RSS 1.0UA Graduate and Undergraduate Research
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The graduate and undergraduate research collections share, archive and preserve research from University of Arizona students. Collections include honors theses, master's theses, and dissertations, in addition to capstone and other specialized research and presentation topics.
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Exploring 3D Visualization Techniques Using Geographic Information Systems Technology at the University of ArizonaAs computers and geographic information systems (GIS) technology improves, more advanced visualization and analysis becomes possible. One area of GIS technology that is seeing improvement is the development of 3D GIS data. The primary focus of this project was to explore three types of building models that can be created from varying quality data and used by a wide variety of users. Using ESRI software, the goal was to provide guidance for GIS users to develop high quality 3D data relevant to their specific needs. Examples of created 3D products are photorealistic-textured buildings, thematically symbolized buildings, and 3D renderings designed for interior navigation. The resulting data were compiled into an interactive web application for visualization and making comparisons between methodologies. All methods involved using 2D building footprint source data and leveraging the attributes and geometry to create 3D structures. These models provide viewers with additional information that would be impossible to convey in two dimensions, such as viewing a route that occupies the same space on different floors of a building, like navigating between offices or classrooms. Interior navigation is one of many examples of an application that can be built upon the fundamental 3D data examined in this project. Additionally, institutions or organizations seeking to develop their first 3D data from 2D data could potentially use the findings of this project to inform their decisions and start supporting the advancement of 3D GIS at a faster rate than if they were to attempt to develop these data independently.
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Growing Up: Greenhouse Designs for Urban SpacesWith the world heading towards a potential food crisis by the year 2050 we need to start looking at current solutions to future problems. One idea is to create more efficient greenhouses where more food can be grown in a smaller space and closer to population centers. By first understanding a brief history of the origins of greenhouses and their historic uses we can further our understanding of how to push these designs into a better future. By utilizing new construction materials, buildings designs, and growing methods, greenhouses may be able to help stem the need for additional agricultural land and food transport. Many companies are already creating urban farms but there is still room for improvement. This study takes a look at some basic ideas towards furthering this goal.
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A Call for Remediation: Food DesertsThe total area covered by cities is projected to triple worldwide in the next forty years (Swilling, 2016). Not only will this urban sprawl continue to consume America’s farmland, but sustainability efforts are largely being hampered, as resources will continue to be depleted, biodiversity will continue to shrink, and ecosystems will be degraded more so than they already are. In recent decades, there has been a flip in where people prefer to reside. Post World War II, America’s upper class preferred living in large mansions in the suburbs, while poorer people lived in or on the edge of central business districts. Nowadays, due to changing demographics and high fuel prices, affluent people prefer to reside in or near cities, and the suburbs have seen an increase in crime and poverty rates (Gallagher, 2014). In layman’s terms, the rich want to be near their jobs, recreation, and amenities, while the poor population has been pushed to less well-rounded/safe areas for residency. The United States’ national population is comprised of almost 326 million people, 23.5 million of whom currently live in a food desert (USDA, 2009). A whopping 2.2% of all American households are located more than ten miles away from a grocery store- this statistic is under-reported, as small corner stores are counted in the same category as big supermarkets in our Industry Classification System (North American Industrial Classification Systems, 2007 ) (Appendix A). Urban growth patterns show that expansion of the suburbs post World War II did not cause increased food access. Expansion radiated outwards, and food access largely remained centralized. Thus, those living on the outskirts where once the rich with means of transportation that would allow them to access food sources easily. However, since the switch in residents, the poor have much more difficulty accessing these supermarkets due to a variety of limitations. These low-income people who find it hard to get and access fresh produce and meat, live in what are called “food deserts.” A food desert does not say residents have no access to food at all, but the options available include numerous quick marts and/or fast food chains that provide a “wealth of processed, sugar, and fat-laden foods” (American Nutrition Association, 2010). Due to transportation barriers, research has demonstrated that people residing in food deserts tend to indulge in unhealthy options more than those living in supermarket accessible areas, and thus residents near or in food deserts tend to have health and weight issues. There is a positive correlation between food deserts increasing in quantity across America and America’s increasing obesity epidemic, where these health concerns end up having a snowball effect for the poor. This capstone is a policy review and lays out ideas to begin to alleviate the food desert crisis in America. The current and historical status of the situation will be thoroughly reviewed, and remediation suggestions will be flushed out throughout the paper.
