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1.  Increases in Creatine Kinase with Atorvastatin Treatment are Not Associated with Decreases in Muscular Performance 
Atherosclerosis  2013;230(1):121-124.
Background
The present study examined if increases in creatine kinase (CK) levels during high-dose atorvastatin treatment are associated with changes in skeletal muscle function and symptoms.
Methods
The Effect of Statins on Muscle Performance study (STOMP) investigated the effects of atorvastatin 80 mg daily for 6 months on muscle performance, exercise capacity, and the incidence of statin-associated muscle complaints in healthy adults.
Results
CK levels increased with atorvastatin (n = 202) from 132.3 ± 120.9 U/L (mean ± SD) at baseline to 159.7 ± 170.4 and 153.1 ± 139.4 U/L at 3 and 6 months, respectively (P≤0.002 for both). Changes in CK with atorvastatin treatment were not associated with changes in muscle function or the incidence of myalgia. More subjects on atorvastatin (n = 24) compared to placebo (n = 12 of 217) doubled their CK level at 6 months (P = 0.02). No differences in muscle function or physical activity were observed between atorvastatin-treated subjects who did or did not double their CK.
Conclusions
Results of the present investigation extend the findings of STOMP by demonstrating that greater increases in CK levels with high-dose atorvastatin treatment did not deleteriously impact skeletal muscle function or predict skeletal muscle complaints.
doi:10.1016/j.atherosclerosis.2013.07.001
PMCID: PMC3779874  PMID: 23958263
statins; myalgia; exercise; muscle
2.  A Randomized Clinical Trial to Assess the Effect of Statins on Skeletal Muscle Function and Performance: Rationale and Study Design 
Preventive cardiology  2010;13(3):104-111.
Hydroxymethylglutaryl-coenzyme A reductase inhibitors or statins are the most effective medications for reducing elevated concentrations of low-density lipoprotein cholesterol (LDL-C). Statins reduce cardiac events in patients with coronary artery disease and previously healthy persons. Current recommendations for LDL-C treatment goals indicate that more patients will be treated with higher doses of these medications. Statins have been extremely well-tolerated in controlled clinical trials but are increasingly recognized to produce skeletal muscle myalgia, cramps, and weakness. The reported frequency of such mild symptoms is not clear, and muscle performance has not been examined with these medications. Accordingly, the present investigation, the Effect of Statins on Skeletal Muscle Function and Performance (STOMP) study, will recruit approximately 440 healthy persons. Participants will be randomly assigned to treatment with atorvastatin 80 mg/d or placebo. Handgrip, elbow and knee isometric and isokinetic strength, knee extensor endurance, and maximal aerobic exercise performance will be determined at baseline. Participants will undergo repeat testing after 6 months of treatment or after meeting the study definition of statin myalgia. This study will determine the effect of statins on skeletal muscle strength, endurance, and aerobic exercise performance and may ultimately help clinicians better evaluate statin-related muscle and exercise complaints.
doi:10.1111/j.1751-7141.2009.00063.x
PMCID: PMC4107659  PMID: 20626664
3.  Serum PCSK9 Levels Distinguish Individuals Who Do Not Respond to High-Dose Statin Therapy with the Expected Reduction in LDL-C 
Journal of Lipids  2014;2014:140723.
