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Todd R Vogel, Jamie B Smith, Robin L Kruse
OBJECTIVE: The effect of postoperative hyperglycemia in patients undergoing open and endovascular procedures on the lower extremities has not been fully characterized with regard to associated admission diagnoses, hospital complications, mortality, and 30-day readmission. This study evaluated the relationship of postoperative hyperglycemia on outcomes after lower extremity vascular procedures for peripheral artery disease. METHODS: Patients with peripheral artery disease admitted for elective lower extremity procedures between September 2008 and March 2014 were selected from the Cerner Health Facts (Cerner Corporation, Kansas City, Mo) database using International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis and procedure codes...
April 19, 2017: Journal of Vascular Surgery
Benjamin J Freda, Alexander B Knee, Gregory L Braden, Paul F Visintainer, Charuhas V Thakar
Although acute kidney injury (AKI) is common in heart failure, yet the impact of the onset, timing, and duration of AKI on short-term outcomes is not well studied. AKI was defined as an increase in serum creatinine SCr of ≥0.3 mg/dl or 1.5 times relative to the admission and further categorized as transient AKI (T-AKI: SCr returning to within 10% of baseline); sustained AKI (S-AKI: those with at least 72 hours of hospital stay and did not meet T-AKI); and unknown duration AKI (U-AKI: those with less than 72 hours stay and did not meet T-AKI)...
June 1, 2017: American Journal of Cardiology
Yannick Fortin, James A G Crispo, Deborah Cohen, Douglas S McNair, Donald R Mattison, Daniel Krewski
Assessing prevalent comorbidities is a common approach in health research for identifying clinical differences between individuals. The objective of this study was to validate and compare the predictive performance of two variants of the Elixhauser comorbidity measures (ECM) for inhospital mortality at index and at 1-year in the Cerner Health Facts® (HF) U.S. DATABASE: We estimated the prevalence of select comorbidities for individuals 18 to 89 years of age who received care at Cerner contributing health facilities between 2002 and 2011 using the AHRQ (version 3...
2017: PloS One
Luis Ostrosky-Zeichner, Rachel Harrington, Nkechi Azie, Hongbo Yang, Nanxin Li, Jing Zhao, Valerie Koo, Eric Q Wu
This study aimed to develop a prediction model to identify patients with candidemia who were at high risk of failing fluconazole treatment. Adult patients in the United States with candidemia who received fluconazole during hospitalization were selected from the Cerner Health Facts Hospital Database (04/2004 to 03/2013). Fluconazole failure was defined as switching/adding another antifungal, positive Candida culture ≥10 days after fluconazole initiation, or death during hospitalization. Patients were randomized into modeling and validation samples...
May 2017: Antimicrobial Agents and Chemotherapy
Nicola Maciocia, Andrew Melville, Simon Cheesman, Faye Sharpley, Karthik Ramasamy, Matthew Streetly, Matthew Jenner, Reuben Benjamin, Steve Schey, Paul Maciocia, Rakesh Popat, Shirley D'sa, Ali Rismani, Aviva Cerner, Kwee Yong, Neil Rabin
Myeloma patients who become refractory to immunomodulatory agents (IMiDs) and bortezomib have poor survival, with limited therapeutic options. Pomalidomide has shown improved survival and good tolerability in this patient cohort in clinical trials, but real world data are scarce. We retrospectively analysed all patients treated with pomalidomide at five UK centres between 2013 and 2016. Of 85 patients identified, 70 had sufficient information for response assessments. Median age was 66 years [40-89], 96·5% were refractory to IMiDs, 72·9% were refractory to both an IMiD and bortezomib and 92·9% were refractory to their last treatment...
March 2017: British Journal of Haematology
Joseph C Melvin, Jamie B Smith, Robin L Kruse, Todd R Vogel
BACKGROUND: Lowering the 30-d re-admission rate after vascular surgery offers the potential to improve healthcare quality. This study evaluated re-admission associated with infections after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD). METHODS: Patients admitted for elective LE procedures for PAD were selected from the Cerner Health Facts(®) database. Chi-square analysis evaluated the characteristics of the index admission associated with infection at 30-d re-admission...