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Tucson regional strategies toward a more sustainable homeIndividuals approach the implementation of sustainable strategies at home depend on many factors, which include personal values and economic status. Questions concerning the viability of sustainable home building persist, even within the industry. Utilizing current research, observations, and personal interviews with industry experts, this study attempted to define a prescriptive list of sustainability strategies to the average resident of the Tucson region interested in becoming more energy-efficient. A hierarchy of strategies emerged, ranging from low to no cost implementation strategies to high cost remodels. A consensus was reached concerning the importance of thermal envelope integrity as well as the often- overlooked benefit of shading strategies on the east and west side of a home. Limitations of this study include the scope of energy savings in the residential sector versus societal consumption as a whole, notably within the transportation or industrial sectors.
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Cost Benefit Analysis of Leasing Versus Buying SolarI conducted a cost-benefit analysis of buying solar panels versus leasing them. This study was performed on three residential locations and three commercial locations, which all had different square footage and usage. I found that with smaller system sizes for residential locations, leasing is not the best option. Otherwise, buying and leasing for larger system sizes is based on personal preference. This study demonstrated what the total cost to buy specific system sizes would be and what a customer would save based upon the cost of a leasing program month to month and annual savings based on a Power Purchase Agreement. This study showed the benefits of going solar and what program, lease or buy, could fit you as an individual.
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SVR Rates of Direct-Acting Antiviral Hepatitis C Therapies in Patients at a Specialty PharmacySpecific Aims: To compare sustained virological response at 12 weeks after the end of therapy (SVR12) rates of direct acting antiviral (DAA) hepatitis C therapies in patients at a specialty pharmacy to SVR12 rates from recently published literature. To identify insurance coverage rates among different insurance payer types. Subjects: Patients that were at least 18 years or older, have a diagnosis of Hepatitis C, and had at least 1 DAA fill from Avella Specialty Pharmacy. Methods: A retrospective chart review was conducted utilizing data extracted from patient profiles who have filled a prescription at Avella Specialty Pharmacy for either Epclusa, Harvoni, Mavyret, Vosevi, or Zepatier during January 2017 to March 2018. Main Results: Of the 1,738 patients extracted for the review, 712 patients had SVR12 outcomes documented. The overall SVR12 rate of patients at Avella Specialty Pharmacy was not significantly different from published literature (97% vs 97%, p=0.96). Patients with genotype 2 at Avella Specialty Pharmacy achieved a total higher SVR12 rate when compared to published literature (100% vs 96%, p<0.05). Medicare had the highest coverage rates and Medicaid had the lowest coverage rates (56% and 16%, respectively). Conclusions: Our findings show that Avella Specialty Pharmacy can help patients obtain high cost medications through their insurance while maintaining SVR12 rates similar to those published in the literature. The services provided to patients by specialty pharmacies are essential to maintain high treatment outcomes and improve coverage rates.
