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4101. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

framework, and should not override good clinical judgement. Treatment should take into account the patient’s co-morbidities, drug tolerance, lifestyle, living circumstances, cultural sensibilities and wishes. When prescribing medication, clinicians should observe usual contraindications, be mindful of potential adverse drug interactions and allergies and monitor responses and review patients regularly.11 1. Overview ARF is an illness caused by an immunological reaction to infection with the bacterium

2012 Clinical Practice Guidelines Portal

4102. Guidelines for preventive activities in general practice (8th edition)

are provided in the electronic version where appropriate). This allows more in-depth information on a particular topic. Organisational detail The information in these guidelines is organised into three levels. The first level is the lifecycle chart, which highlights when preventive activities should be performed and the optimum frequency for each activity. The lifecycle chart is organised by age and clinical topic. Simply check the column under a particular age group to see what activities should

2012 Clinical Practice Guidelines Portal

4103. Are Dentists Really Causing Infective Endocarditis?

with regurgitation (see Table 1). It was suggested that patients stratified into these high and moderate risk categories should be prescribed prophylactic antibiotics prior to undergoing certain dental procedures known to cause bleeding. The listed treatments included extractions, periodontal surgery and scaling, dental implant placement, and complicated endodontic (root canal) treatments. Excluded were less invasive procedures such as standard restorative dentistry (crowns, bridges, fillings), local anesthesia (...) injections, and most orthodontic work.[4] These guidelines were complicated for both patients and practitioners, and it was therefore not uncommon to note over-prescription of antibiotic prophylaxis to low-risk patients for even non-invasive procedures “just in case.”[5] As time passed, the quality of the evidence behind the recommendations came under increasing scrutiny. Table 1 (From 1997 Guidelines) [4] High Risk: Low Risk (no prophylaxis necessary): Prosthetic Cardiac Valves Isolated secundum atrial

2012 Clinical Correlations

4104. Omega-3 Fatty Acids and Atherosclerosis

available, there is now an FDA-approved prescription omega-3 supplement available in the US. Lovaza (Pronova BioPharma ASA, Lysaker, Norway) is 38% DHA, 47% EPA, and 17% other fish oils (840 mg of DHA and EPA) and is approved to treat hypertriglyceridemia. Fish-oil supplements commonly have a fishy smell and aftertaste that can be bothersome to some individuals.[6] These pharmacological agents are well tolerated with statins,[5] which are often co-prescribed. There is some concern that omega-3s, due (...) were reduced much more than on a statin alone. In addition, VLDL-C, triglycerides, and total cholesterol decreased and HDL-C increased– .[5] Of the 3 omega-3 PUFAs discussed, EPA and .[6] The mechanism by which omega-3 PUFAs lower triglycerides is still unknown, but they reduce the hepatic synthesis of VLDLs, which are almost entirely triglycerides, and accelerate lipoprotein lipase, which hydrolyzes triglycerides.[1] With prescription strength omega-3s, triglycerides can be lowered 30-40%.[5

2012 Clinical Correlations

4105. Why Are Asthma Patients Noncompliant With Their Inhalers?

excellent control of symptoms with few side effects. Unfortunately, most asthmatic patients fail to take their medications as prescribed, with compliance rates as low as 30%. The reasons for such high non-compliance rates are complex and varied. Buston and Wood found, in a 2000 study that asked adolescents to describe their reasons for non-compliance, that 50% of those questioned attributed their non-compliance to forgetfulness. They reported that changes in daily routines, such as vacations, holidays (...) . Crompton GK. How to achieve good compliance with inhaled asthma therapy. Respir Med. 2004;98 Suppl B:S35-S40. 6. Yeung M, O’Connor SA, Parry DT, Cochrane GM. Compliance with prescribed drug therapy in asthma. Respir Med. 1994;88(1):31-35. Share: | | One comment on “ Why Are Asthma Patients Noncompliant With Their Inhalers? ” on After reading this article I thought I should comment and let people know there is a brand new personal home spirometer called Spiro PD which empowers people with asthma

2012 Clinical Correlations

4106. Myth VS. Reality: The July Effect

different electronic medical record systems and navigating the other idiosyncrasies of unfamiliar institutions, one cannot help but wonder what implications this may have on patient safety. The notion that nationwide morbidity and mortality increase in July as thousands of interns, residents and fellows adjust to their new roles is typically [2] and ;[3,4] our British colleagues often refer to their analogous transition every ”[5] But what does the available evidence suggest regarding this supposed (...) to track use of aspirin, beta-blockers, statins and ACE/ARBs at time of discharge as these are standard quality metrics for these two cardiac conditions; again, no significant difference was found comparing July-September to October-June prescriptions for any of these guideline recommended medications. In a rather unique examination of over 62 million computerized US death certificates from 1979-2006, Philips and Barker developed a least-squares regression equation to compare observed to expected

