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https://www.readbyqxmd.com/read/29777549/frailty-risk-in-hospitalized-older-adults-with-and-without-diabetes-mellitus
#1
Deborah A Lekan, Thomas P McCoy
BACKGROUND: Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM, however, there is limited research in hospitalized older adults. OBJECTIVES: To determine the extent of frailty in hospitalized older adults with and without DM using a 16-item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30-day rehospitalization, discharge to an institution, and in-hospital mortality...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29777388/a-retrospective-study-of-opioid-prescribing-patterns-at-hospital-discharge-in-surgical-patients-with-obstructive-sleep-apnea
#2
Samir M Kendale, Jing Wang, Jeanna D Blitz, Steven Calvino, Germaine Cuff, Nicholas Barone, Andrew D Rosenberg, Lisa Doan
PURPOSE: Obstructive sleep apnea (OSA) is a risk factor for complications with postoperative opioid use, and in those patients with known or suspected OSA, minimization of postoperative opioids is recommended. We hypothesize that despite these recommendations, surgical patients with known or suspected OSA are prescribed postoperative opioids at hospital discharge at similar doses to those without OSA. METHODS: This was a retrospective analysis of the electronic health records of surgical patients from 1 November 2016 to 30 April 2017 at a single academic institution...
May 18, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29777325/developing-an-interactive-data-visualization-tool-to-assess-the-impact-of-decision-support-on-clinical-operations
#3
Timothy C Huber, Arun Krishnaraj, Dayna Monaghan, Cree M Gaskin
Due to mandates from recent legislation, clinical decision support (CDS) software is being adopted by radiology practices across the country. This software provides imaging study decision support for referring providers at the point of order entry. CDS systems produce a large volume of data, providing opportunities for research and quality improvement. In order to better visualize and analyze trends in this data, an interactive data visualization dashboard was created using a commercially available data visualization platform...
May 18, 2018: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/29776663/barriers-and-facilitators-to-diabetes-self-management-in-a-primary-care-setting-patient-perspectives
#4
Rahul Khairnar, Khalid M Kamal, Vincent Giannetti, Nilanjana Dwibedi, Jamie McConaha
BACKGROUND: Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE: To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS: This cross sectional study combined patient survey data with electronic medical record (EMR) data...
May 9, 2018: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29776436/rates-and-causes-of-30-day-readmission-and-emergency-room-utilization-following-head-and-neck-surgery
#5
Vincent Wu, Stephen F Hall
BACKGROUND: Unplanned returns to hospital are common, costly, and potentially avoidable. We aimed to investigate and characterize reasons for all-cause readmissions to hospital as in-patients (IPs) and visits to the Emergency Department (ED) within 30-days following patient discharge post head and neck surgery (HNS). METHODS: Retrospective case series with chart review. All patients within the Department of Otolaryngology - Head and Neck Surgery who underwent HNS for benign and malignant disease from January 1, 2010 to May 31, 2015 were identified...
May 18, 2018: Journal of Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/29774497/safety-of-commercial-airflight-in-patients-with-brain-tumors-a-case-series
#6
Michelle Phillips, Marlon Saria, Amy Eisenberg, Daniel F Kelly, Garni Barkhoudarian
INTRODUCTION: Patients with intracranial masses are often advised to avoid airflight due to concerns of worsening neurological symptoms or deterioration. However, many patients often travel cross-country or internationally to tertiary care centers for definitive care. This study assesses the safety of commercial airflight for brain and skull base tumor patients without severe or progressive neurological deficits. METHODS: Patients that had traveled to our institution for surgery via commercial airflight from 2014 to 2017 were identified...
May 17, 2018: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29773932/effectiveness-and-tolerability-of-therapy-with-once-weekly-exenatide-versus-basal-insulin-among-injectable-naive-patients-with-type-2-diabetes-in-a-real-world-setting-in-the-united-states
#7
Anita M Loughlin, Qing Qiao, Anthony P Nunes, Stephen M Ezzy, Laura Yochum, C Robin Clifford, Robert V Gately, David D Dore, John D Seeger
A propensity-matched cohort study compared injectable-naive patients with type 2 diabetes initiating exenatide once weekly (EQW) or basal insulin (BI), from 2012 through 2015, within a U.S. electronic health record database. A1C and weight were obtained as observed or multiply imputed values at baseline and quarterly for 1 year (Q1-Q4). Hypoglycemia and gastrointestinal symptoms were identified using diagnostic codes and clinical notes. EQW ( n = 2,008) and BI ( n = 4,016) cohorts were comparable at baseline (mean A1C and weight: EQW, 8...
