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https://www.readbyqxmd.com/read/29458121/the-paradox-of-marrow-adipose-tissue-in-anorexia-nervosa
#1
Pouneh K Fazeli, Anne Klibanski
Anorexia nervosa (AN) is a psychiatric disorder characterized by inappropriate nutrient intake resulting in low body weight. Multiple hormonal adaptations facilitate decreased energy expenditure in this state of caloric deprivation including non-thyroidal illness syndrome, growth hormone resistance, and hypogonadotropic hypogonadism. Although these hormonal adaptations confer a survival advantage during periods of negative energy balance, they contribute to the long-term medical complications associated with AN, the most common of which is significant bone loss and an increased risk of fracture...
February 16, 2018: Bone
https://www.readbyqxmd.com/read/29457258/quality-of-prescribing-by-physicians-nurse-practitioners-and-physician-assistants-in-the-united-states
#2
Shiyin Jiao, Irene B Murimi, Randall S Stafford, Ramin Mojtabai, G Caleb Alexander
OBJECTIVE: Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares to that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and non-physician providers. METHODS: A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed...
February 19, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29454789/less-is-more-a-minimalist-approach-to-endoscopy
#3
Nicholas J Shaheen, M Brian Fennerty, Jacques J Bergman
A substantial literature documents inappropriate usage of gastrointestinal endoscopy in a variety of clinical settings. Overusage of endoscopy appears to be common, and 30% or more of procedures performed in some clinical settings have questionable indications. The potential reasons for overuse of endoscopy are multiple, and include cancer phobia, fear of medical malpractice litigation, profit motive, the investigation of "incidentalomas" found on other imaging, and under-appreciation of the delayed harms of endoscopy, among other reasons...
February 15, 2018: Gastroenterology
https://www.readbyqxmd.com/read/29454378/do-employees-benefit-from-collaborations-between-out-of-hours-general-practitioners-and-emergency-departments
#4
Elisabeth Sybilla Johanna van Gils-van Rooij, Sjoerd Michael Broekman, Dingenus Herman de Bakker, Berthold Rudy Meijboom, Christoffel Joris Yzermans
BACKGROUND: In an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours GP (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs). Work satisfaction is an important factor in analysing the impact of this organisational change. The objective of this study is, firstly, to discover if there is a difference in the employee experiences between those working in UCCs and those in traditional out-of-hours services in which EDs and out-of-hours GP services operate separately (i...
February 17, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29453677/changes-in-medicine-prescription-following-a-medication-review-in-older-high-risk-patients-with-polypharmacy
#5
Marian Z M Hurmuz, Sarah I M Janus, Jeannette G van Manen
Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed...
February 17, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29452289/polypharmacy-in-people-with-dementia-associations-with-adverse-health-outcomes
#6
Christoph Mueller, Mariam Molokhia, Gayan Perera, Nicola Veronese, Brendon Stubbs, Hitesh Shetty, David Codling, Jonathan Huntley, Robert Stewart
Polypharmacy has been linked to higher risks of hospitalisation and death in community samples. It is commonly present in people with dementia but these risks have rarely been studied in this population. We aimed investigate associations between polypharmacy and emergency department attendance, any and unplanned hospitalisation, and mortality in patients with dementia. Using a large mental health care database in South London, linked to hospitalisation and mortality data, we assembled a retrospective cohort of patients diagnosed with dementia...
February 13, 2018: Experimental Gerontology
https://www.readbyqxmd.com/read/29446115/iatrogenic-risk-factors-associated-with-hospital-readmission-of-elderly-patients-a-matched-case-control-study-using-a-clinical-data-warehouse
#7
C Schwab, V Korb-Savoldelli, J B Escudie, C Fernandez, P Durieux, O Saint-Jean, B Sabatier
WHAT IS KNOWN: Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions. OBJECTIVE: The aim of this study was to identify iatrogenic risk factors for readmission...
February 14, 2018: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/29445640/medical-waste-management-in-community-health-centers
#8
Jafar Sadegh Tabrizi, Ramin Rezapour, Mohammad Saadati, Samira Seifi, Behnam Amini, Farahnaz Varmazyar
Background: Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. Methods: In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards...