April 2017: Surgical Infections
Elif I Ekinci, Alvin Kong, Leonid Churilov, Natalie Nanayakkara, Wei Ling Chiu, Priya Sumithran, Frida Djukiadmodjo, Erosha Premaratne, Elizabeth Owen-Jones, Graeme Kevin Hart, Raymond Robbins, Andrew Hardidge, Douglas Johnson, Scott T Baker, Jeffrey D Zajac
AIMS: The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients...
2017: PloS One
Wafaa Yousuf, Sheren Elkomy, Mona Soliman, Noof Al-Mansouri, Mohamed Salem, Amal Al-Ali, Mohamed H Mahmoud, Hisham Elmahdi
Primary healthcare in Qatar uses electronic prescribing to reduce the risk of medication errors. Electronic prescribing is supported by computerized Physician Order Entry systems through Cerner (electronic medical record system). There are still prescription errors, despite electronic prescribing being in place for one year at West Bay Health Center. West Bay Health Center is a famous primary healthcare center in Qatar. It is a training center for the family medicine residency program, which is accredited by the accreditation council of general medical education international (ACGME-I)...
2016: BMJ Quality Improvement Reports
Arpamas Seetasith, David Holdford, Anal Shah, Julie Patterson
BACKGROUND: A number of policy and labeling interventions aimed at reducing inappropriate prescribing of erythropoiesis-stimulating agents (ESAs) were implemented in the U.S. between 2006 and 2010. These interventions included the addition of an FDA Black Box Warning to ESA labeling, the implementation of a Risk Evaluation and Mitigation Strategy program, and the adoption of payment restrictions by the Centers for Medicare and Medicaid Services (CMS). The impact of these safety interventions on different types of ESA prescribing (on-label, off-label; evidence-based, not evidence-based) has not been investigated in a single study...
August 3, 2016: Research in Social & Administrative Pharmacy: RSAP
Mark L Homer, Nathan P Palmer, Olivier Bodenreider, Aurel Cami, Laura Chadwick, Kenneth D Mandl
In biomedical informatics, assigning drug codes to categories is a common step in the analysis pipeline. Unfortunately, incomplete mappings are the norm rather than the exception with coverage values less than 85% not uncommon. Here, we perform this linking task on a nationwide insurance claims database with over 13 million members who were dispensed, according to National Drug Codes (NDCs), over 50,000 unique product forms of medication. The chosen approach employs Cerner Multum's VantageRx and the U.S. National Library of Medicine's RxMix...
2016: AMIA Summits on Translational Science Proceedings
Tara Lagu, Penelope S Pekow, Meng-Shiou Shieh, Mihaela Stefan, Quinn R Pack, Mohammad Amin Kashef, Auras R Atreya, Gregory Valania, Mara T Slawsky, Peter K Lindenauer
BACKGROUND: Heart failure (HF) inpatient mortality prediction models can help clinicians make treatment decisions and researchers conduct observational studies; however, published models have not been validated in external populations. METHODS AND RESULTS: We compared the performance of 7 models that predict inpatient mortality in patients hospitalized with acute decompensated heart failure: 4 HF-specific mortality prediction models developed from 3 clinical databases (ADHERE [Acute Decompensated Heart Failure National Registry], EFFECT study [Enhanced Feedback for Effective Cardiac Treatment], and GWTG-HF registry [Get With the Guidelines-Heart Failure]); 2 administrative HF mortality prediction models (Premier, Premier+); and a model that uses clinical data but is not specific for HF (Laboratory-Based Acute Physiology Score [LAPS2])...
2016: Circulation. Heart Failure
Richard Wawrose, Mary Baraniuk, Lauren Standiford, Charles Wade, John Holcomb, Laura Moore
BACKGROUND: Sepsis is the primary cause of perioperative mortality among general surgery patients and is the leading cause of death in non-cardiac intensive care units. To address this issue, the Surviving Sepsis Campaign Guidelines advocate for sepsis screening. However, there is little information in the current medical literature to suggest which sepsis screening tool is optimal. The purpose of this study was to compare a sepsis screening tool that we have validated and published previously, the Sepsis Screening Score (SSS), with a commercially available sepsis screening tool, the St...