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Measuring adherence trends among patients taking a 3-hydroxy-3-methylglutaryl-coenzyme-A (HMG-CoA) reductase inhibitorSpecific Aims: There are three specific aims for this project. 1) Determine if PDC rates in patients taking a statin medication differ between male and female patients. 2) Determine if PDC rates in patients taking a statin medication differ between patients with only one chronic condition versus those with more than one chronic condition. 3) Determine if PDC rates in patients taking a statin medication differ between type of statin therapy. Our working hypothesis for all three hypotheses is that there is a statistically significant difference between groups. Purpose: How many of your patients are not adherent to their statin regimen? Patients who are nonadherent to their 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor therapy (statin) are at increased risk of uncontrolled cholesterol levels, cardiovascular events, and mortality. As patients are diagnosed with more disease states they are likely to be prescribed more medications for treatment. The study objective was to evaluate how the number of comorbidities affect medication adherence, measured via the Proportion of Days Covered. Additional analyses were conducted for adherence based on patient gender and by type of HMG-CoA reductase inhibitor. Methods: Data was originally collected by SinfoníaRx, a medication management technology and service company, as part of an internal quality improvement project. For this retrospective review, the data were deidentified by SinfoníaRx staff prior to providing it to the researchers. Variables in the de-identified data set included patient age, patient gender, Proportion of Days Covered, the number of chronic conditions for each patient, and the specific 3-hydroxy-3-methylglutaryl-coenzyme A reductase drug the patient was taking. Separate data sets were then created from the original data by filtering patients by gender, number of comorbidities, and specific drug. The gender analysis consisted of two groups (male and female) and a t-test was performed to analyze the average Proportion of Days Covered between the groups. An analysis of variance was performed to analyze the average Proportion of Days Covered. A Bonferonni post-hoc analysis was performed to measure significance between the groups. Results: A total of 55,345 patients were included in the analysis. Patients with multiple comorbidities were significantly more adherent according to their average Proportion of Days Covered (expressed as a percent) as follows: 0- (58.8%, P = <0.01), 1- (63.4%, P = <0.01), and 2-4- comorbidities (68.1%, P = <0.01). Men’s adherence rates were 68.13% and women’s adherent rates were 67.65%. Atorvastatin and the ezetimibe/simvastatin combination medications had significantly better adherence when compared individually to the other drugs included in the analysis. Conclusion: This study suggests that patients with more chronic conditions were more adherent to their medications than those with fewer or no chronic conditions. However, even the most adherent patients in this study still had Proportion of Days Covered values well below the recommended threshold. Future research is warranted to facilitate designing adherence program materials to help patients with fewer chronic conditions improve adherence to prescribed regimens.
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Effect of Rocuronium Versus Succinylcholine on Time to Neurosurgical Intervention in Patients with Intra-Cranial HemorrhageSpecific Aims: To determine if patients with severe traumatic brain injury receiving a longer-acting neuromuscular blocking agent (rocuronium) in RSI lead to a delay in neurosurgical procedures compared to patients receiving a short-acting neuromuscular blocking agent (succinylcholine). Methods: This was a retrospective cohort study conducted in an academic ED in the United States. A list of patients who received RSI in the ED between the periods 1 Jan 2014 to 1 October 2017, was generated from an RSI database maintained by the department of emergency medicine. Data was collected from electronic medical records and entered into Research Electronic Data Capture (REDCap). The primary outcome variable was the time from RSI to neurosurgical procedure. Information collected included patient demographics, medications used, and clinical information about the head injury. Data regarding timing of RSI, neurosurgeon assessment, and subsequent neurosurgical procedure were also collected. Main Results: The median time from ED presentation to RSI was 18 (10-83) minutes with succinylcholine and 46 (16-133) minutes with rocuronium (p=0.187). The median time from RSI to neurosurgeon assessment was 64 (32-211) minutes with succinylcholine and 123 (34-165) minutes with rocuronium (p=0.950). Neurosurgeon assessment occurred >120 min after RSI in 38% (n=15) patients with succinylcholine and 50% (n=9) patients with rocuronium. The median time from RSI to neurosurgical procedure was 179 (93-390) minutes with succinylcholine and 155 (84-226) minutes with rocuronium (p=0.616). Conclusions: Patients with severe traumatic brain injury receiving rocuronium in RSI did not have a significantly longer time to neurosurgical procedure compared to patients receiving succinylcholine.