February 2018: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/29442334/utilization-spending-and-price-trends-for-quinolones-in-the-us-medicaid-programs-25-years-experience-1991-2015
#9
Ziyad S Almalki, Xiaomeng Yue, Ying Xia, Patricia R Wigle, Jeff Jianfei Guo
BACKGROUND: Given that the quinolones is one of the antibacterial classes most frequently used to treat patients with bacterial infections in the United States, any change in prescribing patterns of quinolones will impact Medicaid medical expenditures. OBJECTIVES: This study was undertaken to examine trends in utilization, reimbursement, and prices of quinolone antibacterials for the US Medicaid population. METHODS: The publicly available Medicaid State Drug Utilization outpatient pharmacy files were used for this study...
June 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29440886/missed-diagnosis-and-overtreatment-of-copd-among-smoking-primary-care-population-in-central-greece-old-problems-persist
#10
Eirini Stafyla, Ourania S Kotsiou, Konstantina Deskata, Konstantinos I Gourgoulianis
Background: The diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program. Methods: A study was conducted in 10 primary health care centers of Central Greece during a 7-month period...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29440481/prospective-evaluation-of-medication-related-clinical-decision-support-over-rides-in-the-intensive-care-unit
#11
Adrian Wong, Mary G Amato, Diane L Seger, Christine Rehr, Adam Wright, Sarah P Slight, Patrick E Beeler, E John Orav, David W Bates
BACKGROUND: Clinical decision support (CDS) displayed in electronic health records has been found to reduce the incidence of medication errors and adverse drug events (ADE). Recent data suggested that medication-related CDS alerts were frequently over-ridden, often inappropriately. Patients in the intensive care unit (ICU) are at an increased risk of ADEs; however, limited data exist on the benefits of CDS in the ICU. This study aims to evaluate potential harm associated with medication-related CDS over-rides in the ICU...
February 9, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29440209/to-what-extent-do-hospitalised-patients-receive-appropriate-ct-and-mri-scans-results-of-a-cross-sectional-study-in-southern-italy
#12
Aida Bianco, Rossella Zucco, Francesca Lotito, Maria Pavia
OBJECTIVES: The aim of this study was to assess the frequency of appropriateness of inpatient CT and MRI scans performed in Southern Italy. METHODS: The study was carried out by retrospectively reviewing medical records of adult patients admitted between 1 January and 31 December 2012 in two hospitals. The evaluation of appropriateness was performed according to the American College of Radiology Appropriateness Criteria, which assigns a score between 1 and 9. RESULTS: Eight hundred and fifty-three medical records were reviewed...
February 12, 2018: BMJ Open
https://www.readbyqxmd.com/read/29439425/inappropriate-use-of-medication-by-elderly-polymedicated-or-multipathological-patients-with-chronic-diseases
#13
REVIEW
Virtudes Pérez-Jover, José J Mira, Concepción Carratala-Munuera, Vicente F Gil-Guillen, Josep Basora, Adriana López-Pineda, Domingo Orozco-Beltrán
The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological...
February 10, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29438504/potentially-inappropriate-medication-and-hospitalization-emergency-department-visits-among-the-elderly-in-korea
#14
Ha-Lim Jeon, Juhee Park, Euna Han, Dong-Sook Kim
Objective: To investigate the association between potentially inappropriate medicine (PIM) use, defined using the American Geriatric Society (AGS) 2012 Beers criteria, and the risk of hospitalization or emergency department (ED) visits in elderly patients, and to examine the most frequently used PIMs among patients with adverse outcomes. Design/Setting: This was a retrospective study using National Health Insurance claims data from 2010 to 2012. Intervention(s): Elderly patients who took PIMs are compared to those who were not taking PIMs...