October 2016: Surgical Infections
Jennifer G Stadler, Kipp Donlon, Jordan D Siewert, Tessa Franken, Nathaniel E Lewis
The digitization of a patient's health record has profoundly impacted medicine and healthcare. The compilation and accessibility of medical history has provided clinicians an unprecedented, holistic account of a patient's conditions, procedures, medications, family history, and social situation. In addition to the bedside benefits, this level of information has opened the door for population-level monitoring and research, the results of which can be used to guide initiatives that are aimed at improving quality of care...
June 2016: Big Data
Michele E Gaguski, Hien T Nguyen
This article provides a review of the interdisciplinary approach, implementation methods, and subsequent outcomes of transitioning to an electronic-based chemotherapy and biotherapy ordering system in a community hospital-based ambulatory medical oncology department. The electronic medical record solution system platform that was used in this setting was Cerner PowerChart®, which is certified by the Certification Commission for Healthcare Information Technology.
August 1, 2016: Clinical Journal of Oncology Nursing
Valerie M Herbert, Helen Connors
Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful...
August 2016: Computers, Informatics, Nursing: CIN
Wing W Chan, Katherine Waltman Johnson, Howard S Friedman, Prakash Navaratnam
OBJECTIVES: Myocardial injury, worsening renal function, and hepatic impairment are independent risk factors for poor patient acute heart failure (AHF) outcomes. Biomarkers of organ damage may be useful in identifying patients at risk for poor outcomes. The objective of this analysis was to assess the relationship between abnormal AHF biomarkers and outcomes in AHF patients. METHODS: AHF admissions (N = 104,794) data from the Cerner Health Facts® inpatient database were analyzed retrospectively...
August 2016: Hospital Practice (Minneapolis)
Andrea Downing Peck
No abstract text is available yet for this article.
January 10, 2016: Medical Economics
Anna Grodzinsky, Abhinav Goyal, Kensey Gosch, Peter A McCullough, Gregg C Fonarow, Alexandre Mebazaa, Frederick A Masoudi, John A Spertus, Biff F Palmer, Mikhail Kosiborod
BACKGROUND: Hyperkalemia is common and potentially dangerous in hospitalized patients; its contemporary prevalence and prognostic importance after acute myocardial infarction are not well described. METHODS: In 38,689 consecutive patients with acute myocardial infarction from the Cerner Health Facts database, we evaluated the association between maximum in-hospital potassium levels and in-hospital mortality. Patients were stratified by dialysis status and grouped by maximum potassium as follows: <5 mEq/L, 5 to <5...
August 2016: American Journal of Medicine
David Andes, Nkechi Azie, Hongbo Yang, Rachel Harrington, Caroline Kelley, Ruo-Ding Tan, Eric Q Wu, Billy Franks, Rita Kristy, Edward Lee, Nikhil Khandelwal, James Spalding
The majority of hospitalized patients receiving mold-active triazoles are at risk of drug-drug interactions (DDIs). Efforts are needed to increase awareness of DDIs that pose a serious risk of adverse events. Triazoles remain the most commonly utilized antifungals. Recent developments have included the mold-active triazoles (MATs) itraconazole, voriconazole, and posaconazole, which are first-line agents for the treatment of filamentous fungal infections but have the potential for DDIs. This objective of this study was to evaluate the prevalence of triazole DDIs...
June 2016: Antimicrobial Agents and Chemotherapy
Weihong Fan, Stephanie Plent, Jayne Prats, Efthymios N Deliargyris
Practice in patients undergoing invasive evaluation for coronary artery disease is variable regarding choice of P2Y12 inhibitor and timing of treatment initiation and is usually dictated by institutional or even individual operator preference. Limited data are available on the actual patterns of P2Y12 inhibitor use in contemporary practice in the United States. We used electronic medical records from the Cerner "Health Facts" database of adults who underwent coronary angiography with or without percutaneous coronary intervention (PCI) from January 2008 to June 2013 and who received a loading dose of clopidogrel, prasugrel, or ticagrelor at any time from 48 hours before the start of procedure up to 6 hours after...
May 1, 2016: American Journal of Cardiology
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