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Drug-drug interaction between Protease inhibitors and statins and Proton pump inhibitorsObjective: The purpose of this article is to provide a systematic review of the pharmacokinetic and clinical data on drug-drug interactions between protease inhibitors (PIs) and statins, atazanavir and proton pump inhibitors (PPIs)and their clinical relevance. Methods: A literature search was performed using Medline, EMBASE and google scholar, abstracts from 1970 to 2019 of major conferences were searched and FDA drug information package inserts of the manufacturer of every currently available PI was looked at. All data was summarized and verified by at least two investigators. Results: A total of 246 references were identified, 8 of which were studies of pharmacokinetic and pharmacodynamics interactions between simvastatin, lovastatin and protease inhibitors and an additional 7 articles that provided pharmacokinetic of proton pump inhibitors and Atazanavir. Conclusions: Protease inhibitors increases the AUC and Cmax of simvastatin by approximately 500% and 517% respectively. Therefore, simvastatin and Lovastatin are not recommended for a co-administration with a protease inhibitor. Other statins such as rosuvastatin and pravastatin, can be used and are the main statins recommended. Atazanavir can be administered with PPIs but change of an acid reducing agent may be warranted, if possible. Providers should keep a close eye to those patients taking atazanavir and PPIs and consider a change to H2RA.
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Metastatic Colorectal Cancer: A Systematic Review of Disease Manifestation and Response to Treatment in Right- vs Left-Sided AdenocarcinomaMetastatic colorectal cancer (mCRC) is a well-known and recognized disease. It is a heterogeneous, progressive, non-cutaneous, multi-stage example of hyperactive cellular dysfunction and genetic overexpression. It is widely documented as being the third most prolific form of cellular carcinogenesis and it accounts for approximately 90% of malignancy in tumors within the large bowel. In recent years, advances in clinical research have revealed that much of the diversity associated with the manifestation of colonic adenoma may be linked to the heterogeneous embryonic origins of the colonic landscape. For example, adenocarcinoma of the proximal (ascending) right-side of the colon, which develops embryologically from the midgut, typically presents with microsatellite instability and a higher frequency of BRAF mutations. In contrast, disease expression within the distal (descending) left-side of the colon, which shares nascent origins with the hindgut, is characterized by chromosomal instability and activation of the epidermal growth factor receptor (EGFR) pathway. As a result, these variances highlight an important relationship between site-specific embryology and disease etiology. It is believed that a heterogeneous approach to therapeutic treatment methodologies based upon the biogeography of the colonic landscape, may hold an important key to unlocking and advancing the overall efficacy of first-line therapies used in the treatment of metastatic colorectal cancer. SPECIFIC AIMS: The purpose of this project is to perform a systematic review of primary literature from studies where-in targeted anti-VEGF and anti-EGFR treatments were administered as first-line therapy to patient populations inclusive of right-sided and/or left-sided colorectal cancer in order to evaluate the efficacy of site-specific treatment on Overall Survival (OS), Objective Response (OR), and Progression-Free Survival (PFS) rates.
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Assessing Language Assist Program Usage in Retail Pharmacies Through An Online Survey Among AzPA MembersSpecific Aims: To find out if pharmacists use translation assist programs when counseling patients who have very limited ability to speak or understand English. Subjects: Pharmacists in Arizona who are employed at least part-time and work in a community setting. Methods: Surveys were distributed through the Arizona Pharmacists Association (AzPA) newsletter to community pharmacists. Participants were questioned about demographics including work environment, English as a first language, and gender. Other information collected included how busy the pharmacist’s store was, how many opportunities they had to use a language assist program, if their employer provided a language assist service, if they used the service, and what some reasons may be for not using a language assist service. Main Results: Surveys were complete by 58 pharmacists in Arizona. 52 of the 58 participants (90%) said that their employer provided a language assist program, but only half reported that they actually use it. The most common reason reported for not using a translation service was because they were “too busy or did not have enough time” (69%). No statistically significant results were found comparing translation service use between rural versus urban pharmacists, pharmacists with different script volumes, or the number of years a pharmacist has been working. Conclusion: Although more pharmacists were aware of translation services available than predicted, only half of the pharmacists reported using the service.