May 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29772946/safety-and-effectiveness-of-apixaban-in-comparison-to-warfarin-in-patients-with-nonvalvular-atrial-fibrillation-a-propensity-matched-analysis-from-japanese-administrative-claims-data
#8
Shun Kohsaka, Jun Katada, Kumiko Saito, Yasuo Terayama
OBJECTIVE: To investigate the risk of bleeding events and stroke/systemic embolism (SE) among Japanese patients with nonvalvular atrial fibrillation (NVAF), focusing on the initial dosage of apixaban and patient age. METHODS: This retrospective cohort study used de-identified electronic health records-based claims data from 314 acute-care hospitals in Japan. NVAF patients newly initiated on warfarin or apixaban, with no prescription during the 180-day blanking period, were eligible...
May 18, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29771741/impacts-of-the-affordable-care-act-on-community-health-centers-characteristics-of-new-patients-and-early-changes-in-delivery-of-care
#9
Brigit Hatch, Ning Smith, Mary Ann McBurnie, Thu Quach, Kenneth H Mayer, Mary J Dunne, Erika Cottrell
The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each)...
May 15, 2018: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/29771740/closing-the-referral-loop-improving-ambulatory-referral-management-electronic-health-record-connectivity-and-care-coordination-processes
#10
Stephen L Davidow, Jignesh Sheth, Constance S Sixta, Linda Thomas-Hemak
More than 105 million referrals of Medicare beneficiaries to specialists occur annually. Different settings and electronic health records have made care coordination complex. PCPI (formerly American Medical Association-convened Physicians Consortium for Performance Improvement) and The Wright Center for Graduate Medical Education sponsored the Closing the Referral Loop pilot project. Twelve dyads of primary care and specialist physicians sought to improve ambulatory referrals by mapping the referral process, and using care compacts, metrics, and electronic health records...
May 15, 2018: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/29771350/accuracy-of-the-medication-list-in-the-electronic-health-record-implications-for-care-research-and-improvement
#11
Kathleen E Walsh, Keith A Marsolo, Cori Davis, Theresa Todd, Bernadette Martineau, Carlie Arbaugh, Frederique Verly, Charles Samson, Peter Margolis
Objective: Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. Our aim was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. Methods: We reviewed charts of 30 patients with inflammatory bowel disease (IBD) from each of 6 gastroenterology centers. Centers compared IBD medications from the medication list to the clinical narrative...
May 15, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29770315/a-high-burden-of-comorbid-conditions-leads-to-decreased-survival-in-breast-cancer
#12
Ingrid A Woelfel, Leopoldo J Fernandez, Michael O Idowu, Kazuaki Takabe
Background: Despite our most advanced medical and surgical treatment 40,000 women die from breast cancer each year. The aging population and their increasing burden of comorbidities may not be able to realize the full benefit of treatments due to a combination of the side effects and patient frailty. The aim of this study was to characterize the comorbidities of breast cancer patients and to determine if the number of comorbidities is a significant contributor to survival. Methods: A database including patients from the year 2002 to 2012 was created to include health comorbidities from the electronic medical record...
April 2018: Gland Surgery
https://www.readbyqxmd.com/read/29769554/long-term-extension-of-a-randomised-controlled-trial-of-probiotics-using-electronic-health-records
#13
Gareth Davies, Sue Jordan, Caroline J Brooks, Daniel Thayer, Melanie Storey, Gareth Morgan, Stephen Allen, Iveta Garaiova, Sue Plummer, Mike Gravenor
Most randomised controlled trials (RCTs) are relatively short term and, due to costs and available resources, have limited opportunity to be re-visited or extended. There is no guarantee that effects of treatments remain unchanged beyond the study. Here, we illustrate the feasibility, benefits and cost-effectiveness of enriching standard trial design with electronic follow up. We completed a 5-year electronic follow up of a RCT investigating the impact of probiotics on asthma and eczema in children born 2005-2007, with traditional fieldwork follow up to two years...
