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https://www.readbyqxmd.com/read/28329388/healthcare-claims-data-an-underutilized-tool-for-pediatric-outpatient-antimicrobial-stewardship
#1
Joshua R Watson, Ling Wang, Jennifer Klima, Melissa Moore-Clingenpeel, Sean Gleeson, Kelly Kelleher, Preeti Jaggi
Background: Healthcare claims are under-utilized to identify factors associated with high outpatient antibiotic use. Methods: We evaluated ambulatory encounter claims of Medicaid-insured children in 34 Ohio counties in 2014. 1) Rates of total antibiotic and azithromycin prescriptions dispensed were determined by county of patient residence. 2) Standardized treatment rates by county were estimated for uncomplicated upper respiratory tract encounters (acute otitis media, pharyngitis, sinusitis, presumed viral infection) after adjusting for patient age and encounter provider type...
March 9, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28329125/outcomes-in-patients-with-cardiovascular-implantable-electronic-device-infection-managed-with-chronic-antibiotic-suppression
#2
Eugene M Tan, Daniel C DeSimone, M Rizwan Sohail, Larry M Baddour, Walter R Wilson, James M Steckelberg, Abinash Virk
Background: Most cardiovascular implantable electronic device (CIED) recipients are elderly, have multiple comorbid conditions, and are at increased risk of CIED infection (CIEDI). Current guidelines recommend complete device removal in patients with CIEDI to prevent relapse and mortality. However, comorbidities or other factors may preclude device removal, thus prompting a non-surgical approach that includes chronic antibiotic suppression (CAS). There are limited data on outcomes of patients receiving CAS for CIEDI...
February 24, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28324484/sodium-glucose-co-transporter-2-sglt2-inhibitor-comparing-trial-data-and-real-world-use
#3
Andrew McGovern, Michael Feher, Neil Munro, Simon de Lusignan
INTRODUCTION: The first cardiovascular safety trial in the sodium-glucose co-transporter-2 (SGLT2) inhibitor drug class, the Empagliflozin Cardiovascular Outcomes and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, demonstrated significant cardiovascular risk reduction with empagliflozin. It is currently not clear what proportions of people with type 2 diabetes (T2DM) have the same high cardiovascular risk as those included in the trial, and will therefore be likely to experience the same cardiovascular benefit...
March 21, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28322162/arginine-complexes-with-simvastatin-apparent-solubility-in-vitro-dissolution-and-solid-state-characterization
#4
Mmr Meor Mohd Affandi, Minaketan Tripathy, Aba Majeed
Categorized as a Biopharmaceutics Classification System (BCS) Class II drugs, statin exhibit low aqueous solubility and bioavailability thus presenting an obstacle and great challenge to formulation researchers. This paper describes a de novo approach to enhance the aqueous solubility of one of the most commonly prescribed statins i.e. simvastatin (SMV) by forming a complex (SMV-ARG) with cosolute arginine (ARG). The complex has been characterized for its apparent solubility and in vitro dissolution. The solid state characterization has been carried out using Fourier Transform Infra-Red (FTIR) Spectroscopy, Elemental Analysis, X-Ray Powder Diffraction (XRD), Differential Scanning Calorimetry (DSC) analysis, Thermal Gravimetric Analysis (TGA) and Scanning Electron Microscopy (SEM)...
March 20, 2017: Current Drug Delivery
https://www.readbyqxmd.com/read/28315538/self-administered-premedication-improving-taxane-chemotherapy-treatment%C3%A2
#5
Kristin Roper, Mary Lou Siefert, Frances Fuller, Diane Lucier, Donna L Berry
BACKGROUND: Patients receiving taxane therapy are at risk for hypersensitivity reactions without appropriate premedication management. Patients must understand the importance of taking premedications as prescribed to prevent reactions.
. OBJECTIVES: The objectives of this study were to implement and evaluate a multidisciplinary practice protocol comprised of standardized nursing documentation of premedication regimens, teaching, and patient adherence to at-home premedication in an electronic health record (EHR)...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28306135/how-common-are-pulmonary-and-hepatic-adverse-effects-in-older-adults-prescribed-nitrofurantoin
#6
Karin Claussen, Edward Stocks, Deepa Bhat, Jason Fish, Craig D Rubin
OBJECTIVES: To determine the frequency of serious pulmonary and hepatic adverse events (AEs) in persons aged 65 and older prescribed nitrofurantoin. DESIGN: Retrospective electronic health record (EHR) audit of nitrofurantoin prescriptions and associated AEs. SETTING: Urban academic medical center. PARTICIPANTS: All inpatients and outpatients aged 65 and older prescribed nitrofurantoin from January 1, 2010, to December 31, 2014...