The purpose of the present report was to examine whether proprotein convertase subtilisin/kexin type 9 (PCSK9) levels differ in individuals who do not exhibit expected reductions in low density lipoprotein cholesterol (LDL-C) with statin therapy. Eighteen nonresponder subjects treated with 80 mg atorvastatin treatment for 6 months without substantial reductions in LDL-C (ΔLDL-C: 2.6 ± 11.4%) were compared to age- and gender-matched atorvastatin responders (ΔLDL-C: 50.7 ± 8.5%) and placebo-treated subjects (ΔLDL-C: 9.9 ± 21.5%). Free PCSK9 was marginally higher in nonresponders at baseline (P = 0.07) and significantly higher in atorvastatin responders after 6 months of treatment (P = 0.04). The change in free PCSK9 over 6 months with statin treatment was higher (P < 0.01) in atorvastatin responders (134.2 ± 131.5 ng/mL post- versus prestudy) than in either the nonresponders (39.9 ± 87.8 ng/mL) or placebo subjects (27.8 ± 97.6 ng/mL). Drug compliance was not lower in the nonresponders as assessed by pill counts and poststudy plasma atorvastatin levels. Serum PCSK9 levels, both at baseline and in response to statin therapy, may differentiate individuals who do versus those who do not respond to statin treatment.
doi:10.1155/2014/140723
PMCID: PMC4127223  PMID: 25136459
4.  Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression 
Thrombosis Journal  2014;12:14.
Background
Atrial fibrillation (AF) patients frequently require anticoagulation with vitamin K antagonists (VKAs) to prevent thromboembolic events, but their use increases the risk of hemorrhage. We evaluated time spent in therapeutic range (TTR), proportion of international normalized ratio (INR) measurements in range (PINRR), adverse events in relation to INR, and predictors of INR control in AF patients using VKAs.
Methods
We searched MEDLINE, CENTRAL and EMBASE (1990-June 2013) for studies of AF patients receiving adjusted-dose VKAs that reported INR control measures (TTR and PINRR) and/or reported an INR measurement coinciding with thromboembolic or hemorrhagic events. Random-effects meta-analyses and meta-regression were performed.
Results
Ninety-five articles were included. Sixty-eight VKA-treated study groups reported measures of INR control, while 43 studies reported an INR around the time of the adverse event. Patients spent 61% (95% CI, 59–62%), 25% (95% CI, 23–27%) and 14% (95% CI, 13-15%) of their time within, below or above the therapeutic range. PINRR assessments were within, below, and above range 56% (95% CI, 53–59%), 26% (95% CI, 23–29%) and 13% (95% CI, 11-17%) of the time. Patients receiving VKA management in the community spent less TTR than those managed by anticoagulation clinics or in randomized trials. Patients newly receiving VKAs spent less TTR than those with prior VKA use. Patients in Europe/United Kingdom spent more TTR than patients in North America. Fifty-seven percent (95% CI, 50-64%) of thromboembolic events and 42% (95% CI, 35 – 51%) of hemorrhagic events occurred at an INR <2.0 and >3.0, respectively; while 56% (95% CI, 48-64%) of ischemic strokes and 45% of intracranial hemorrhages (95% CI, 29-63%) occurred at INRs <2.0 and >3.0, respectively.
Conclusions
Patients on VKAs for AF frequently have INRs outside the therapeutic range. While, thromboembolic and hemorrhagic events do occur patients with a therapeutic INR; patients with an INR <2.0 make up many of the cases of thromboembolism, while those >3.0 make up many of the cases of hemorrhage. Managing anticoagulation outside of a clinical trial or anticoagulation clinic is associated with poorer INR control, as is, the initiation of therapy in the VKA-naïve. Patients in Europe/UK have better INR control than those in North America.
doi:10.1186/1477-9560-12-14
PMCID: PMC4094926  PMID: 25024644
Vitamin K antagonists; Atrial fibrillation; International normalized ratio; Anticoagulation
5.  A Randomized Trial of Coenzyme Q10 in Patients with Statin Myopathy: Rationale and Study Design 
Journal of clinical lipidology  2013;7(3):187-193.
Background
Statins are the most commonly prescribed and effective medications for reducing low-density lipoprotein levels. Some patients experience myopathic symptoms during statin treatment. The etiology is not known, but depletion of mevalonate pathway metabolites, including coenzyme Q10 (CoQ10), has been suggested. CoQ10 supplementation has been recommended to patients who experience myalgic symptoms despite a lack of conclusive evidence supporting its utility.