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Investigating the Impact of a Mental Health Adherence Intervention on Mental Health Medication Adherence in Patients with DiabetesSpecific Aims: Evaluate the impact of targeted psychotropic medication adherence interventions by pharmacists on psychotropic medication adherence rates in patients with type 2 diabetes and determine whether patient-specific variables, such as age, gender, or type of psychotropic medication being taken, influence the degree of impact. Methods: Adherence, as indicated by proportion of days covered (PDC), was measured before and after face-to-face counseling by a community pharmacist. Pharmacists were alerted to counsel patients receiving Medicare Part D prescription coverage who were prescribed a psychotropic medication and exhibited a PDC of <85%. Data regarding PDC, age, gender, and type of psychotropic medication were analyzed for patients between 18 and 84 years of age with type 2 diabetes. Main Results: The data set contained 8,167 patients eligible for analysis, including 5,438 women (mean age=63.6 years, SD=11.5) and 2,729 men (mean age=61.6 years, SD=10.3). There was significant improvement in PDC after pharmacist intervention overall (mean PDC increase=13.5%, SD=20.2, p<0.01) and for each subgroup, with the exception of nefazodone (n=3, p=0.66). Patients 65 years and older showed the greatest improvement (PDC change=14.5, p<0.01), followed by patients aged 40-64 years (PDC change=12.5, p<0.01) and then 20-39 years (PDC change=9.1, p<0.01). Conclusions: Targeted face-to-face interventions by pharmacists significantly improved psychotropic medication adherence in adult patients with type 2 diabetes receiving Medicare Part D prescription coverage. Improvement was seen regardless of gender, age, or type of psychotropic medication, except nefazodone, and was greater with increasing age. The degree of improvement also varied among certain psychotropic medications.
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A Safety and Efficacy Meta-Analysis of Immune Checkpoint Inhibitors for Non-Small Cell Lung CancerSpecific Aims: The objective of this study was to compare the median progression-free survival and safety profiles of the immune checkpoint inhibitors nivolumab, pembrolizumab, and atezolizumab in patients with non-small cell lung cancer. Other analyses included the incidence of any grade adverse event, any grade nausea, fatigue, and diarrhea. Methods: This meta-analysis included the original Phase II and Phase III clinical trials that lead to the approval of these agents. A screening tool was used to identify studies to be included, and a data extraction tool was utilized for data collection. One-way ANOVA and Chi-square tests were used to analyze the results. Main Results: Median progression-free survival was not equal between the three drugs (p=0.0007). Pembrolizumab provided the longest median progression-free survival of 9.6 months compared to both atezolizumab (3.1 months, p=0.029), and nivolumab (3.3 months, p=0.041). Despite its efficacy, pembrolizumab had a higher incidence of adverse events leading to discontinuation than both atezolizumab and nivolumab (p<0.00001). While there was not a significant difference in the incidence of any grade adverse events between pembrolizumab and atezolizumab (p=0.24), nivolumab showed significantly less incidence than the other drugs (p<0.00001). Conclusions: The results of this study suggest that nivolumab, pembrolizumab, and atezolizumab are not equally effective or safe. While pembrolizumab provided the longest median progression-free survival, it also had the highest rates of discontinuation due to adverse effects. These differences in efficacy and side effect profiles can aid oncologists in choosing the most appropriate agent for their patients with non-small cell lung cancer.
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Prescribing Habits of Citalopram at El Rio Health Center for Patients Older than 60 Years of AgeSpecific Aims: To analyze current prescribing habits of citalopram in patients over 60 years of age and to identify concomitant use of cytochrome P450 2C19 (CYP2C19) inhibitors with citalopram at any dose. Subjects: El Rio Health patients that are greater than 60 years of age and are receiving citalopram Methods: A retrospective chart review was conducted to collect data on El Rio patients over 60 years of age that were prescribed citalopram. The citalopram dose and use of concomitant CYP2C19 inhibitors were recorded for these patients. Demographic data including age, gender, and race along with various labs such as EKG, QTC, liver function, kidney function, and PHQ-9 were also collected if available. Main Results: 45.1% vs. 23.5% were on concomitant CYP2C19 inhibitors with citalopram at doses less than 40 mg group versus with citalopram at doses greater than 40 mg respectively (p<0.001). Conclusions: In patients over 60 years old, there were a greater number prescribed citalopram at dose less than 40 mg than at doses greater than 40 mg, and there were also fewer patients concomitantly taking CYP2C19 inhibitors with citalopram at doses greater than 40 mg than those concomitantly taking CYP2C19 inhibitors with citalopram at doses less than 40 mg.