March 17, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28302674/urine-culture-follow-up-and-antimicrobial-stewardship-in-a-pediatric-urgent-care-network
#7
Dipanwita Saha, Jimisha Patel, Don Buckingham, David Thornton, Terry Barber, Joshua R Watson
BACKGROUND AND OBJECTIVES: Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. METHODS: A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record...
March 16, 2017: Pediatrics
https://www.readbyqxmd.com/read/28302112/automation-bias-in-electronic-prescribing
#8
David Lyell, Farah Magrabi, Magdalena Z Raban, L G Pont, Melissa T Baysari, Richard O Day, Enrico Coiera
BACKGROUND: Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. METHODS: One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system...
March 16, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28299946/single-institute-experience-with-methylphenidate-and-american-ginseng-in-cancer-related-fatigue
#9
Young D Chang, Joshua Smith, Diane Portman, Richard Kim, Ritika Oberoi-Jassal, Sahana Rajasekhara, Mellar Davis
BACKGROUND: Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown. AIM: The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28292504/pharmacists-perceptions-regarding-the-impact-of-hydrocodone-rescheduling-on-prescription-volume-workflow-management-and-patient-outcomes
#10
Tyler J Varisco, Motolani E Ogunsanya, Jamie C Barner, Marc L Fleming
OBJECTIVES: To determine (1) pharmacists' perceptions of how rescheduling of hydrocodone combination products (HCPs) from Drug Enforcement Agency (DEA) Schedule III to DEA Schedule II has influenced prescription volume and revenue, pharmacy workflow management, and patient outcomes; and (2) whether perceptions differed between pharmacists who support versus those who oppose HCP rescheduling. DESIGN: A cross-sectional mail survey. SETTING: Texas community pharmacies from October to December 2015...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28292304/design-and-implementation-of-electronic-health-record-integrated-clinical-prediction-rules-icpr-a-randomized-trial-in-diverse-primary-care-settings
#11
David A Feldstein, Rachel Hess, Thomas McGinn, Rebecca G Mishuris, Lauren McCullagh, Paul D Smith, Michael Flynn, Joseph Palmisano, Gheorghe Doros, Devin Mann
BACKGROUND: Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems...
March 14, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28291910/utilization-of-a-3d-printer-to-fabricate-boluses-used-for-electron-therapy-of-skin-lesions-of-the-eye-canthi
#12
Magdalena Łukowiak, Karolina Jezierska, Marek Boehlke, Marzena Więcko, Adam Łukowiak, Wojciech Podraza, Mirosław Lewocki, Bartłomiej Masojć, Michał Falco
This work describes the use of 3D printing technology to create individualized boluses for patients treated with electron beam therapy for skin lesions of the eye canthi. It aimed to demonstrate the effectiveness of 3D-printed over manually fabricated paraffin boluses. The study involved 11 patients for whom the construction of individual boluses were required. CT scans of the fabricated 3D-printed boluses and paraffin boluses were acquired and superimposed onto patient CT scans to compare their fitting, bolus homogeneity, and underlying dose distribution...
January 2017: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/28289563/persistent-erectile-dysfunction-in-men-exposed-to-the-5%C3%AE-reductase-inhibitors-finasteride-or-dutasteride
#13
Tina Kiguradze, William H Temps, Paul R Yarnold, John Cashy, Robert E Brannigan, Beatrice Nardone, Giuseppe Micali, Dennis Paul West, Steven M Belknap
IMPORTANCE: Case reports describe persistent erectile dysfunction (PED) associated with exposure to 5α-reductase inhibitors (5α-RIs). Clinical trial reports and the manufacturers' full prescribing information (FPI) for finasteride and dutasteride state that risk of sexual adverse effects is not increased by longer duration of 5α-RI exposure and that sexual adverse effects of 5α-RIs resolve in men who discontinue exposure. OBJECTIVE: Our chief objective was to assess whether longer duration of 5α-RI exposure increases risk of PED, independent of age and other known risk factors...