Objective
The Co-Enzyme Q10 in Statin Myopathy study is designed to examine the effect of CoQ10 supplementation on the extent and intensity of muscle pain during treatment with simvastatin.
Methods
We will recruit patients with a documented history of myalgia during statin treatment. The presence of statin-related myalgia will be confirmed in a crossover run-in trial during which presence and absence of symptoms will be documented during statin and placebo treatment, respectively. Individuals with myalgic symptoms while on statin but not placebo will be randomized to receive simvastatin 20 mg daily plus either 600 mg daily of CoQ10 or placebo. Muscle pain intensity will be documented during weekly phone calls using the Brief Pain Inventory (Short Form) (BPI-SF). Treatment will continue for 8 weeks or until muscle symptoms are reported continuously for one week or become intolerable, and then subjects will crossover to the alternative treatment (CoQ10 or placebo).
Results
This study is an ongoing clinical trial.
Conclusions
This study will determine the utility of CoQ10 for reducing pain intensity in myalgic patients and will provide guidance for clinicians treating patients with hypercholesterolemia who are intolerant to statins.
doi:10.1016/j.jacl.2013.02.002
PMCID: PMC3671481  PMID: 23725917
simvastatin; myalgia; ubiquinone; muscle pain; physical performance; strength
6.  25(OH) Vitamin D is Associated with Greater Muscle Strength in Healthy Men and Women 
Purpose
The purpose of the study was to examine the relationship between serum 25-hydroxy vitamin D (25(OH)D) levels and muscle strength in 419 healthy men and women over a broad age range (20-76 years of age).
Methods
Isometric and isokinetic strength of the arms and legs was measured using computerized dynamometry and its relation to vitamin D was tested in multivariate models controlling for age, gender, resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), maximal oxygen uptake (VO2max,), physical activity counts, and season of vitamin D measurement.
Results
Vitamin D was significantly associated with arm and leg muscle strength when controlling for age and gender. When controlling for other covariates listed above, vitamin D remained directly related to both isometric and isokinetic arm strength but only to isometric leg strength.
Conclusion
These data suggests that there may be a differential effect of vitamin D on upper and lower body strength. The mechanism for this difference remains unclear but could be related to differences in androgenic effects or to differences in vitamin D receptor expression. Our study supports a direct relationship between vitamin D and muscle strength and suggests that vitamin D supplementation be evaluated to determine if it is an effective therapy to preserve muscle strength in adults.
doi:10.1249/MSS.0b013e31826c9a78
PMCID: PMC3544152  PMID: 22895376
25-Hydroxyvitamin D; Dynamometry; Androgen; VDR
7.  Methods used to conduct and report Bayesian mixed treatment comparisons published in the medical literature: a systematic review 
BMJ Open  2013;3(7):e003111.
Objectives
To identify published closed-loop Bayesian mixed treatment comparisons (MTCs) and to summarise characteristics regarding their conduct and reporting.
Design
Systematic review.
Methods
We searched multiple bibliographic databases (January 2006–31 July 2011) for full-text, English language publications of Bayesian MTCs comparing the effectiveness or safety of ≥3 interventions based on randomised controlled trials and having at least one closed loop. Methodological and reporting characteristics of MTCs were extracted in duplicate and summarised descriptively.