2012 Clinical Correlations

4107. Medicine?s Favorite Default Diagnosis: Non-compliance

to catch on. They may actually be hindering the process of change toward forming more synergistic alliances with their patients.[2] Terminology aside, the issue of patient non-adherence is currently plaguing the health care system. It is estimated that half of the 3.2 billion prescriptions dispensed in the US annually are not taken as prescribed, even though there exists substantial evidence that medical therapy .[5, 6] Not only does medication non-adherence lead to poor clinical outcomes, .[7] In fact (...) threatened, so I ask, “But Ms. S, have you been taking your medications as prescribed?” “Oh yes, of course, Doctor. I never miss a dose,” she responds. Her statement leaves me perplexed. How could the conditions of this woman, who over the past 6 months has reportedly been compliant with her medications and adherent to physician-recommended life modifications, continue to be so poorly controlled in so many parameters? The first thought to cross my mind is that maybe she is not telling the truth. She may

2012 Clinical Correlations

4108. BiDil: The Future of Medicine or a Return to a Dark Past?

” [5] to the more inflammatory “There is no ” [6]. One consistent criticism was the conflation of race and genetics: if the drug is targeted for African Americans, how do we know who are African Americans to whom we should be prescribing BiDil? An exhaustive analysis of the complexities surrounding the formation of the modern African American community is beyond the scope of this discussion. Yet the term “African American” and the racial category of “black” are inherently social inventions (...) . Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2012 Clinical Correlations

4109. Patient blood management guidelines module 2. Perioperative

. An editable electronic copy of this template is available on the National Blood Authority’s website (www.nba.gov.au). Preoperative tests • Full blood count • Iron studies 2 including ferritin • CRP and renal function Is the patient anaemic? Hb 100 mcg/L Preoperative haemoglobin assessment and optimisation template 10 Patient Blood Management Guidelines: Module 2 | Perioperative# Iron therapy Oral iron in divided daily doses. Evaluate response after 1 month. Provide patient information material. IV iron (...) ’ for intervention questions), PPO (‘population, predictor and outcome’ for prognostic questions) or PRO (‘population, risk factor and outcome’ for aetiology questions) criteria. Three main strategies were used to identify potentially relevant literature: electronic database searching, manual searching and use of literature recommended by expert members of the CRG. The primary databases searched were EMBASE, Medline, the Cochrane Library Database and PreMedline. Additional searches were conducted of Cumulative

2012 Clinical Practice Guidelines Portal

4110. Is There a Long-Term Mortality Benefit From Bariatric Surgery?

] Perioperative mortality rate must be carefully considered when recommending bariatric surgery to a patient. While the aforementioned studies have demonstrated a 21-40% reduction in long-term mortality after bariatric surgery compared to matched controls prescribed medical management for obesity, a 2011 study in JAMA by Maciejewski and colleagues did not demonstrate a statistically-significant mortality benefit for bariatric surgery. The study was a retrospective analysis of 1695 patients (74% male (...) . 2011;26(10):1183-1194. Share: | | One comment on “ Is There a Long-Term Mortality Benefit From Bariatric Surgery? ” on Great article, Here is the latest research and news on trials. NICE guidelines, tools & resources for you to keep up-to-date in Medical & Primary Care. Comments are closed. Sites We Follow: Useful Links: Questions? Comments? Contact us! © New York University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2012 Clinical Correlations

4111. The Placebo Effect: Can Understanding Its Role Improve Patient Care?

Rev. 2010(1):CD003974. 6. Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336(7651):999-1003. 7. Kaptchuk TJ, Friedlander E, Kelley JM, et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PloS One. 2010;5(12):e15591. 8. Surbone A. Is prescribing placebos an ethical practice? www.clinicalcorrelations.org. February 18th 2009. 9. Daugherty CK, Ratain MJ (...) , Emanuel EJ, Farrell AT, Schilsky RL. Ethical, scientific, and regulatory perspectives regarding the use of placebos in cancer clinical trials. J Clin Oncol. 2008;26(8):1371-1378. 10. Harris G. Half of doctors routinely prescribe placebos. New York Times. October 24th, 2008. 11. Berkowitz K, Sutton T, et al. Clinical use of placebo: an ethics analysis. National ethics teleconference. July 28, 2004. Share: | | 3 comments on “ The Placebo Effect: Can Understanding Its Role Improve Patient Care

2012 Clinical Correlations

4112. A Study of Cultural Complications in the Management of Diabetes

with both the diabetic diet and cultural beliefs. Furthermore, the impact of snacks on glycemic control should be directly addressed with Bangladeshi patients. 18 out of 18 study participants were in favor of eating snacks between meals to “sustain strength”. Only 5 of these 18 subjects thought snacks could cause any harm [5]. Ms. KS commonly snacked throughout the day, and although a diabetic diet was delivered to her for each meal, she never ate the prescribed diet and instead chose to eat food (...) : Questions? Comments? Contact us! © New York University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2012 Clinical Correlations

