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Joseph E Tanenbaum, Vincent J Alentado, Jacob A Miller, Daniel Lubelski, Edward C Benzel, Thomas E Mroz
BACKGROUND CONTEXT: Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) utilized by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Christopher Rowe, Eric Vittinghoff, Glenn-Milo Santos, Emily Behar, Caitlin Turner, Phillip Coffin
OBJECTIVES: Opioid overdose mortality has tripled in the USA since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events...
October 20, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Wei-Syun Hu
OBJECTIVE: The aim of the study was to address the impact of hemorrhoid on the development of CHD with or without concomitant comorbidities. DESIGN AND METHOD: Database was derived from Taiwanese national insurance beneficiaries. Study subjects were composed of patients with hemorrhoid (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 455) (n = 33034), and a comparison cohort without the hemorrhoid (n = 132136) from 2000 to 2010...
September 2016: Journal of Hypertension
Garen A Collett, Kangwon Song, Carlos A Jaramillo, Jennifer S Potter, Erin P Finley, Mary Jo Pugh
BACKGROUND: The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse. OBJECTIVES: We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors...
March 2016: Drugs—Real World Outcomes
Samuel Golpanian, David J Gerth, Jun Tashiro, Seth R Thaller
INTRODUCTION: Conventionally, free transverse rectus abdominis myocutaneous (fTRAM) flap breast reconstruction has been associated with decreased donor site morbidity and improved flap inset. However, clinical success depends upon more sophisticated technical expertise and facilities. This study aims to characterize postoperative outcomes undergoing free versus pedicled TRAM (pTRAM) flap breast reconstruction. METHODS: Nationwide inpatient sample database (2008-2011) was reviewed for cases of fTRAM (ICD-9-CM 85...
October 14, 2016: Aesthetic Plastic Surgery
Mehul R Dalal, Mahmood R Kazemi, Fen Ye
OBJECTIVE: To evaluate the impact of 6-month hypoglycemia on treatment discontinuation and hospitalization of patients initiating basal insulin for type 2 diabetes (T2D) in real-world practice. METHODS: This was a retrospective cohort study of patient-level data using electronic medical records (EMR) in the Predictive Health Intelligence diabetes dataset. Data from adult patients with T2D initiating basal insulin glargine, insulin detemir, or Neutral Protamine Hagedorn insulin between January 2008 and March 2014 were analyzed...
October 14, 2016: Current Medical Research and Opinion
Jeffrey A Guy, Lisa M Knight, Yinding Wang, Jeanette M Jerrell
BACKGROUND: Musculoskeletal injuries may be associated with attention-deficit/hyperactivity disorder (ADHD) symptom severity, comorbid psychiatric or medical conditions, and the prescribed psychostimulant. METHODS: A population-based, retrospective cohort design was employed using South Carolina's Medicaid claims data set covering outpatient and inpatient medical services and medication prescriptions over an 11-year period (January 1, 1996, through December 31, 2006) for patients ≤ 17 years of age with ≥ 2 visits for ICD-9-CM diagnostic codes for ADHD...
2016: Primary Care Companion to CNS Disorders
Daniel J Rubin, Elizabeth A Handorf, Sherita Hill Golden, Deborah B Nelson, Marie E McDonnell, Huaqing Zhao
OBJECTIVE: To develop and validate a tool to predict the risk of all-cause readmission within 30 days (30-d readmission) among hospitalized patients with diabetes. METHODS: A cohort of 44,203 discharges was retrospectively selected from the electronic records of adult patients with diabetes hospitalized at an urban academic medical center. Discharges of 60% of the patients (n = 26,402) were randomly selected as a training sample to develop the index. The remaining 40% (n = 17,801) were selected as a validation sample...
October 2016: Endocrine Practice
C Bouza, T Lopez-Cuadrado, J M Amate-Blanco
BACKGROUND: Severe sepsis is a challenge for healthcare systems, and epidemiological studies are essential to assess its burden and trends. However, there is no consensus on which coding strategy should be used to reliably identify severe sepsis. This study assesses the use of explicit codes to define severe sepsis and the impacts of this on the incidence and in-hospital mortality rates. METHODS: We examined episodes of severe sepsis in adults aged ≥18 years registered in the 2006-2011 national hospital discharge database, identified in an exclusive manner by two ICD-9-CM coding strategies: (1) those assigned explicit ICD-9-CM codes (995...
October 3, 2016: Critical Care: the Official Journal of the Critical Care Forum
James Furr, Tanya Watts, Ryan Street, Brian Cross, Gennady Slobodov, Sanjay Patel
OBJECTIVE: To describe clinical management of Fournier's gangrene, and to characterize predictive factors associated with inpatient mortality and extended hospital stay. MATERIALS AND METHODS: The National Inpatient Sample was queried from 2004 to 2012 based on ICD-9-CM procedural and diagnosis codes. Patients admitted for Fournier's gangrene who underwent debridement were selected. Multivariate logistic regression analysis was performed to identify predictors of inpatient mortality and extended hospital stay...
September 27, 2016: Urology
Yao-Tung Lee, Hsin-Chien Lee, Chaur-Jongh Hu, Li-Kai Huang, Shu-Ping Chao, Chia-Pei Lin, Emily Chia-Yu Su, Yi-Chen Lee, Chu-Chieh Chen
OBJECTIVES: To determine whether periodontitis is a modifiable risk factor for dementia. DESIGN: Prospective cohort study. SETTING: National Health Insurance Research Database in Taiwan. PARTICIPANTS: Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028). MEASUREMENTS: Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia...