Results
We identified 34 Bayesian MTCs spanning 13 clinical areas. Publication of MTCs increased over the 5-year period; with 76.5% published during or after 2009. MTCs included a mean (±SD) of 35.9±30.1 trials (n=33 459±71 233 participants) and 8.5±4.3 interventions (85.7% pharmacological). Non-informative and informative prior distributions were reported to be used in 44.1% and 8.8% of MTCs, respectively, with the remainder failing to specify the prior used. A random-effects model was used to analyse the networks of trials in 58.5% of MTCs, all using WinBUGS; however, code was infrequently provided (20.6%). More than two-thirds of MTCs (76.5%) also conducted traditional meta-analysis. Methods used to evaluate convergence, heterogeneity and inconsistency were infrequently reported, but from those providing detail, methods appeared varied. MTCs most often used a binary effect measure (85.3%) and ranking of interventions based on probability was common (61.8%), although rarely displayed in a figure (8.8% of MTCs). MTCs were published in 24 different journals with a mean impact factor of 9.20±8.71. While 70.8% of journals imposed limits on word counts and 45.8% limits on the number of tables/figures, online supplements/appendices were allowed in 79.2% of journals. Publication of closed-loop Bayesian MTCs is increasing in frequency, but details regarding their methodology are often poorly described. Efforts in clarifying the appropriate methods and reporting of Bayesian MTCs should be of priority.
doi:10.1136/bmjopen-2013-003111
PMCID: PMC3717466  PMID: 23878173
Statistics & Research Methods; mixed treatment comparison; network meta-analysis
8.  Integrating Genomic Based Information into Clinical Warfarin (Coumadin®) Management: An Illustrative Case Report 
Connecticut medicine  2008;72(7):399-403.
Warfarin is a well established oral anticoagulant for the treatment of thromboembolic disorders. Warfarin therapy is complicated by a narrow therapeutic index and marked inter-individual dose variability with therapeutic doses ranging from 1 mg to 10 mg/day.1 Recently genetic variation and resultant drug metabolizing polymorphisms have been found to contribute to warfarin dose variability with resultant hemorrhagic or thromboembolic complications. Cytochrome P450 2C9 alters the rate of warfarin metabolism and clearance. A second enzyme, vitamin K epoxide reductase comple (VKOR) binds and reduces vitamin K which is necessary for activation of clotting Factors II, VII, IX and X. The VKORC1 gene encodes for vitamin K epoxide reductase complex subunit 1, a key component of VKOR. The combination of physiologic factors (30%), CYP2C9 variations (20%) and VKORC1 variants (25%) accounts for approximately 75% of warfarin dose variability. This illustrative case report demonstrates the clinical importance of this new information. Clinicians need to incorporate these new genomic findings into appropriate management of warfarin dose anticoagulation.
PMCID: PMC3696193  PMID: 18763667
9.  Atorvastatin Increases Exercise Leg Blood Flow in Healthy Adults 
Atherosclerosis  2011;219(2):768-773.
OBJECTIVES
We sought to examine the effect of atorvastatin therapy on exercise leg blood flow in healthy middle-aged and older, men and women.
BACKGROUND
The vasodilatory response to exercise decreases in humans with aging and disease and this reduction may contribute to reduced exercise capacity.
METHODS
We used a double-blind, randomly assigned, placebo-controlled protocol to assess the effect of atorvastatin treatment on exercising leg hemodynamics. We measured femoral artery blood flow (FBF) using Doppler ultrasound and calculated femoral vascular conductance (FVC) from brachial mean arterial pressure (MAP) before and during single knee-extensor exercise in healthy adults (ages 40–71) before (PRE) and after (POST) 6 months of 80 mg atorvastatin (A: 14 men, 16 women) or placebo (P: 14 men, 22 women) treatment. FBF and FVC were normalized to exercise power output and estimated quadriceps muscle mass.
RESULTS
Atorvastatin reduced LDL cholesterol by approximately 50%, but not in the placebo group (p < 0.01). Atorvastatin also increased exercise FBF from 44.2 ± 19.0 to 51.4 ± 22.0 mL/min/W/kg muscle whereas FBF in the placebo group was unchanged (40.1 ± 16.0 vs 39.5 ± 16.1) (p <0.01). FVC also increased with atorvastatin from 0.5 ± 0.2 to. 0.6 ± 0.2 mL/min/mmHg/W/kg muscle, but not in the placebo subjects (P: 0.4 ± 0.2 vs 0.4 ± 0.2) ( p < 0.01).
