Welcome to What’s it Worth! Join your host, Dr. Diana Langworthy as we’re strengthening our EBP skills in power and subject allocation with the STRONG-HF trial - a prospective, randomized, open-label study comparing high-intensity titration to guideline-directed medical therapy vs usual cares in patients with recent heart failure exacerbations. Special guest - Dr. Christian Bell, PharmD and PGY1 Pharmacy Practice Resident at M Health Fairview.

Key Points

1. Critique of subject allocation in clinical trials helps practitioners understand key balancing characteristics between study groups
2. Evaluating the outcomes to determine clinical relevance is key in determining how the intervention fits within clinical practice
3. Describing the representation of racial and ethnic minority groups within clinical trials matters
4. How should you present strengths and limitations in a journal club? -> Tune in to find out!

Abbreviations from the episode

ARNI - Angiotensin receptor neprilysin inhibitor

ACEI (or ACE) - Angiotensin-converting enzyme inhibitor

ARB - Angiotensin receptor blocker

GDMT - Guideline-directed medical therapies

Episode References

1. Mebazaa A, Davison B, Chioncel O, et al.  Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet 2022;400(10367):1938-1952.
2. Heidenreich PA, Bozkurt B, Aguilar D, et al.  2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.  Circulation 2022;148(18):e895-e1032.
3. Kim J, Shin W. How to Do Random Allocation (Randomization).  Clin Orthop Surg 2014;6(1):103-109.

Contact Information

Podcast email: [email protected]

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Welcome to What’s it Worth! Join Dr. Diana Langworthy, Garrison Griest, and Nathan Uk for our first episode where we go down the WATERFALL and take a deep dive into the details of a prospective, open-label trial comparing aggressive and moderate fluid resuscitation strategies in the initial treatment of acute pancreatitis.

Key Points

1. Aggressive fluid resuscitation has historically been preferred in the treatment of acute pancreatitis
2. There is conflicting evidence as to whether aggressive or moderate resuscitation is the safest and most effective approach in patients with acute pancreatitis
3. Statistical power is an important concept to understand to determine whether the study has the means to reject the null hypothesis
4. The trial was stopped early due to safety concerns with the aggressive resuscitation arm - what does this mean for efficacy? -> Tune in to find out!

Episode References

1. de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N Engl J Med 2022;387:989-1000. [WATERFALL study]
2. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62(1):102-111.
3. Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J 2003;20:453-458. 

Contact Information

Podcast email: [email protected]

Host Information: 

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist-Inpatient Internal Medicine, M Health Fairview East Bank Hospital

BONUS EPISODE! We're dropping Episode 2 early so you have even more journal critique music to your ears. Welcome back to What’s it Worth! Today we soar through the topics of pilot studies, medical cannabis, and cancer related pain. We are joined by Dr. Kirollos Hanna, Director of Pharmacy at Minnesota Oncology, as we attempt to take the pain out of assessing feasibility trials.

Key Points

• Pilot studies are conducted to determine whether a large-scale trial would be feasible
• Cancer-related pain can be challenging to manage and additional approaches to multimodal pain management are needed
• Medical cannabis carries a stigma which may be one of the barriers to its use in cancer-related pain
• What can you take away from pilot studies? -> Tune in to find out!

References

1. Zylla D, et al. “Oncology Clinicians and the Minnesota Medical Cannabis Program: A Survey on Medical Cannabis Practice Patterns, Barriers to Enrollment, and Educational Needs.” Cannabis and cannabinoid research vol. 3,1 195-202. 1 Oct. 2018, doi:10.1089/can.2018.0029.

2. Braun IM et al. “Medical Oncologists' Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study.” Journal of clinical oncology : official journal of the American Society of Clinical Oncology vol. 36,19 (2018): 1957-1962. doi:10.1200/JCO.2017.76.1221.

3. Swarm RA, Paice JA, Anghelescu DL, et al. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw  17.8 (2019): 977-1007.

Contact Information

Podcast email: [email protected]

Host Information: 

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist-Inpatient Internal Medicine, M Health Fairview East Bank Hospital