February 9, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29437075/changing-the-time-of-blood-collection-to-determine-vancomycin-concentrations-in-intensive-care-unit-patients
#15
Drayton A Hammond, Taylor B James, Lexis N Atkinson, Jacob T Painter, Katherine Lusardi
BACKGROUND: Clinical practice guidelines for initiation and therapeutic drug monitoring, but not timing, of vancomycin dosing exist at many institutions. Scheduling vancomycin trough measurements and doses around the morning blood sample collection could yield more interpretable troughs and increase patient safety. OBJECTIVE: To evaluate the appropriateness of blood sample collection times for vancomycin trough measurements before and after an initiative to change the timing of blood sampling to determine vancomycin doses and trough levels in a medical intensive care unit...
February 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29436726/molecular-testing-practices-and-perceptions-among-dermatopathologists
#16
Kristin Torre, Preeti Jhorar, Rong Wu, John Pfeifer, Zendee Elaba, Michael Murphy
BACKGROUND: We evaluated how dermatopathologists are employing molecular testing in the setting of neoplastic skin diseases, and assess their opinions of the broader role and utility of molecular technologies in clinical practice. METHODS: A 15-question online survey was sent to Fellows of the American Society of Dermatopathology in April 2017. RESULTS: One hundred and thirty-six dermatopathologists completed the survey (response rate = 16%)...
February 13, 2018: Journal of Cutaneous Pathology
https://www.readbyqxmd.com/read/29434389/outcomes-from-a-pharmacist-led-proton-pump-inhibitor-stewardship-program-at-a-single-institution
#17
Rebekah A Wahking, Randal L Steele, Rachel E Hanners, Sean M Lockwood, Kelly W Davis
Background: Proton pump inhibitors (PPIs) are effective medications for acid-related disorders; however, they are also overused and may be associated with several adverse effects. A PPI stewardship program was implemented at one institution to combat the overuse of PPIs. Objective: The purpose of this study is to evaluate the effectiveness of an inpatient PPI stewardship program in reducing PPI use, both during hospitalization and upon discharge. Methods: This was a retrospective cohort study of all patients admitted to an internal medicine service at a single institution from March 14, 2016, to August 14, 2016, with an intervention by the PPI stewardship team...
February 2018: Hospital Pharmacy
https://www.readbyqxmd.com/read/29434387/antimicrobial-utilization-pattern-in-pediatric-patients-in-tertiary-care-hospital-eastern-ethiopia-the-need-for-antimicrobial-stewardship
#18
Samuel Girma, Mekonnen Sisay, Getnet Mengistu, Firehiwot Amare, Dumessa Edessa
Background: Antimicrobials are among the most frequently prescribed medications for pediatric patients. However, inappropriate use of them can increase morbidity, mortality, healthcare costs, and largely antimicrobial resistance. This study aims to assess the antimicrobial utilization pattern in the pediatric ward of Hiwot Fana Specialized University Hospital. Methods: Retrospective cross-sectional study was conducted to assess the antimicrobial utilization. In this study, 403 pediatric medical records selected by systematic random sampling were reviewed...
February 2018: Hospital Pharmacy
https://www.readbyqxmd.com/read/29433501/international-core-outcome-set-for-clinical-trials-of-medication-review-in-multi-morbid-older-patients-with-polypharmacy
#19
Jean-Baptiste Beuscart, Wilma Knol, Shane Cullinan, Claudio Schneider, Olivia Dalleur, Benoit Boland, Stefanie Thevelin, Paul A F Jansen, Denis O'Mahony, Nicolas Rodondi, Anne Spinewine
BACKGROUND: Comparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research. The objective in this study was to develop a core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy...
February 13, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29433489/predictors-of-inappropriate-and-excessive-use-of-reliever-medications-in-asthma-a-16-year-population-based-study
#20
Hamid Tavakoli, J Mark FitzGerald, Larry D Lynd, Mohsen Sadatsafavi
BACKGROUND: Understanding factors associated with the inappropriate or excessive use of short-acting beta agonists (SABA) can help develop better policies. METHODS: We used British Columbian (BC)'s administrative health data (1997-2014) to create a retrospective cohort of asthma patients aged between 14 and 55 years. The primary and secondary outcomes were, respectively, inappropriate and excessive use of SABA based on a previously validated definition. Exposures were categorised into groups comprising socio-demographic variables, indicators of type and quality of asthma care, and burden of comorbid conditions...
February 12, 2018: BMC Pulmonary Medicine
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