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Biomedical subjects

Thomas L Lenz

Publications and source records attributed to Thomas L Lenz.

12 recordsLinked to original sources
PubMed2006

Using performance-based assessments to evaluate parity between a campus and distance education pathway.

OBJECTIVES: To compare the performance of campus-based students with that of distance students during the first 2 years of a doctor of pharmacy program to evaluate parity between the pathways. METHODS: Twelve cases were created for each year of the program along with performance criteria. The cases were converted into computer-based simulations for programmatic assessment at the end of the 2002-2003 and 2003-2004 school years. All first-professional year (P1) and second-professional year (P2) students participated in the assessments. Overall class means were calculated and used to compare student performances between campus and distance education pathways. RESULTS: Overall scores for the 2003 P1 class were 56.4% for the campus-based students and 62.4% for the distance students, (p = 0.002); overall scores for the 2003 P2 class were 48.8% and 55.5%, respectively (p < 0.0001). The 2004 overall scores for P1 campus and distance students were 59.0% and 65.7%, respectively, (p = 0.001); and for 2004 P2 scores the results were 51.8% and 56.5%, respectively (p = 0.049). CONCLUSIONS: Students receiving their pharmacy education via a distance pathway scored higher on performance-based assessments compared with students receiving their pharmacy education via the traditional campus-based pathway. This indicates that distance students are receiving at least an equivalent curricular experience in the P1 and P2 years compared to that received by campus-based students.

Education, Distance↗
PubMed2005

Osteoporosis in long-term care residents with multiple sclerosis.

OBJECTIVE: To assess the fracture risk of long-term care residents with multiple sclerosis (MS) using ultrasound heel-scan technology and identification of risk factors and areas where intervention by a pharmacist might affect patient outcomes. DESIGN: Bilateral-heel scans were performed on all patients who consented to take part in the study. A retrospective review of each subject's medical records was performed to identify known risk factors for osteoporosis. SETTING: A long-term care facility in Omaha, Nebraska. PARTICIPANTS: All patients with a primary diagnosis of MS residing at the facility were eligible for participation. Of 11 patients identified, 10 consented to participate. MAIN OUTCOME MEASURES: T-scores of the right and left heel as determined by ultrasound-heel scan were used to determine if study participants met criteria for osteopenia or osteoporosis as set forth by the World Health Organization. CONCLUSION: Patients in our population who have MS are at high risk for fracture. There are several areas in which pharmacists can intervene to prevent fracture and improve patient outcomes, including administration of heel scans for persons believed to be at risk, recommendation of over-the-counter supplements, and education of both patients and health care practitioners.

Journal Article↗
PubMed2004

Amiodarone versus sotalol for the treatment of atrial fibrillation after open heart surgery: the Reduction in Postoperative Cardiovascular Arrhythmic Events (REDUCE) trial.

OBJECTIVES: This prospective, randomized, double-blind, placebo-controlled study compared the efficacy and safety of amiodarone and sotalol in the prevention of atrial fibrillation (AF) following open heart surgery. BACKGROUND: The incidence of supraventricular arrhythmias following open heart surgery ranges from 20% to 40%, with AF being the most common. Both amiodarone and sotalol have been shown to be effective in reducing postoperative arrhythmias, but no direct comparison of these agents has been conducted. METHODS: A total of 160 patients were randomized, of whom 134 underwent coronary artery bypass graft surgery (CABG) alone, 17 underwent CABG and concomitant aortic valve replacement surgery (AVR), 9 underwent AVR only, and 1 patient's surgery was canceled. Patients with signs or symptoms of congestive heart failure (CHF), ejection fraction < or =30%, estimated creatinine clearance <30 mL/min, or serum creatinine > or =2.5 mg/dL were excluded. Patients were randomized to receive either sotalol 80 mg 2 times per day (n = 76) or intravenous amiodarone 15 mg/kg over 24 hours followed by oral amiodarone 200 mg 3 times per day (n = 83). Study drug was started at the time of surgery and continued for 7 days or until discharge, whichever came first. RESULTS: AF occurred in 17% of patients randomized to amiodarone and 25% of the patients randomized to sotalol (P =.21). However, the duration of AF was significantly shorter in amiodarone-treated patients (169 +/- 224 min) compared to sotalol treated patients (487 +/- 505 min; P =.04). In a subgroup analysis, the incidence of AF in patients undergoing AVR or CABG with AVR was significantly less with amiodarone (1/15, 7%) compared to sotalol (9/11, 82%) (P <.001). Blood pressure was lower immediately after surgery with amiodarone but comparable to sotalol at 24 hours. Of the hemodynamic indices measured, only stroke volume was significantly lower in patients randomized to sotalol at 24 hours (P =.035). CONCLUSIONS: Amiodarone and sotalol share similar efficacy and safety in reducing postoperative AF. Hemodynamic effects were similar between both drugs at 24 hours, with the exception that stroke volume was lower in sotalol-treated patients. In patients undergoing more complex surgery, postoperative AF occurred more frequently with sotalol than with amiodarone.

