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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])...
August 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
James A G Crispo, Allison W Willis, Dylan P Thibault, Yannick Fortin, Harlen D Hays, Douglas S McNair, Lise M Bjerre, Dafna E Kohen, Santiago Perez-Lloret, Donald R Mattison, Daniel Krewski
BACKGROUND: Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population. METHODS: Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011...
2016: PloS One
Lu Chen, Uta Guo, Lijo C Illipparambil, Matt D Netherton, Bhairavi Sheshadri, Eric Karu, Stephen J Peterson, Parag H Mehta
BACKGROUND: Since the late 1980s, resident physicians have spent increasing amounts of time on electronic health record (EHR) data entry and retrieval. Objective longitudinal data measuring time spent on the EHR are lacking. OBJECTIVE: We sought to quantify the time actually spent using the EHR by all first-year internal medicine residents in a single program (N = 41). METHODS: Active EHR usage data were collected from the audit logs for May, July, and October 2014 and January 2015...
February 2016: Journal of Graduate Medical Education
Jessica L Petrick, Tuyet Nguyen, Michael B Cook
PURPOSE: Esophageal adenocarcinoma incidence has increased approximately 600% over the last 4 decades in the United States. Little research has been conducted on the temporal trends of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE), yet it is important to establish whether these conditions have also increased with time or differ by age. METHODS: The Cerner Health Facts(®) database contains information on 35 million patients between 2001 and 2010...
February 2016: Annals of Epidemiology
Ruopeng An, Lingyun Lu
OBJECTIVE: The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults. METHODS: Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum's Lexicon...
January 2016: Journal of Psychosomatic Research
Steve Deitelzweig, Amanda Bruno, Jeffrey Trocio, Natalie Tate, Kiran Gupta, Jay Lin, Melissa Lingohr-Smith
OBJECTIVE: Clinical trials have demonstrated that direct oral anticoagulants (DOACs) are efficacious in reducing stroke risk among patients with nonvalvular atrial fibrillation (NVAF) with differences in the reduction of bleeding risks vs. warfarin. The objective of this study was to assess bleeding-related hospital readmissions among hospitalized NVAF patients treated with dabigatran, rivaroxaban, and apixaban in the US. RESEARCH DESIGN AND METHODS: Patients (≥18 years) with a discharge diagnosis of NVAF who received apixaban, dabigatran, or rivaroxaban during hospitalization were identified from the Premier Hospital database (1 January 2012-31 March 2014) and the Cerner Health Facts hospital database (1 January 2012-31 August 2014)...
2016: Current Medical Research and Opinion
Jacqueline B Palmer, Howard S Friedman, Katherine Waltman Johnson, Prakash Navaratnam, Stephen S Gottlieb
BACKGROUND: Data comparing effects of transient worsening renal function (WRFt) and persistent WRF (WRFp) on outcomes in patients hospitalized with acute heart failure (AHF) are lacking. We determined the characteristics of hospitalized AHF patients who experienced no worsening renal function (non-WRF), WRFt, or WRFp, and the relationship between cohorts and AHF-related outcomes. METHODS AND RESULTS: A patient's first AHF hospitalization (index) was identified in the Cerner Health Facts(®) database (January 2008-March 2011)...
2015: ClinicoEconomics and Outcomes Research: CEOR
James A G Crispo, Yannick Fortin, Dylan P Thibault, Matthew Emons, Lise M Bjerre, Dafna E Kohen, Santiago Perez-Lloret, Donald Mattison, Allison W Willis, Daniel Krewski
PURPOSE: Although therapeutic options and clinical guidelines for Parkinson's disease (PD) have changed significantly in the past 15 years, prescribing trends in the USA remain unknown. The purpose of this population-based cohort study was to examine patterns of inpatient antiparkinson drug use between January 2001 and December 2012 in relation to clinical guideline publication, drug introduction/withdrawal, and emerging safety concerns. METHODS: A total of 16,785 inpatients receiving pharmacological treatment for PD were identified in the Cerner Health Facts database...
August 2015: European Journal of Clinical Pharmacology
Sophie Hamel, Douglas S McNair, Nicholas J Birkett, Donald R Mattison, Anthony Krantis, Daniel Krewski
PURPOSE: To determine the level of off-label cancer therapy use in a population of female breast cancer patients and to establish whether this use was evidence-based. METHODS: A study was conducted by sampling Cerner's data warehouse for all women diagnosed with breast cancer between January 2000 and June 2009 who received at least one cancer therapy approved by the US-FDA during the study period. Drug encounters were considered off-label if the circumstances of use did not match the age or medical diagnoses specified on the product label at the time of study...
2015: SpringerPlus
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