4114. Comparative Efficacy of Bilateral Thoracoscopic Splanchnicectomy for Intractable Pain Secondary to Pancreatic Cancer vs Chronic Pancreatitis. (Abstract)

pancreatitis.A University of Louisville database was evaluated from July 1998 to March 2016 for patients undergoing bilateral thoracoscopic splanchnicectomy for intractable pain secondary to pancreatic cancer (n = 48) or chronic pancreatitis (n = 75). Patients were evaluated pre- and postoperatively with regard to abdominal pain and related symptoms, narcotic analgesic requirements, and hospital admissions. Narcotic use was quantified using the Kentucky All Schedule Prescription Electronic Reporting

2017 Journal of the American College of Surgeons

4115. Automated Software System to Promote Anticoagulation and Reduce Stroke Risk: Cluster-Randomized Controlled Trial. (Full text)

Automated Software System to Promote Anticoagulation and Reduce Stroke Risk: Cluster-Randomized Controlled Trial. Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals (...) during routine care through a cluster-randomized trial.Screen reminders appeared each time the electronic health records of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at 6 months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects

2017 Stroke Controlled trial quality: predicted high PubMed abstract

4116. The unclosing premature mortality gap in gout: a general population-based study. (Abstract)

The unclosing premature mortality gap in gout: a general population-based study. Gout, the most common inflammatory arthritis, is associated with premature mortality. Whether this mortality gap has improved over time, as observed in rheumatoid arthritis (RA), is unknown.Using an electronic medical record database representative of the UK general population, we identified incident gout cases and controls between 1999 and 2014. The gout cohort was divided based on year of diagnosis into early (...) (1999-2006) and late (2007-2014) cohorts. We compared the mortality rates and HRs, adjusting for potential confounders between the cohorts. We conducted sensitivity analyses among patients with gout who received at least one prescription for urate-lowering therapy, which has been found to have a validity of 90%.In both cohorts, patients with gout showed similar levels of excess mortality compared with their corresponding comparison cohort (ie, 29.1 vs 23.5 deaths/1000 person-years and 23.0 vs 18.8

2017 Annals of the Rheumatic Diseases

4117. Incidence and medical management of bisphosphonate-associated atypical femoral fractures in a major trauma centre: a retrospective observational study. (Full text)

management of AFFs against published recommendations.A retrospective analysis of the admissions database for a major trauma centre identified all femoral fractures (3150) in a five-year period (July 2009 to June 2014). Electronic health records and radiographs were reviewed using the 2013 American Society for Bone and Mineral Research (ASBMR) diagnostic criteria for AFF to establish the number of cases. To estimate incidence, the total number of bisphosphonate users was derived from primary care (...) prescription and secondary care day-case records. Medical management of cases with AFF on bisphosphonates was audited against guidance from ASBMR and Medicines & Healthcare Products Regulatory Agency.10 out of 3150 femoral fractures met criteria for AFF; 7 of these patients had a history of exposure to bisphosphonates (6 oral, 1 intravenous). There were 19.1 AFFs per 100,000 years of bisphosphonate use in our region. Bisphosphonates were stopped and the contralateral femur imaged in only 2 of the 7

2017 BMC Musculoskeletal Disorders PubMed abstract

4118. A novel reflex cough testing device. (Full text)

reflex, and verified whether screening with this new instrument is feasible for evaluating the risk of aspiration pneumonia.This device consists of a special pipe with a double lumen, a nebulizer, and an electronic spirometer. We used a solution of prescription-grade L-tartaric acid to initiate the cough reflex. The solution was inhaled through a mouthpiece as a microaerosol produced by an ultrasonic nebulizer. The peak cough flow (PCF) of the induced cough was measured with the spirometer. The 70

2017 BMC pulmonary medicine PubMed abstract

4119. Treatment Adherence Intervention Studies in Dermatology and Guidance on How to Support Adherence. (Abstract)

Treatment Adherence Intervention Studies in Dermatology and Guidance on How to Support Adherence. Adequate adherence to prescribed treatment regimens can help to break the cycle of treatment failure, disease progression and subsequent treatment escalation. Unfortunately, adherence in the treatment of skin disorders such as acne, atopic dermatitis/eczema and psoriasis is often inadequate. A review of the literature identified a number of studies that tested an intervention to improve adherence (...) in dermatology, including the following: electronic messages and/or reminders; more frequent or 'extra' clinic visits; audio-visual and internet-based interventions; and patient support programmes and/or self-management, educational training programmes. While there is no one solution or action for improving adherence, some interventions were more successful than others. We provide practical guidance on how to support adherence based on aspects of the successful interventions identified and on our collective

2017 American journal of clinical dermatology

4120. Transfusion in critical care - a UK regional audit of current practice. (Full text)

, it is surprising that a scarce and potentially dangerous resource is still being overused within critical care. Simple solutions such as electronic patient records that force pause for thought before blood transfusion, or prescriptions that only allow administration of a single unit in non-emergency circumstances may help to reduce the incidence of unnecessary blood transfusions.© 2017 The Association of Anaesthetists of Great Britain and Ireland.

2017 Anaesthesia PubMed abstract

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