Aged↗
PubMed2004

Impact of nesiritide on health care resource utilization and complications in patients with decompensated heart failure.

STUDY OBJECTIVE: To determine the impact of nesiritide on health care resource utilization and complications in patients hospitalized with decompensated heart failure. DESIGN: Retrospective case-control study. SETTING: United States hospitals. PATIENTS: Two hundred sixteen patients hospitalized for decompensated heart failure. MEASUREMENTS AND MAIN RESULTS: One hundred eight patients who received a nesiritide infusion for a minimum of 12 hours during the first 48 hours after hospital admission were matched with 108 patients not receiving nesiritide. Health care resource utilization, consisting of hospital length of stay (LOS), rate of rehospitalization within 90 days, concomitant drugs administered, and laboratory and diagnostic tests, was determined for each hospital admission. Rates of adverse events also were recorded. Patients receiving nesiritide had a significantly shorter LOS in a critical care unit (p=0.03). General medical ward or step-down unit LOS was not different between the treatment groups. A favorable trend toward a lower rate of rehospitalization over the 90-day follow-up period was observed with nesiritide (p=0.07). The number of patients who developed life-threatening ventricular arrhythmias and hypotension was similar for both treatment groups. However, in patients receiving nesiritide, significantly less atrial fibrillation (p=0.03) and renal dysfunction (p=0.04) occurred compared with patients not receiving nesiritide. CONCLUSION: Nesiritide therapy is associated with significant reductions in both health care resource utilization and complications in patients with decompensated heart failure.

Aged↗
PubMed2004

Potential interactions between exercise and drug therapy.

Certain physiological changes caused by aerobic exercise can alter the pharmacokinetics of some drugs. A systematic review of the pharmacokinetic changes that can affect drugs as a result of aerobic exercise is provided. Eleven commonly used drugs are reviewed for their potential interaction with exercising patients. Serum concentrations of two beta-blocking agents, atenolol and propranolol, and one antibiotic, doxycycline, have shown to increase as a result of exercise. No pharmacokinetic changes have been found in exercising patients taking carvedilol or verapamil. Patients who exercise after taking digoxin experience a decreased digoxin serum concentration with an increased skeletal muscle concentration. The clearance of theophylline has been shown to decrease resulting in an increase in plasma half-life during exercise. The risk of hypoglycaemia may increase when patients with diabetes mellitus inject insulin into a muscle just prior to exercising that muscle. Increasing physical activity in patients taking warfarin has been shown to decrease the international normalised ratio. Much is still unknown regarding the interactions that exist between exercise and drug therapy. More studies need to be completed in this area before definite conclusions are made and clinical relevance can be established. Clinicians should be aware that the potential for such interactions exists, especially for drugs with a narrow therapeutic range and in patients who participate in extreme sporting activities.

Absorption↗
PubMed2003

Gabapentin for the treatment of tremor.

OBJECTIVE: To review the use of the antiepileptic drug gabapentin for the treatment of various types of tremor. DATA SOURCES: A search of biomedical literature was completed through MEDLINE and EMBASE (1993-May 2002) to identify all clinical trials pertaining to the use of gabapentin for the treatment of tremor in humans. DATA SYNTHESIS: Outcome data from the few published studies have varied widely. Patient groups have been small, and conclusions have been based largely on subjective patient and investigator ratings. CONCLUSIONS: A trial of gabapentin is warranted in patients who fail therapy with traditional agents. Improvement should be measured by a patient's perceived functional ability.