September 29, 2016: Journal of the American Geriatrics Society
Shen-Shong Chang, Nicole Huang, Hsiao-Yun Hu
Patients with end-stage renal disease (ESRD) show a high incidence of bacterial translocation and impaired gastrointestinal motility. The intestinal tract is believed to be the most crucial source of translocated bacteria. To evaluate the risk of colonic diverticulitis in patients with ESRD, we conducted a nationwide population-based cohort study. Patients who met the following 3 criteria were defined as patients with ESRD: patients diagnosed with ESRD who received regular hemodialysis between 2000 and 2005, patients who received hemodialysis for more than 90% of the time during the observation period (2000-2011), and patients with no prior history of hemodialysis between 1997 and 1999...
September 2016: Medicine (Baltimore)
Reshma Shinde, Xiting Cao, Smita Kothari
BACKGROUND: Epidermal growth factor receptor (EGFR) gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements are key therapeutic targets for biomarker-driven treatment with an EGFR or ALK tyrosine kinase inhibitor (TKI) in patients with metastatic non-small cell lung cancer (NSCLC). To appropriately guide treatment decisions, since 2011, the National Comprehensive Cancer Network and the American Society of Clinical Oncology therefore recommend EGFR and ALK analysis in tumor samples obtained at the time of diagnosis in patients with non-squamous NSCLC...
October 2016: Journal of Managed Care & Specialty Pharmacy
David N Bernstein, Amit Jain, David Brodell, Yue Li, Paul T Rubery, Addisu Mesfin
OBJECTIVE: To analyze overall trends of elective cervical spine surgery in the United States from 2003-13 with the goal of determining whether the economic downturn had an impact. METHODS: Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) were used in order to identify elective cervical spine surgery procedures in the Nationwide Inpatient Sample (NIS) from 2003-13. National Health Expenditure, Gross Domestic Product (GDP) and Standard and Poor's (S&P) 500 Index were used as measures of economic performance...
September 22, 2016: World Neurosurgery
Malcolm Koo, Juen-Haur Hwang
OBJECTIVE: To investigate the risk of tinnitus in patients with sleep disturbance or sleep apnea. STUDY DESIGN: Case control study. METHODS: We identified 21,798 middle-aged and elderly patients with otolaryngologist-diagnosed tinnitus between January 1, 2000, and December 31, 2012, from the Longitudinal Health Insurance Database 2000 of the Taiwan National Health Insurance Research Database. A total of 108,990 controls were also identified from the same database based on frequency-matching on 10-year age interval, sex, and year of index date of the cases...
September 26, 2016: Laryngoscope
Milos Jovanovic, Sandro Radovanovic, Milan Vukicevic, Sven Van Poucke, Boris Delibasic
OBJECTIVES: Quantification and early identification of unplanned readmission risk have the potential to improve the quality of care during hospitalization and after discharge. However, high dimensionality, sparsity, and class imbalance of electronic health data and the complexity of risk quantification, challenge the development of accurate predictive models. Predictive models require a certain level of interpretability in order to be applicable in real settings and create actionable insights...
September 2016: Artificial Intelligence in Medicine
Syed K Mehdi, Joseph E Tanenbaum, Vincent J Alentado, Jacob A Miller, Daniel Lubelski, Edward C Benzel, Thomas E Mroz
STUDY DESIGN: Retrospective cohort study. BACKGROUND CONTEXT: CMS defines "adverse quality events" as the incidence of certain complications such as post-surgical hematoma and/or iatrogenic pneumothorax during an inpatient stay. Patient safety indicators (PSI) are a means to measure the incidence of these adverse events. When these occur, reimbursement to the hospital decreases. The incidence of adverse quality events among patients hospitalized for primary spinal neoplasms is unknown...
September 21, 2016: Spine Journal: Official Journal of the North American Spine Society
Julio J Jauregui, Dean C Perfetti, Frank S Cautela, David B Frumberg, Qais Naziri, Carl B Paulino
BACKGROUND: Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse. METHODS: A retrospective review of the Kids' Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries...
September 22, 2016: Journal of Pediatric Orthopedics
Dean M Cestari, Eric D Gaier, Peggy Bouzika, Taylor S Blachley, Lindsey B De Lott, Joseph F Rizzo, Janey L Wiggs, Jae H Kang, Louis R Pasquale, Joshua D Stein
OBJECTIVE: Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION. DESIGN: Retrospective longitudinal cohort study. PARTICIPANTS: Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network...
September 19, 2016: Ophthalmology
Michael Guo, Balraj Heran, Ryan Flannigan, Abbas Kezouh, Mahyar Etminan
PURPOSE: To examine the risk of persistent sexual dysfunction (PSD) with finasteride 1mg. METHODS: We conducted a retrospective cohort study using the IMS U.S. health claims database. From an original cohort of 6,110,723 patients, we identified 1390 men who had stopped using finasteride 1mg and 20,000 randomly selected age- and calendar time-matched users of omeprazole from 2006 to 2014. First PSD event was defined as 1) the first PSD diagnosis through the first International Classification for Diseases, Ninth Revision Clinical Modification [ICD-9-CM]) code for sexual dysfunction and 2) use of a phosphodiesterase inhibitor (sildenafil, tadalafil, or vardenafil) RESULTS: In the primary analysis, we identified 1,390 men taking finasteride 1mg and 20,000 omeprazole users...
September 19, 2016: Pharmacotherapy
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