Dabigatran (Pradaxa) Is Safe for Extended Venous Thromboembolism Prophylaxis After Surgery for Pancreatic Cancer.

BACKGROUND: The American College of Chest Physicians and American Hepato-Pancreato-Biliary Association recommend using low-molecular-weight heparin for 28 days postoperatively for venous thromboembolism prophylaxis after cancer surgery. Dabigatran is a once daily oral anticoagulant that is FDA approved for venous thromboembolism prophylaxis after orthopedic surgery, uses fixed dosing, and has an antidote. METHODS: Patients undergoing surgery for malignant pancreatic tumors (neuroendocrine excluded) from January 2017 to January 2018 were converted to dabigatran 220 mg daily on discharge until postoperative day 28; patients with medical or insurance contraindications were converted to enoxaparin or another direct oral anticoagulant. The primary endpoint was bleeding complications through 90 days. RESULTS: A total of 134 patients were considered for this study (median age 67 ± 10; 58.9% male). Eighty-seven (82.9%) patients received dabigatran and 18 (17.1%) received another form of anticoagulation. There were 19 (4.2%) patients not prescribed dabigatran due to medical or inpatient contraindications. Four patients experienced bleeding complications after discharge while on dabigatran. Two (2%) were major bleeds (Clavien-Dindo IV and V), and 2 (2%) were minor (Clavien-Dindo I). Patient compliance was excellent, with 93% of prescribed patients fully completing their prophylaxis. There were 2 patients that developed symptomatic deep vein thrombosis. CONCLUSION: The use of a direct oral anticoagulant as extended venous thromboembolism prophylaxis after major gastrointestinal surgery has not been studied to date. These results show dabigatran to be a safe alternative to low-molecular-weight heparin for extended venous thromboembolism prophylaxis with regard to bleeding complications.

Oxygen isotope exchange with quartz during pyrolysis of silver sulfate and silver nitrate.

RATIONALE: Triple oxygen isotopes of sulfate and nitrate are useful metrics for the chemistry of their formation. Existing measurement methods, however, do not account for oxygen atom exchange with quartz during the thermal decomposition of sulfate. We present evidence for oxygen atom exchange, a simple modification to prevent exchange, and a correction for previous measurements. METHODS: Silver sulfates and silver nitrates with excess (17)O were thermally decomposed in quartz and gold (for sulfate) and quartz and silver (for nitrate) sample containers to O(2) and byproducts in a modified Temperature Conversion/Elemental Analyzer (TC/EA). Helium carries O(2) through purification for isotope-ratio analysis of the three isotopes of oxygen in a Finnigan MAT253 isotope ratio mass spectrometer. RESULTS: The Δ(17)O results show clear oxygen atom exchange from non-zero (17)O-excess reference materials to zero (17)O-excess quartz cup sample containers. Quartz sample containers lower the Δ(17)O values of designer sulfate reference materials and USGS35 nitrate by 15% relative to gold or silver sample containers for quantities of 2-10 µmol O(2). CONCLUSIONS: Previous Δ(17)O measurements of sulfate that rely on pyrolysis in a quartz cup have been affected by oxygen exchange. These previous results can be corrected using a simple linear equation (Δ(17)O(gold) = Δ(17)O(quartz) * 1.14 + 0.06). Future pyrolysis of silver sulfate should be conducted in gold capsules or corrected to data obtained from gold capsules to avoid obtaining oxygen isotope exchange-affected data.

An evaluation of the validity of inferences made from 3 diabetes assessment instruments: a Rasch analysis.

BACKGROUND: Many patients who have diabetes lack adequate knowledge, positive attitudes, and sufficient resources to achieve optimal outcomes in the management of their disease. A key to assessing the impact of pharmacists' interactions with diabetes patients is the resultant impact on patient knowledge, attitudes, and satisfaction. As such, it is important that quality instruments be used to obtain accurate and dependable measures of these outcomes. OBJECTIVE: To evaluate the validity of inferences made from 3 separate diabetes instruments used in the assessment of patient knowledge, attitudes, and satisfaction. METHODS: This pilot study enrolled 30 patients with diabetes mellitus to evaluate the following 3 instruments: (1) Check Your Hemoglobin A1CIQ, (2) the revised Diabetes Questionnaire, and (3) a satisfaction questionnaire. The instruments were used to assess patient knowledge of diabetes and diabetes-related complications, attitudes toward having diabetes mellitus, and satisfaction with the services provided in a pharmacist-run diabetes clinic, respectively. Rasch analysis was used to determine if the instruments were able to measure the concepts they are intended to measure when used in this sample. RESULTS: After evaluating the 3 instruments, it was determined that Instrument 1 displayed construct underrepresentation and some mistargeting. Moreover, Instrument 2 demonstrated reasonably good rating scale function but exhibited construct underrepresentation and ceiling effects. Finally, Instrument 3 did not meet the necessary requirements for proper rating scale function and displayed ceiling effects and mistargeting. CONCLUSIONS: This pilot evaluation suggested that none of the instruments were useful in this population, which reinforces the need for researchers to use item response theories to examine the psychometric properties of instruments used in reporting various patient outcome measures. Pharmacists and other health care professionals should be alerted to potential problems with the validity of inferences made from underperforming instruments, so as to prevent inaccurate conclusions.

Evaluation of a pediatric asthma awareness program.

OBJECTIVE: To evaluate knowledge and attitudinal outcomes of an educational asthma program for third-grade children with and without asthma. METHODOLOGY: "The Lion Who Couldn't Roar" was presented to third-grade classes in three Chicago area Counties. Participant asthma knowledge and attitudes were assessed via a print-based pretest-posttest design. Teacher satisfaction was also assessed. Data were analyzed using Rasch analysis before paired t tests were performed. RESULTS: Pre- and post-assessments were completed by 943 participants. A statistically significant increase in mean logit scores was identified on both knowledge and attitude evaluations (p < 0.001, p < 0.001). CONCLUSIONS: The results provide evidence of program impact.

Improving medication use through pharmacists' access to patient-specific health care information.

OBJECTIVE: To review and discuss the importance of pharmacists having access to patient-specific health care information in order to provide pharmaceutical care. DATA SOURCES: Articles identified through searches of MEDLINE and International Pharmaceutical Abstracts using the following key words: information, decision making, and pharmacist. STUDY SELECTION: English-language articles were evaluated for inclusion. DATA SYNTHESIS: Pharmacists have demonstrated their ability to positively affect patient outcomes related to medication use, including reducing patients' risk for medication-related adverse effects. CONCLUSION: Pharmacists, with proper access to patient-specific health care information, can reduce patients' risk for medication-related problems and improve the quality of their health care.