May 16, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29769151/real-time-automated-detection-of-ventilator-associated-events-avoiding-missed-detections-misclassifications-and-false-detections-due-to-human-error
#14
Erica S Shenoy, Eric S Rosenthal, Yu-Ping Shao, Siddharth Biswal, Manohar Ghanta, Erin E Ryan, Dolores Suslak, Nancy Swanson, Valdery Moura Junior, David C Hooper, M Brandon Westover
OBJECTIVETo validate a system to detect ventilator associated events (VAEs) autonomously and in real time.DESIGNRetrospective review of ventilated patients using a secure informatics platform to identify VAEs (ie, automated surveillance) compared to surveillance by infection control (IC) staff (ie, manual surveillance), including development and validation cohorts.SETTINGThe Massachusetts General Hospital, a tertiary-care academic health center, during January-March 2015 (development cohort) and January-March 2016 (validation cohort)...
May 17, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29769017/a-cross-sectional-investigation-of-the-health-needs-of-asylum-seekers-in-a-refugee-clinic-in-germany
#15
Laura F Goodman, Guy W Jensen, Joseph M Galante, Diana L Farmer, Stephanie Taché
BACKGROUND: Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic. METHODS: Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016...
May 16, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29768672/catheter-ablation-for-atrial-fibrillation-on-uninterrupted-direct-oral-anticoagulants-a-safe-approach
#16
V Sawhney, M Shaukat, E Volkova, N Jones, R Providencia, S Honarbakhsh, G Dhillon, A Chow, M Lowe, P Lambiase, M Dhinoja, S Sporton, M J Earley, R J Schilling, R J Hunter
BACKGROUND: Current consensus guidelines suggest DOACs are interrupted peri-procedurally for catheter ablation (CA) of AF. However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. METHODS: Single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinised prior to trans-septal puncture with a target activated clotting time (ACT) of 300-350 seconds...
May 16, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29768667/analyzing-self-controlled-case-series-data-when-case-confirmation-rates-are-estimated-from-an-internal-validation-sample
#17
Stanley Xu, Christina L Clarke, Sophia R Newcomer, Matthew F Daley, Jason M Glanz
Vaccine safety studies are often electronic health record (EHR)-based observational studies. These studies often face significant methodological challenges, including confounding and misclassification of adverse event. Vaccine safety researchers use self-controlled case series (SCCS) study design to handle confounding effect and employ medical chart review to ascertain cases that are identified using EHR data. However, for common adverse events, limited resources often make it impossible to adjudicate all adverse events observed in electronic data...
May 16, 2018: Biometrical Journal. Biometrische Zeitschrift
https://www.readbyqxmd.com/read/29768633/evaluating-the-efficiency-and-safety-of-speech-recognition-within-a-commercial-electronic-health-record-system-a-replication-study
#18
Tobias Hodgson, Farah Magrabi, Enrico Coiera
OBJECTIVE:  To conduct a replication study to validate previously identified significant risks and inefficiencies associated with the use of speech recognition (SR) for documentation within an electronic health record (EHR) system. METHODS:  Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR using a commercial EHR system. The experiment design, setting, and tasks (E2) replicated an earlier study (E1), while technical integration issues that may have led to poorer SR performance were addressed...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29766520/the-role-of-electronic-health-records-in-clinical-reasoning
#19
REVIEW
Markus Berndt, Martin R Fischer
Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi-and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation...
May 16, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29766382/reduced-effectiveness-of-interruptive-drug-drug-interaction-alerts-after-conversion-to-a-commercial-electronic-health-record
#20
Adam Wright, Skye Aaron, Diane L Seger, Lipika Samal, Gordon D Schiff, David W Bates
BACKGROUND: Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue. OBJECTIVE: To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates. DESIGN: Two before-and-after studies. PARTICIPANTS: 3277 clinicians who received a DDI alert in the outpatient setting...
May 15, 2018: Journal of General Internal Medicine
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