Acetates↗
PubMed2002

Amiodarone vs. sotalol as prophylaxis against atrial fibrillation/flutter after heart surgery: a meta-analysis.

BACKGROUND: The incidence of supraventricular arrhythmias remains high following open-heart surgery. The most common of these arrhythmias are atrial fibrillation and flutter (AFF), for which treatment is not well defined. Recent studies have focused on prophylactically treating patients in an attempt to reduce postoperative AFF. Several studies have shown that sotalol and amiodarone are both effective in reducing AFF following heart surgery. However, no studies have been done comparing both drugs. METHODS: A meta-analysis was done to compare the efficacy of sotalol and amiodarone after bypass graft surgery. Randomized controlled trials were included if patients were clearly monitored, and the incidence of AFF was noted. Ten studies were included in the final analysis. RESULTS: Both amiodarone and sotalol were more effective than placebo treatment in reducing the incidence of postoperative AFF. However, when the data were pooled, no differences were noted between amiodarone and sotalol for efficacy (sotalol, - 21.5%; 95% confidence interval [CI], - 28.3 to - 14.6; amiodarone, - 14.1%; CI, - 20.1 to - 8.1), length of stay (sotalol, - 0.13 d; CI, - 0.33 to 0.07 d; amiodarone, - 0.18; CI, - 0.38 to 0.02 d), or adverse drug reactions causing drug termination (sotalol, 9.7%; CI, 0.086 to 19.3; amiodarone, 1.95%; CI, - 0.48 to 4.38). CONCLUSIONS: This data would suggest that either drug could be used in a prophylactic regimen to reduce the incidence of AFF following heart surgery.

Aged↗
PubMed2002

Comparison of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease.

STUDY OBJECTIVE: To compare the lipid-lowering effects of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease. DESIGN: Open label, fixed-dosage, retrospective-prospective, one-way crossover from gemfibrozil to fenofibrate. SETTING: University-affiliated outpatient clinics. PATIENTS: Eighty patients with coronary heart disease with a baseline low-density lipoprotein cholesterol (LDL) level above 130 mg/dl or a triglyceride level of 200 mg/dl or higher who had been receiving gemfibrozil 600 mg twice/day. Thirty-nine (49%) patients had received concomitant therapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) for a minimum of 9 months. INTERVENTION: All patients received gemfibrozil 600 mg twice/day for at least 3 months before being switched to fenofibrate 201 mg/day. Patients receiving concomitant statin therapy before crossover continued the statin at the same dosage after crossover. Before crossover, a fasting lipid profile was determined and patients were queried about the side effects of lipid-lowering therapy. A repeat fasting lipid profile was obtained 12 weeks after the crossover. MEASUREMENTS AND MAIN RESULTS: Patients were stratified into those receiving versus those not receiving concomitant statin therapy. In both of these groups, fenofibrate was associated with significantly greater reductions in total cholesterol, LDL, and triglycerides than gemfibrozil (all p < 0.001). In addition, fenofibrate was associated with a significantly greater increase in high-density lipoprotein cholesterol (HDL) than gemfibrozil (p < 0.001). No patients reported new-onset adverse effects after the crossover. CONCLUSIONS: Compared with gemfibrozil, fenofibrate produced significantly greater reductions in total cholesterol, LDL, and triglycerides and significantly greater increases in HDL. These changes were evident in patients receiving and not receiving concomitant statin therapy.

Aged↗
PubMedDate not supplied

Supplemental products used for weight loss.

