Meek, Patrick Publications

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ACPHS student authors are denoted by an asterisk (*). Pharmacy resident authors are denoted by a double plus sign (++).

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Now showing 1 - 5 of 17
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    Prescribing of Proton Pump Inhibitors for Prevention of Upper Gastrointestinal Bleeding in US Outpatient Visits.
    (Clinical Gastroenterology and Hepatology, 2024-02-15) Kurlander, Jacob E; Mafi, John N; Racz, Michael J; Barnes, Geoffrey D; Saini, Sameer D; Meek, Patrick D
    Antisecretory medications, primarily proton pump inhibitors (PPIs), have proven effective in reducing upper gastrointestinal toxicities, including upper gastrointestinal bleeding (UGIB), associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, which are among the most commonly used medications in the United States. Accordingly, professional guidance recommends PPIs for patients at high risk for UGIB. However, little is known about trends in use of antisecretory medications for gastrointestinal prophylaxis ("gastroprotection"). Herein, we examined contemporary use and prescribing of antisecretory medications in visits by patients at high risk for UGIB, relative to visits by patients diagnosed with acid-related disorders.
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    Emerging therapies for eosinophilic esophagitis.
    (Pharmacotherapy, 2023-04) Meek, Patrick D; Hemstreet, Brian
    Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus that is quickly becoming a more recognized cause of esophageal dysfunction and dysphagia. The cause of EoE is thought to be due to an inflammatory response triggered by exposure to dietary or environmental antigens. Symptoms may be progressive and include reflux, nausea, vomiting, dysphagia, and reduction in quality of life. Both children and adults may be affected. Initial treatments for EoE have focused on elimination diets to potentially identify and remove dietary triggers, acid suppression with proton pump inhibitors, and topical delivery of orally administered swallowed corticosteroids. These therapies are often ineffective in a large proportion of patients, leading to exploration of other approaches by focusing on cytokines involved in the inflammatory response. Most recently, dupilumab, a monoclonal antibody targeting IL-4 received approval for use in patients aged 12ā€‰years or older with EoE. Use of dupilumab has seen favorable improvements in disease progression and symptoms with chronic use. Other therapies targeting IL-5, such as mepolizumab, reslizumab, and benralizumab are currently being studied for use in EoE. Therapies targeting other key inflammatory mediators in EoE, such as Siglec-8 (lirentelimab), IL-13 (cendakimab), and the sphingosine 1-phosphate receptor (etrasimod) are currently being evaluated in clinical trials.
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    Pain management-related assessment and communication across the care continuum: Consensus of the opioid task force of the Island Peer Review Organization pain management coalition
    (Journal of the American College of Clinical Pharmacy, 2/5/2022) Juba, Katherine M; Triller, Darren; Myrka, Anne; Cleary, Jacqueline H; Winans, Amanda; Wahler Jr, Robert G; Argoff, Charles; Meek, Patrick D
    Prescription opioid analgesics contribute to serious, preventable adverse drug events (ADEs) and despite efforts ranging from regulatory changes to quality improvement initiatives, national studies indicate that opioid-related emergency department visits and hospitalizations are increasing amid the coronavirus disease 2019 (COVID-19) pandemic. Effective pain management is challenging during care transitions, and system imperfections make patients vulnerable to ADEs as they leave one care setting and move to another. Therefore, the Island Peer Review Organization (IPRO) pain management coalition convened a task force to develop resources to guide improvements in opioid-related communication during patient care transitions. Create a consensus list of requisite communication elements (RCEs) that should accompany all patients prescribed opioids as they undergo care transitions. An interprofessional task force of pain management experts was convened and completed a blinded, iterative Delphi process. After four Delphi rounds, the panel reached consensus on a pain management discharge communication (PMDC) List of 24 RCEs across the domains of opioid dosing and pain management (nine elements), factors associated with adverse drug events (nine elements), and patient education and caregiver support (six elements). During transitions of care providers need detailed information on opioid dosing, pain characteristics, risk factors for adverse events, and patient/caregiver capacity to adequately manage symptoms while avoiding potentially fatal ADEs. The PMDC list may guide the development of new clinical tools, quality measures, accreditation standards, and checklists for pharmacists involved in the delivery of opioid stewardship during a care transition. Additional work is needed to design comprehensive, interprofessional opioid stewardship programs to ensure that the requisite communication elements are consistently available at the time of a care transition.
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    Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility.
    (Journal of the American Geriatrics Society, 2020-01) Davenport, Claire ++; Brodeur, Michael R; Wolff, Michael; Meek, Patrick D; Crnich, Christopher J
    Objectives: To derive weighted-incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use. Design: Retrospective analysis of microbial data from a regional laboratory. Setting: We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015. Participants: A total of 28 regional SNFs (rSNFs) and 7 in-network SNFs (iSNFs). Measurements: WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole. Results: Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11-113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76-11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols. Conclusion: These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55-61, 2019.
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    Defining Minimum Necessary Anticoagulation-Related Communication at Discharge: Consensus of the Care Transitions Task Force of the New York State Anticoagulation Coalition.
    (Joint Commission Journal on Quality and Patient Safety, 2018-11) Triller, Darren; Myrka, Anne; Gassler, John; Rudd, Kelly; Meek, Patrick; Kouides, Peter; Burnett, Allison E; Spyropoulos, Alex C; Ansell, Jack
    Background: Anticoagulated patients are particularly vulnerable to ADEs when they experience changes in medical acuity, pharmacotherapy, or care setting, and resources guiding care transitions are lacking. The New York State Anticoagulation Coalition convened a task force to develop a consensus list of requisite data elements (RDEs) that should accompany all anticoagulated patients undergoing care transitions. Methods: A multidisciplinary panel of 15 anticoagulation experts voluntarily completed an iterative Delphi process. Resources were disseminated and deliberated via remote technology, with consensus achieved via blinded electronic polling. Results: The panel reached consensus on a list of 15 RDEs for anticoagulation communication at discharge (the ACDC List). Consensus was rapidly achieved by the full panel on 13 elements, while 3 (2 of which were combined into 1 element) required multiple iterations and achieved consensus with votes from 8 available panelists. The elements encompassed a range of factors, including drug use and indications, previous exposure and duration of therapy, recent drug exposure and laboratory results and expectations for subsequent administration, therapy goals, patient education and comprehension, and expectations for clinical management. Twelve of the elements are applicable to any anticoagulant, and 3 are specific to warfarin. Conclusion: The ACDC List identifies specific pieces of clinical information that a panel of anticoagulant experts agree should be communicated to downstream providers for all anticoagulated patients undergoing care transitions. Additional study is needed to objectively evaluate the ability of existing care systems to communicate the elements and to assess possible relationships between communication of the elements and clinical outcomes.