CONCLUSIONS
High-dose atorvastatin augments exercising leg hyperemia. Statins may mitigate reductions in the exercise vasodilatory response in humans that are associated with aging and disease.
doi:10.1016/j.atherosclerosis.2011.09.049
PMCID: PMC3226851  PMID: 22018642
Atorvastatin; leg vasodilation; exercise hyperemia
10.  Effect of Biologic Agents on Non-PASI Outcomes in Moderate-to-Severe Plaque Psoriasis: Systematic Review and Meta-Analyses 
Introduction
The objective of this review was to conduct a systematic review with meta-analysis and Bayesian mixed treatment comparisons (MTC) evaluating the impact of biologics on non-Psoriasis Area and Severity Index (PASI) health outcomes in patients with moderate-to-severe plaque psoriasis.
Methods
MEDLINE and Cochrane Central Register of Controlled Trials were searched from 1966 to May 2009. Citations were screened for randomized, controlled trials of biologics versus either placebo or each other in adults with moderate-to-severe plaque psoriasis and reported any of several outcomes. Traditional and Bayesian MTC meta-analyses were conducted for each endpoint using either a random- or fixed-effect model where appropriate.
Results
Thirty-eight studies met eligibility criteria. All biologics showed significant improvement in achieving a good response on the static physician’s global assessment (PGA) versus placebo while, in the MTC, differences were noted between individual drugs. In achieving a good response on the dynamic PGA, all biologics showed significant improvements over placebo, while the MTC showed significant improvements with the anti-interleukins versus anti-T cells. Relative to placebo, antitumor necrosis factor (TNF) agents and anti-interleukins showed significant improvements in the Dermatology Life Quality Index (DLQI). Compared with placebo, the anti-TNF agents showed significant improvements in both 36-item Medical Outcomes Study Short-Form General Health Survey (SF-36) mental and physical component scores, while anti-T cell agents showed no improvements. The MTC showed no differences between any biologics for either the DLQI or SF-36.
Conclusion
Individual biologics and classes showed consistent benefits across non-PASI health outcomes in patients with moderate-to-severe plaque psoriasis while MTC meta-analyses suggested that some differences exist.
doi:10.1007/s13555-012-0009-3
PMCID: PMC3510417  PMID: 23205332
Biologics; Meta-analysis; Plaque psoriasis
11.  Effect of Biologic Agents on Non-PASI Outcomes in Moderate-to-Severe Plaque Psoriasis: Systematic Review and Meta-Analyses 
Dermatology and Therapy  2012;2(1):9.
Introduction
The objective of this review was to conduct a systematic review with meta-analysis and Bayesian mixed treatment comparisons (MTC) evaluating the impact of biologics on non-Psoriasis Area and Severity Index (PASI) health outcomes in patients with moderate-to-severe plaque psoriasis.
Methods
MEDLINE and Cochrane Central Register of Controlled Trials were searched from 1966 to May 2009. Citations were screened for randomized, controlled trials of biologics versus either placebo or each other in adults with moderate-to-severe plaque psoriasis and reported any of several outcomes. Traditional and Bayesian MTC meta-analyses were conducted for each endpoint using either a random- or fixed-effect model where appropriate.
Results
Thirty-eight studies met eligibility criteria. All biologics showed significant improvement in achieving a good response on the static physician’s global assessment (PGA) versus placebo while, in the MTC, differences were noted between individual drugs. In achieving a good response on the dynamic PGA, all biologics showed significant improvements over placebo, while the MTC showed significant improvements with the anti-interleukins versus anti-T cells. Relative to placebo, antitumor necrosis factor (TNF) agents and anti-interleukins showed significant improvements in the Dermatology Life Quality Index (DLQI). Compared with placebo, the anti-TNF agents showed significant improvements in both 36-item Medical Outcomes Study Short-Form General Health Survey (SF-36) mental and physical component scores, while anti-T cell agents showed no improvements. The MTC showed no differences between any biologics for either the DLQI or SF-36.
