Publications by authors named "Andrew Whitman"

5 Publications

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Context-Dependent Role of Vinculin in Neutrophil Adhesion, Motility and Trafficking.

Sci Rep 2020 02 7;10(1):2142. Epub 2020 Feb 7.

Department of Surgery, Division of Surgical Research, Rhode Island Hospital, Providence, RI, 02903, USA.

Neutrophils are innate immune effector cells that traffic from the circulation to extravascular sites of inflammation. β2 integrins are important mediators of the processes involved in neutrophil recruitment. Although neutrophils express the cytoskeletal protein vinculin, they do not form mature focal adhesions. Here, we characterize the role of vinculin in β2 integrin-dependent neutrophil adhesion, migration, mechanosensing, and recruitment. We observe that knockout of vinculin attenuates, but does not completely abrogate, neutrophil adhesion, spreading, and crawling under static conditions. However, we also found that vinculin deficiency does not affect these behaviors in the presence of forces from fluid flow. In addition, we identify a role for vinculin in mechanosensing, as vinculin-deficient neutrophils exhibit attenuated spreading on stiff, but not soft, substrates. Consistent with these findings, we observe that in vivo neutrophil recruitment into the inflamed peritoneum of mice remains intact in the absence of vinculin. Together, these data suggest that while vinculin regulates some aspects of neutrophil adhesion and spreading, it may be dispensable for β2 integrin-dependent neutrophil recruitment in vivo.
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http://dx.doi.org/10.1038/s41598-020-58882-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005776PMC
February 2020

Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study.

Support Care Cancer 2018 Dec 4;26(12):4105-4113. Epub 2018 Jun 4.

Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, USA.

Purpose: The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic.

Methods: Adult patients with cancer aged 65 and older underwent a comprehensive geriatric assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies. Potentially inappropriate medications were screened using the Beers Criteria, Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions, and the Medication Appropriateness Index. Deprescribing occurred after discussion with the pharmacist, geriatric oncologist, patient, and caregiver.

Results: Data were collected for 26 patients. The mean number of medications was 12. The Beers Criteria alone identified 38 potentially inappropriate medications compared to 119 potentially inappropriate medications with the three-tool assessment; a mean of 5 potentially inappropriate medications were identified per patient. After the application of the three-tool assessment, 73% of potentially inappropriate medications identified were deprescribed, resulting in a mean of 3 medications deprescribed per patient. Approximately two thirds of patients reported a reduction in symptoms after the deprescribing intervention. Healthcare expenditures of $4282.27 per patient were potentially avoided as a result of deprescribing.

Conclusions: Our three-tool assessment identified three times more potentially inappropriate medications than the Beers Criteria alone. Pharmacist-led deprescribing interventions are feasible and may lead to improved patient outcomes and cost savings. This three-tool assessment process should be incorporated into interdisciplinary assessments of older patients with cancer and validated in future studies.
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http://dx.doi.org/10.1007/s00520-018-4281-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204077PMC
December 2018

A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient.

Oncologist 2016 06 5;21(6):723-30. Epub 2016 May 5.

Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA.

Unlabelled: : Inappropriate medication use and polypharmacy are extremely common among older adults. Numerous studies have discussed the importance of a comprehensive medication assessment in the general geriatric population. However, only a handful of studies have evaluated inappropriate medication use in the geriatric oncology patient. Almost a dozen medication screening tools exist for the older adult. Each available tool has the potential to improve aspects of the care of older cancer patients, but no single tool has been developed for this population. We extensively reviewed the literature (MEDLINE, PubMed) to evaluate and summarize the most relevant medication screening tools for older patients with cancer. Findings of this review support the use of several screening tools concurrently for the elderly patient with cancer. A deprescribing tool should be developed and included in a comprehensive geriatric oncology assessment. Finally, prospective studies are needed to evaluate such a tool to determine its feasibility and impact in older patients with cancer.

Implications For Practice: The prevalence of polypharmacy increases with advancing age. Older adults are more susceptible to adverse effects of medications. "Prescribing cascades" are common, whereas "deprescribing" remains uncommon; thus, older patients tend to accumulate medications over time. Older patients with cancer are at high risk for adverse drug events, in part because of the complexity and intensity of cancer treatment. Additionally, a cancer diagnosis often alters assessments of life expectancy, clinical status, and competing risk. Screening for polypharmacy and potentially inappropriate medications could reduce the risk for adverse drug events, enhance quality of life, and reduce health care spending for older cancer patients.
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http://dx.doi.org/10.1634/theoncologist.2015-0492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912369PMC
June 2016

Empiric vancomycin use in febrile neutropenic oncology patients.

Open Forum Infect Dis 2014 Mar 10;1(1):ofu006. Epub 2014 Apr 10.

Virginia Commonwealth University School of Pharmacy, Falls Church, Virginia ; Department of Pharmacotherapy and Outcome Sciences.

Vancomycin is commonly added as empiric therapy for febrile neutropenia. A retrospective chart review was conducted at a large community teaching institution to evaluate vancomycin use in oncology patients. The results revealed that a majority of empiric vancomycin therapy was inappropriate, raising concern for antibiotic resistance and prompting opportunities for improvement.
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http://dx.doi.org/10.1093/ofid/ofu006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324182PMC
March 2014

Managing obligations: right of privacy and release of clinical records.

J Healthc Risk Manag 2003 ;23(3):27-32

Longwood Management Corp, Santa Monica, CA, USA.

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http://dx.doi.org/10.1002/jhrm.5600230308DOI Listing
May 2005