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Evaluation of Treatment Complexity and Initial Behavioral Health Screenings in Patients with Cystic FibrosisPurpose: The purpose of this study is to investigate the potential association between patient factors, including treatment complexity score (TCS), and initial behavioral health screening outcomes in patients with cystic fibrosis (CF). Introduction: CF, a multi-organ genetic disease, often results in time-consuming treatment regimens, frequent hospitalizations, and disease progression. High treatment burden may contribute to behavioral health complications that can negatively impacting health outcomes. Methods: This was a secondary analysis of de-identified data from a quality improvement initiative on implementing guideline recommended behavior health screenings in an accredited, CF Care Center in patients ages 12 years and older. TCS was calculated using previous method in literature and modified to account for other chronic medications for comorbidities as well as CFTR modulator use. Inclusion criteria was complete medication data and generalized anxiety disorder-7 (GAD-7) and/or patient health questionnaire-9 (PHQ-9) results. Data included demographics and medications at time of initial screening. Statistical analysis consisted of descriptive statistics including Wilcoxon Rank Sum, Chi square, and Fisher's Exact tests. Results: A significant difference was observed within the demographic as well as GAD-7 and PHQ-9 classification in respect to pre-existing comorbidities of anxiety and depression, respectively. Within the modified treatment complexity score (MTC) grouped by PHQ-9 and GAD-7 score classification, no significant differences were seen. Conclusion: No significant difference was observed in modified TCS between patients who screened moderate to severe in the depression and anxiety screenings. Multiple patient specific factors may contribute to positive screenings describing the complex nature of behavioral health.
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Examining Persistence for Ibrance (palbociclib) for FDA Approved indication and dosing through a retrospective analysisSpecific Aims: To determine whether receiving all medication therapy from a single pharmacy positively impacts medication adherence and lengthens duration of therapy in patients who are taking palbociclib for the treatment of HR+, HER2- metastatic breast cancer. Methods: In a retrospective cohort study, we analyzed 347 patients concurrently taking palbociclib and letrozole or fulvestrant. Patients with HR+, HER2- metastatic breast cancer currently on combination therapy of palbociclib and letrozole or fulvestrant filling at Avella Specialty Pharmacy between March 2016 to December 2017. Patients were divided into two groups characterized by those that filled both agents at Avella Specialty Pharmacy and those that only filled palbociclib at Avella and the other agent at a retail pharmacy. We compared the mean length of therapy, the PDC mean, and payor type between both patient groups. Primary outcome was the Proportion of Days Covered (PDC). Secondary outcomes included days on therapy and payor type. Main Results: Data analysis was conducted among the 347 patients (mean age = 69.37; SD = 11.40). Comparison of PDC mean resulted in no significant difference (SPP mean = 94.5%, SD = 0.11; Non-SPP mean = 95.06%, SD = 0.09; t-test p-value = 0.82/Mann-Whitney U test p-value = 0.76). Days on therapy presented no significant difference (SPP mean = 177.81, SD = 136.95; Non-SPP mean = 173.09, SD 157.69; t-test p-value= 0.83/Mann-Whitney U test p-value: 0.07). Comparison of payor type between patient groups had no significant difference (p-value = 0.13). Conclusions: Adherence and length of therapy for patients filling both agents at Avella were similar to those filling the second agent at an alternative retail pharmacy.
