screened in order to ensure that they were not pregnant before participating in the study. The study however is not finished and is scheduled to conclude in September of 2016, thus data results can not be analyzed until then.

How can the findings of this study revolutionize the way we treat diabetes on a global scale? If it is found that cinnamon can in fact prevent diabetes progression, what does that mean for the future of patient care and pharmaceutical industries?  Will this lead to an increased push for natural medications? Will the FDA begin to test natural substances for effectiveness rather than just safety like they do now?

Citation:

Crawford, Paul, Chuong Thai, Joshua Obholz, Jeffrey Schievenin, Mark True, Sachin A. Shah, John Hallgren, Jill Clark, and Danny Sharon. “Assessment of the EffeCt of LIfestyle INtervention plus Water-soluble CiNnAMon Extract On LoweriNg Blood Glucose in Pre-diabetics, a Randomized, Double-blind, Multicenter, Placebo Controlled Trial: Study Protocol for a Randomized Controlled Trial.” Trials 17.1 (2016): n. pag. Web.

Improving Heart Failure Patient Care

Heart failure is the condition in which the heart cannot sufficiently pump blood throughout the body creating a lack of oxygen and other nutrients reaching certain parts of the body and thus failing to meet metabolic needs across the body. This condition, even if treated appropriately, still has a high degree of mortality associated with this disease state and often results in frequent hospitalizations before death occurs. However, all hope is not lost as new and improved guidelines are released each and every year to help improve the quality of life for persons affected by this disease state. The  Pharmacist’s Letter/ Prescriber’s Letter as of February 2016, has created a set of practical tips and resources that can be used to help manage patients with heart failure and prevent re-admissions into the hospital.

These recommendations range from changes in drug therapy such as choosing the right medications for patients with this condition such as: a diuretic for fluid retention and the addition of other medications based on race and heart strength as determined by ejection fraction(EF). The article also discusses avoiding certain medications that will worsen the condition such as NSAIDS, verapamil, and dilitiazem. Furthermore, tips are provided on how to adequately provide patient education on their disease state, how to bolster patient adherence as well as tips on what to monitor to ensure their disease state is being adequately managed.

Do you feel that these new and improved guidelines will lead to an improvement in the management of patients with heart failure? Why or Why not? Are new guidelines always better than the old? Will guidelines for different disease states continue to be updated indefinitely as time passes or will we reach a point where the guidelines can no longer be advanced because they are leading to the ultimate management of patient disease state.

Citation:

PL Detail-Document, Improving Heart Failure Care. Pharmacist’s Letter/Prescriber’s Letter. February 2016.