2017: PeerJ
https://www.readbyqxmd.com/read/28288634/understanding-the-implementation-and-adoption-of-a-technological-intervention-to-improve-medication-safety-in-primary-care-a-realist-evaluation
#14
Mark Jeffries, Denham L Phipps, Rachel L Howard, Anthony J Avery, Sarah Rodgers, Darren M Ashcroft
BACKGROUND: Monitoring for potentially hazardous prescribing is increasingly important to improve medication safety. Healthcare information technology can be used to achieve this aim, for example by providing access to prescribing data through surveillance of patients' electronic health records. The aim of our study was to examine the implementation and adoption of an electronic medicines optimisation system that was intended to facilitate clinical audit in primary care by identifying patients at risk of an adverse drug event...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28288272/interventions-to-improve-inhaler-technique-for-people-with-asthma
#15
REVIEW
Rebecca Normansell, Kayleigh M Kew, Alexander G Mathioudakis
BACKGROUND: Asthma is a common chronic disease worldwide. Inhalers are often prescribed to help control asthma symptoms, improve quality of life and reduce the risk of exacerbations or flare-ups. However, evidence suggests that many people with asthma do not use their inhaler correctly. It is therefore important to evaluate whether interventions aimed specifically at improving technique are effective and safe, and whether use of these interventions translates into improved clinical outcomes...
March 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28285065/pharmacist-use-of-the-electronic-medical-record-to-identify-adults-at-risk-for-anaphylaxis-without-epinephrine-for-self-administration
#16
Autumn Stewart, Katherine Sulkowski
OBJECTIVES: To describe an innovative pharmacist-led approach, with the use of electronic medical record (EMR) data, to identify patients at risk of anaphylaxis in need of epinephrine auto-injector (EAI) for self-administration. SETTING: An urban free health care center for an uninsured indigent adult population in Pittsburgh, PA. PRACTICE INNOVATION: In this pilot service, patients with allergy history fields containing the words "anaphylaxis," "nut," "bee," or "shellfish" were screened for inclusion...
March 8, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28284783/the-allergist-s-role-in-detection-of-severe-alpha-1-antitrypsin-deficiency
#17
Theodore Kelbel, Darren Morris, Deirdre Walker, Maria Paula Henao, Timothy Craig
BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) frequently presents as difficult to manage asthma or asthma with fixed obstruction and is well documented as being underdiagnosed in the population. OBJECTIVE: This study aimed to better describe allergists'/immunologists' involvement in the care of patients with AATD and whether they currently contribute to the underdiagnosis by lack of screening for the condition. METHODS: Using the Research Electronic Data Capture tool, we submitted a questionnaire to 500 patients with severe AATD (ZZ, SZ, ZNull, and FZ) through the Alpha-1 Foundation Research Registry to collect information about patient diagnosis and treatment patterns...
March 8, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28281244/effectiveness-of-liraglutide-and-lixisenatide-in-the-treatment-of-type-2-diabetes-real-world-evidence-from-the-health-improvement-network-thin-database-in-the-united-kingdom
#18
Michael Feher, Gabriela Vega-Hernandez, Emina Mocevic, Brian Buysse, Melissa Myland, Geraldine S Power, Lise L Nystrup Husemoen, Joseph Kim, Daniel R Witte
INTRODUCTION: The glucagon-like peptide-1 receptor agonists liraglutide and lixisenatide are effective at reducing glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM). Although liraglutide has demonstrated superior efficacy in head-to-head clinical trials, real-world evidence of comparative effectiveness is lacking. This observational study aimed to assess the effectiveness of liraglutide versus lixisenatide in UK clinical practice. METHODS: Electronic medical records from The Health Improvement Network (THIN) UK primary care database were analyzed...
March 9, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28279950/insuonline-an-electronic-game-for-medical-education-on-insulin-therapy-a-randomized-controlled-trial-with-primary-care-physicians
#19
Leandro Arthur Diehl, Rodrigo Martins Souza, Pedro Alejandro Gordan, Roberto Zonato Esteves, Izabel Cristina Meister Coelho
BACKGROUND: Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated. OBJECTIVE: The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity...
March 9, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28273157/dosimetric-comparison-of-simultaneous-integrated-boost-with-whole-breast-irradiation-for-early-breast-cancer
#20
Seok Hyun Son, Kyu Hye Choi, Shin-Wook Kim
PURPOSE: The purpose of this study was to identify a more suitable boost plan for simultaneously integrated boost scheme in patients with breast cancer by comparing among 3 types of whole-breast irradiation plus tumor bed boost plans. METHODS: Twenty patients who received radiotherapy following breast-conserving surgery for early breast cancer were enrolled in this study. We performed 1 type of electron plan (E1P plan) and 2 types of 3-dimensional conformal plans using a photon (P3P and P5P plans)...
2017: PloS One
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