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10 results

  • 170 Prospective Evaluation of the Economic Utility of Combinatorial Pharmacogenomics in Generalized Anxiety Disorder and Major Depressive Disorder
  • Nathan Roe, Catherine Passariello, Lisa Brown, James Li, Michael Jablonski, Bryan M Dechairo
  • Journal: CNS Spectrums / Volume 23 / Issue 1 / February 2018
  • Published online by Cambridge University Press: 15 June 2018, pp. 99-100
  • Print publication: February 2018
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    Abstract

    Mental illness is one of the leading causes of disability, with direct and indirect costs posing a significant financial burden. Previously, a large prospective economic utility study (n>13,000) showed that the GeneSight® test, a psychiatric pharmacogenomic decision support tool powered by CPGx® technology, reduced medication costs, increased adherence, andreduced polypharmacy for patients who had failed monotherapy for psychiatric disorders. The current study, which is a sub-analysis of this larger study, assessed cost savings associated with combinatorial pharmacogenomic testing in patients with generalized anxiety disorder (GAD) and major depressive disorder (MDD). Medication costs were extracted using pharmacy claims data provided by Medco, a large pharmacy benefits manager, for patients with GAD (n=318) and MDD (n=459). Medication cost savings per member per year (PMPY) for 1 year following the test were compared between patients whose medication regimens were congruent with the test recommendations and those whose medication regimens were incongruent with these recommendations. When healthcare providers’ decisions were congruent with combinatorial pharmacogenomic testing, PMPY savings was $6,747 (p<0.004) for GAD patients and $3,738 (p<0.004) for MDD patients versus incongruent decisions within these disease states. Among the congruent group, GAD patients experienced greater savings in central nervous system (CNS) medications (2-fold) compared to MDD patients. Additionally, analysis of a subset of patients prescribed at least one benzodiazepine six months prior to testing (n=660) demonstrated a significant decrease in benzodiazepine drug counts (p<0.001) and refills (p<0.001) after testing. Using the GeneSight test as a treatment decision support tool for patients with GAD or MDD resulted in significant medication cost savings when HCPs made congruent decisions with the combinatorialpharmacogenomic results. Furthermore, use of the GeneSight test decreased the use of benzodiazepines.

    Funding Acknowledgements

    Research was funded by Assurex Health, Inc.

  • Managing the First Factor: Context Is Important
  • Anne Thissen-Roe, Michael S. Finger, Pamela G. Ing
  • Journal: Industrial and Organizational Psychology / Volume 8 / Issue 3 / September 2015
  • Published online by Cambridge University Press: 02 October 2015, pp. 463-467
  • Print publication: September 2015
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    In the focal article, Ree, Carretta, and Teachout (2015) address a common error in research methods, in which researchers neglect the shared variance between facets of a multidimensional construct. We agree with the need to attend to the entire factor structure of constructs when using measures, whether in research or application. The objective of this commentary is to elaborate on useful practices when a dominant general factor (DGF), as defined by the focal article, is found to be present and, in particular, to explore cases of DGF results under research paradigms not considered by the focal article.

  • The response of glaciers to intrinsic climate variability: observations and models of late-Holocene variations in the Pacific Northwest
  • Gerard H. Roe, Michael A. O’Neal
  • Journal: Journal of Glaciology / Volume 55 / Issue 193 / 2009
  • Published online by Cambridge University Press: 08 September 2017, pp. 839-854
  • Print publication: 2009
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    Discriminating between glacier variations due to natural climate variability and those due to true climate change is crucial for the interpretation and attribution of past glacier changes, and for the expectations of future changes. We explore this issue for the well-documented glaciers of Mount Baker in the Cascades Mountains of Washington State, USA, using glacier histories, glacier modeling, weather data and numerical weather model output. We find that natural variability alone is capable of producing kilometer-scale excursions in glacier length on multi-decadal and centennial timescales. Such changes are similar in magnitude to those attributed to a global Little Ice Age. The null hypothesis, that no climate change is required to explain the glacier fluctuations in this setting, cannot be rejected. These results for Mount Baker glaciers are also consistent with an earlier study analyzing individual glaciers in Scandinavia and the Alps. The principle that long-timescale fluctuations of glacier length can be driven by short-timescale fluctuations in climate reflects a robust and fundamental property of stochastically forced physical systems with memory. It is very likely that this principle also applies to other Alpine glaciers and that it therefore complicates interpretations of the relationship between glacier and climate history. However, the amplitude and timescale of the length fluctuations depends on the details of the particular glacier geometry and climatic setting, and this remains largely unevaluated for most glaciers.

  • Resistant Enterococci: A Prospective, Study of Prevalence, Incidence, and Factors Associated With Colonization in a University Hospital
  • Jeffrey W. Weinstein, Matthew Roe, Michael Towns, Linda Sanders, Jackie J. Thorpe, G. Ralph Corey, Daniel J. Sexton
  • Journal: Infection Control & Hospital Epidemiology / Volume 17 / Issue 1 / January 1996
  • Published online by Cambridge University Press: 02 January 2015, pp. 36-41
  • Print publication: January 1996
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    Objective:

    To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci.

    Design:

    A prospective cohort study conducted between February 1 and March 15, 1993.

    Methods:

    Rectal cultures were obtained within 24 hours of admission or transfer onto the study wards and repeated at weekly intervals and at the time of discharge. Patients harboring antibiotic-resistant enterococci at the time of admission or after admission were compared to patients who were not colonized with these organisms. Clinical and epidemiologic risk factors for colonization were abstracted prospectively by daily chart review. Following a univariate analysis of risk factors associated with colonization, a multivariate statistical analysis using three separate models was done.

    Setting:

    A 1,125-bed, tertiary-care teaching hospital in North Carolina.

    Patients:

    A total of 350 patients admitted to two general medical wards and the medical intensive care unit during the study period.

    Results:

    Antibiotic-resistant enterococci were isolated from 52 patients: 19 were colonized at admission to the study, and 33 later acquired resistant strains. At the time of admission, 5.4% of the patients were colonized with ampicillin-resistant enterococci (ARE), including 1.1% that were colonized with vancomycin-resistant enterococci. Prior hospitalization was associated with colonization with ARE at admission (P=.01). Independent risk factors for nosocomial acquisition of ARE included treatment with more than three antibiotics, empiric use of antibiotics, use of third-generation cephalosporins, and the use of enteral tube feedings. Antibiotics used prophylactically were not associated with resistant enterococcal colonization.

    Conclusions:

    Our data help to elucidate the epidemiology of gastrointestinal tract colonization with resistant enterococci. We hypothesize that surveillance and control programs will be more likely to succeed if targeted at patients receiving more than three antibiotics, empiric antibiotics, and enteral tube feedings.