OBJECTIVE: To review the scientific literature on several dietary supplements and herbal products commonly promoted for weight loss. DATA SOURCES: Recently published articles and abstracts identified through PubMed (May 1987-May 2003), MEDLINE (January 1966-May 2003), International Pharmaceutical Abstracts (January 1970-May 2003), and Natural Medicines Comprehensive Database (January 1995-May 2003) using the search terms supplement, herbal, weight loss, obesity, overweight, conjugated linoleic acid, ephedra, ephedrine, chromium, Garcinia cambogia, hydroxycitric acid, chitosan, and pyruvate. STUDY SELECTION: Performed manually by the authors. DATA EXTRACTION: Performed manually by the authors. Only single-agent, randomized, blinded, controlled studies with sufficient scientific rigor in overweight or obese subjects were included. DATA SYNTHESIS: Approximately 50 individual supplemental products and hundreds of combination products are promoted for weight loss. As a result, much confusion exists among health care professionals regarding the efficacy and safety of these products. Results for conjugated linoleic acid were positive in three clinical studies, with few adverse effects. Ephedra has been shown to be effective in promoting weight loss, especially when combined with caffeine, but it has a high adverse effect risk profile. The data regarding ephedra and ephedra combinations are conflicting, and many of the studies were poorly designed. Garcinia and chitosan have not shown much promise for weight loss, but little research has been done. Pyruvate has consistently shown positive weight loss effects. CONCLUSION: Overall, herbal products and dietary supplements promoted for weight loss lack sufficient supporting efficacy and safety data. More research is needed to draw definitive conclusions. Conjugated linoleic acid and pyruvate have the best supporting evidence, but larger and better-controlled trials are needed before pharmacists should recommend these agents to patients seeking to lose weight.

Clinical Trials as Topic↗
PubMedDate not supplied

Therapeutic lifestyle changes and pharmaceutical care in the treatment of dyslipidemias in adults.

OBJECTIVE: To review each therapeutic lifestyle change (TLC) component listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) cholesterol guidelines and discuss how the guidelines can be used by pharmacists in the treatment of patients with dyslipidemias. DATA SOURCES: Published guidelines and abstracts identified through PubMed (May 1987-March 2004), Medline (January 1966-March 2004), using the search terms cholesterol, hypercholesterolemia, dyslipidemia, hyperlipidemia, diet, saturated fats, unsaturated fats, trans-fatty acids, overweight, obese, exercise, physical activity, program adherence, and guidelines; as well as the NCEP ATP III guidelines, the 2004 ATP III update, National Heart, Lung, and Blood Institute Obesity Guidelines, and Dietary Guidelines for Americans 2005. STUDY SELECTION: Performed manually by author. DATA EXTRACTION: Performed manually by author. DATA SYNTHESIS: TLC components are recommended in the NCEP ATP III guidelines for treatment of patients with dyslipidemias independent of medication use. Dietary modifications are the primary focus of TLC therapy. Saturated fat intake should be limited to less than 7% of total caloric intake and trans-fatty acid intake should be low for patients with dyslipidemias. Persons who are overweight or obese with dyslipidemias should reduce body weight through a combination of physical activity, total calorie reduction, and behavior therapy modifications. CONCLUSION: Pharmacists, given the proper training, can be effective at offering preventive pharmaceutical care for decreasing high blood cholesterol and the risk for coronary heart disease through patient counseling on TLC components as well as drug therapy in patients with dyslipidemias.

Adult↗
PubMedDate not supplied

Lifestyle modification counseling of patients with dyslipidemias by pharmacists and other health professionals.

OBJECTIVES: To establish whether patients who are taking lipid-lowering medications receive information on lifestyle modifications from health care providers when originally prescribed and whether they continue to receive follow-up information on lifestyle modifications, and to establish where patients with dyslipidemias are receiving information about lowering their serum cholesterol levels through lifestyle modifications. DESIGN: Cross-sectional survey. SETTING: Two community pharmacies and two hospitals in two medium-sized cities in the midwestern area of the United States. PARTICIPANTS: 234 patients taking medication to lower serum lipids. INTERVENTION: Paper-based survey. MAIN OUTCOME MEASURE: Responses to survey items. RESULTS: Nearly three quarters (73.9%) of participants received information about lowering their serum lipids through lifestyle modifications when they were first diagnosed with elevated serum cholesterol concentrations. Of these, most (83.8%) said that the information came from their physician. Fewer than one half (48.3%) of all participants said that they continued to receive this type of information. Those who received lifestyle modification information at their original diagnosis and who continued to receive this type of information were more likely to be actively trying to lower their serum lipid levels through diet (93.1%) and exercise (71.6%). Participants visited their pharmacy more often than their physician's office each year, yet they recalled pharmacists offering less patient counseling on lifestyle modifications than did physicians and nurses. CONCLUSION: Despite being well positioned to assist patients with elevated serum cholesterol concentrations, pharmacists offer less patient counseling about therapeutic lifestyle modifications compared with physicians and nurses.

Adult↗