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Acute Adverse Effects of Cannabis: A Perspective from Arizona’s Poison Control CentersSpecific Aims: The overall purpose of this study was to examine and describe some of the acute adverse effects of cannabis that have been reported in the state of Arizona in order to provide insights into potentially pertinent toxicities. Another aim was to examine the data for any correlation between age and side effects experienced. Methods: De-identifed data tables detailing case information for cannabis-related calls made to either of the two poison control centers in the state of Arizona in the year 2017 were prepared and analyzed. Data examined included age, gender, number of substances involved, and general descriptors of the side effects reported for each patient case. A chi-square with Yates’s correction was utilized to look for any association between age group and the different types of adverse effects reported. Main Results: A total of 82 poison control center cases were examined. Side effects involving the central nervous system, cardiac systems, and mental health were among the most commonly reported. No association was found between age and the occurrence of any particular type of adverse effect (p = 0.866). Conclusions: Though seemingly not dependent on the age of the user, our data may suggest that the use of cannabis can potentially contribute to a wide variety of acute adverse effects – most notably involving the central nervous system, cardiac systems, and mental health. However, as this study is lacking in generalizability, further research will need to be done in order to elucidate a more accurate side effect profile.
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Evaluation of immune-related adverse events with pembrolizumab for the treatment of advanced metastatic melanomaSpecific Aims: Immune checkpoint inhibitors (CPI) have made breakthrough therapeutic advances in oncology, but are associated with a unique spectrum of side effects. A thorough understanding of immune-related adverse events (irAEs) is vital in reducing mortality and morbidity from immunotherapy. The purpose of this study was to evaluate the irAE profile of pembrolizumab, a PD-1 inhibitor, in melanoma patients treated at The University of Arizona Cancer Center. Methods: We identified patients treated with pembrolizumab for advanced melanoma between 2011 and 2017. Demographics, treatment, irAEs, and hospitalization details were collected. IrAEs were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Results: Of the 64 patients included in this analysis, seven had unresectable stage III and 57 had stage IV melanoma. The median age was 67 with 43 patients (67.2%) being male. In total, 158 irAEs were reported, and 49 out of 64 (76.6%) patients had an irAE. 134 (84.8%) were grade 1 irAEs, 21 (13.3%) were grade 2, whereas grade 3 and 4 were 1.9%. Pruritus (20.9%) was the most common grade 1 to 2 irAE, followed by joint/muscle pain (12.7%) and diarrhea (12.0%). Conclusions: In general, treatment with pembrolizumab at our institution suggests a higher incidence of irAEs per patient compared to previous clinical trials: diarrhea (29.7% vs 14.4%, p=0.004), pruritus (51.6% vs 14.1%, p <0.00001), and rash (25% vs 13.4%, p=0.021), respectively. Most irAEs resolved with appropriate therapy or were self-limiting.
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Patterns and Predictors of Off-Label Antipsychotic Use Among Older Adults with Dementia in Ambulatory Care Settings in the United States (US)Specific Aims: To examine the patterns and predictors of off-label antipsychotic use among older adults with dementia in the ambulatory care settings in US. Methods: This was a retrospective, cross-sectional study using pooled data from the National Ambulatory Medical Care Survey (NAMCS) (2005-2015). The study sample consisted of ambulatory visits by older adults (age ≥ 65 years) with dementia who were prescribed off-label antipsychotic(s). Dementia was identified by using ICD-9-CM codes of 290.xx, 294.xx, or 331.xx or by examining use of cholinesterase inhibitors or memantine. Antipsychotics are approved for treating individuals with schizophrenia (ICD-9-CM: 2950x–2959x), bipolar disorder (ICD-9-CM: 2960x, 2961x, 2964x–2969x), Tourette syndrome (ICD-9-CM: 307.23), or Huntington’s disease (ICD-9-CM: 333.4). Patients with these co-occurring diseases were excluded from the final study sample. Predictors of off-label antipsychotic use were determined using multivariable logistic regression adjusting for individual-level factors. All analyses were adjusted for the complex survey design of NAMCS to obtain nationally representative estimates. Main Results: Over the 11-year study period, there over 74 million visits by older adults with dementia without conditions approved for treatment with an antipsychotic, among whom 6.2 million (8.37%) visits received an off-label antipsychotic prescription. Factors that were significantly associated with off-label antipsychotic use were age, gender, race/ethnicity, physician specialty, region, number of medications recorded at the sampled visit, and number of past visits. Conclusions: Considering over 8% of older adults with dementia received off-label antipsychotic, appropriate interventions are warranted to minimize off-label antipsychotic use in this vulnerable population.