Conclusion
Individual biologics and classes showed consistent benefits across non-PASI health outcomes in patients with moderate-to-severe plaque psoriasis while MTC meta-analyses suggested that some differences exist.
doi:10.1007/s13555-012-0009-3
PMCID: PMC3510417  PMID: 23205332
Biologics; Meta-analysis; Plaque psoriasis
12.  Number and Impact of Published Scholarly Works by Pharmacy Practice Faculty Members at Accredited US Colleges and Schools of Pharmacy (2001-2003) 
Objective
To evaluate the quantity and quality of published literature conducted by pharmacy practice faculty members in US colleges and schools of pharmacy for the years 2001-2003.
Methods
The Web of Science bibliographic database was used to identify publication citations for the years 2001-2003, which were then evaluated in a number of different ways. Faculty members were identified using American Association of Colleges of Pharmacy rosters for the 2000-2001, 2001-2002, and 2002-2003 academic years.
Results
Two thousand three hundred seventy-four pharmacy practice faculty members generated 1,896 publications in Web of Science searchable journals. A small number of faculty members (2.1%) were responsible for a large proportion of publications (30.6%), and only 4.9% of faculty members published 2 or more publications in these journals per year. The average impact factor for the top 200 publications was 7.6.
Conclusion
Pharmacy practice faculty members contributed substantially to the biomedical literature and their work has had an important impact. A substantial portion of this work has come from a small subset of faculty members.
PMCID: PMC1913293  PMID: 17619644
13.  Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels 
Background
During percutaneous coronary intervention (PCI), dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse cardiovascular events (MACE) and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI of native vessels.
Methods
We conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011), http://www.clinicaltrials.gov, abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs) that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s) in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus.
Results
37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3) by 39%, and thrombolysis in myocardial infarction (TIMI) 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment.
Distal filter embolic protection devices significantly increased the risk of target revascularization by 39% although the use of mechanical thrombectomy or embolic protection devices did not significantly impact other final health outcomes. Distal balloon or any embolic protection device increased the achievement of MBG-3 by 61% and 20% and TIMI3 flow by 11% and 6% but did not significantly impact other intermediate outcomes versus control. Upon qualitative analysis, all device categories, with exception of catheter aspiration devices, appear to significantly prolong procedure time compared to PCI alone while none appear to significantly impact ejection fraction. Many of the final health outcome and adverse event evaluations were underpowered and the safety of devices overall is unclear due to insufficient amounts of data.
Conclusions
In patients with STEMI, for most devices, few RCTs evaluated final health outcomes over a long period of follow-up. Due to insufficient data, the safety of these devices is unclear.
doi:10.1186/1471-2261-11-74
PMCID: PMC3313863  PMID: 22185559
14.  Association Between CHADS2 Risk Factors and Anticoagulation-Related Bleeding: A Systematic Literature Review 
Mayo Clinic Proceedings  2011;86(6):509-521.
OBJECTIVE: To determine the strength of evidence supporting an accentuated bleeding risk when patients with CHADS2 risk factors (chronic heart failure, hypertension, advanced age, diabetes, and prior stroke/transient ischemic attack) receive warfarin.
METHODS: A systematic literature search of MEDLINE (January 1, 1950, through December 22, 2009) and Cochrane CENTRAL (through December 22, 2009) was conducted to identify studies that reported multivariate results on the association between CHADS2 covariates and risk of bleeding in patients receiving warfarin. Each covariate was evaluated for its association with a specific type of bleeding. Individual evaluations were rated as good, fair, or poor using methods consistent with those recommended by the Agency for Healthcare Research and Quality. The strength of the associations between each CHADS2 covariate and a specific type of bleeding was determined using Grading of Recommendations Assessment, Development and Evaluation criteria as insufficient, very low, low, moderate, or high for the entire body of evidence.
RESULTS: Forty-one studies were identified, reporting 127 multivariate evaluations of the association between a CHADS2 covariate and bleeding risk. No CHADS2 covariate had a high strength of evidence for association with any bleeding type. For the vast majority of evaluations, the strength of evidence between covariates and bleeding was low. Advanced age was the only covariate that had a moderate strength of evidence for association; this was the strongest independent positive predictor for major bleeding. Similar findings were observed regardless of whether all included studies, or only those evaluating patients with atrial fibrillation, were assessed.
CONCLUSION: The associations between CHADS2 covariates and increased bleeding risk were weak, with the exception of age. Given the known association of the CHADS2 score and stroke risk, the decision to prescribe warfarin should be driven more by patients' risk of stroke than by the risk of bleeding.
The associations between CHADS2 covariates and increased bleeding risk were weak, with the exception of age; given the known association of CHADS2 score and stroke risk, the decision to prescribe warfarin should be driven more by the patient's risk of stroke than by risk of bleeding.
doi:10.4065/mcp.2010.0755
PMCID: PMC3104910  PMID: 21628615
15.  The impact of ethnicity and gender on agreement of severe allergy history between inpatient and outpatient electronic medical records 
Pharmacy Practice  2008;6(4):197-200.
Objective
To evaluate the rate of allergy documentation during inpatient admissions and determine if discrepancies exist between ethnicities and English proficiency, genders, and by medication classes.
Methods
Patients at an outpatient clinic with severe medication allergies documented in their electronic medical record were identified. Inpatient hospital admissions following the date this allergy was documented were reviewed and the presence or absence of this documentation in the inpatient electronic medical record was noted. An overall rate of successful documentation of allergies was calculated by dividing the number of admissions where the allergy was entered into by the total number of admissions where the opportunity to enter the allergy existed. Each patients ethnicity, gender, and the class of medication to which they were allergic to, was also recorded to determine if difference exist within each demographic.
Results
Overall, allergy information was successfully entered in 84.6% of 246 hospital admissions. This rate was significantly lower (37.5%) among patients whose ethnicity groups, on average, have lower rates of English fluency. There was no significant difference between genders. Allergies to cephalosporins were less likely to be entered (44.4%).
Conclusion
Patients who are not proficient in speaking English may be at an increased risk of experiencing an adverse drug reaction as their severe allergies are less likely to be documented during a hospital admission.
PMCID: PMC4141730  PMID: 25157294
Drug Hypersensitivity; Medical Records Systems; Computerized; Healthcare Disparities; United States
16.  Journal publications by pharmacy practice faculty evaluated by institution and region of the United States (2001-2003) 
Pharmacy Practice  2007;5(4):151-156.
Objective
To compare the quantity of manuscripts published in journals by departments of pharmacy practice at schools and colleges of pharmacy in the United States for the years 2001-2003.
Methods
We utilized the Web of Science bibliographic database to identify publication citations for the years 2001 to 2003 which were then evaluated in a number of different ways. Faculty were identified via American Association of Colleges of Pharmacy rosters for 2000-2001, 2001-2002, and 2002-2003 academic years.
Results
Rankings were done based on the number of publications per institution and average number of publications per faculty member at an institution. Upon linear regression analysis, a relationship exists between an institution’s faculty size and the total number of publications but not for tenure/nontenure-track faculty ratio. Rating highest in overall publication number did not guarantee high rankings in the average number of publications per faculty member at an institution assessment. Midwestern schools were responsible for more publications per institution than other regions. Many schools only generated minimal scholarship over this evaluative period.
Conclusion
While many schools have pharmacy practice faculty that strongly contributed to the biomedical literature, other schools have not. Pharmacy practice faculty in the Midwest publish more journal manuscripts than faculty in other regions of the country. More pharmacy schools need to engage their faculty in scholarly endeavors by providing support and incentives.
PMCID: PMC4147793  PMID: 25170351
Bibliometrics; Faculty; Pharmacy Schools; United States

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