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4261. Therapeutic Inertia in Patients Treated With Two or More Antidiabetics in Primary Care: Factors Predicting Intensification of Treatment. Full Text available with Trip Pro

Therapeutic Inertia in Patients Treated With Two or More Antidiabetics in Primary Care: Factors Predicting Intensification of Treatment. To determine the patterns and predictors of treatment intensification in patients with type 2 diabetes on ≥2 non-insulin antidiabetic drugs (NIADs) and inadequate glycaemic control in primary care in Catalonia, Spain.This was a retrospective analysis using electronic medical records from patients with HbA1c ≥ 7% and a first prescription for a new NIAD

2017 obesity & metabolism

4262. Predicting risk of undiagnosed COPD: development and validation of the TargetCOPD score. Full Text available with Trip Pro

with no prior diagnosis of COPD received a postal or opportunistic screening questionnaire. Those reporting chronic respiratory symptoms were assessed with spirometry. COPD was defined as presence of relevant symptoms with a post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. A risk score was developed using logistic regression with variables available from electronic health records for 2398 participants who returned a postal questionnaire (...) . This was externally validated among 1097 participants who returned an opportunistic questionnaire to derive the c-statistic, and the sensitivity and specificity of cut-points.A risk score containing age, smoking status, dyspnoea, prescriptions of salbutamol and prescriptions of antibiotics discriminated between patients with and without undiagnosed COPD (c-statistic 0.74, 95% CI 0.68-0.80). A cut-point of ≥7.5% predicted risk had a sensitivity of 68.8% (95% CI 57.3-78.9%) and a specificity of 68.8% (95% CI 65.8.1

2017 European Respiratory Journal Controlled trial quality: uncertain

4263. Different approaches to the assessment of adherence and persistence with cardiovascular-disease preventive medications. (Abstract)

Different approaches to the assessment of adherence and persistence with cardiovascular-disease preventive medications. To assess suitability and comparability of the most common methods of treatment adherence and persistence assessment, as applied to the same pharmacy dataset.Data on drugs prescribed for cardiovascular primary prevention to participants in the Aragon Workers' Health Study (AWHS) were collected from a regional electronic drug prescription database. Several different approaches

2017 Current medical research and opinion

4264. Protective effect of hormone therapy among women with hysterectomy/oophorectomy. Full Text available with Trip Pro

treatment starts and whether women have an intact uterus.A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013.The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were

2017 Human Reproduction

4265. Renin-angiotensin system blockers and residual kidney function loss in patients initiating peritoneal dialysis: an observational cohort study. Full Text available with Trip Pro

in a more diverse population of patients with multiple comorbid conditions. We investigated the association between ACEI/ARB use and development of recorded anuria in a cohort of patients initiating PD in the U.S.We conducted a retrospective observational cohort study using the US Renal Data System and electronic health records data from a large national dialysis provider. We identified adult patients who initiated PD from 2007 to 2011. Only patients who participated in the federal prescription drug (...) benefit program, Medicare Part D, for the first 90 days of dialysis were included. Patients who filled a prescription for an ACEI or ARB during those 90 days were considered users. We applied Cox proportional hazards models to an inverse probability of treatment-weighted (IPTW) cohort to estimate the hazard ratio (HR) for anuria (24-h urine volume < 200 ml) in ACEI/ARB users vs. non-users.Among 886 patients, 389 (44%) used an ACEI/ARB. Almost a third of these patients were black or Hispanic, and more

2017 BMC Nephrology

4266. A Computable Phenotype Improves Cohort Ascertainment in a Pediatric Pulmonary Hypertension Registry. Full Text available with Trip Pro

A Computable Phenotype Improves Cohort Ascertainment in a Pediatric Pulmonary Hypertension Registry. To compare registry and electronic health record (EHR) data mining approaches for cohort ascertainment in patients with pediatric pulmonary hypertension (PH) in an effort to overcome some of the limitations of registry enrollment alone in identifying patients with particular disease phenotypes.This study was a single-center retrospective analysis of EHR and registry data at Boston Children's (...) Hospital. The local Informatics for Integrating Biology and the Bedside (i2b2) data warehouse was queried for billing codes, prescriptions, and narrative data related to pediatric PH. Computable phenotype algorithms were developed by fitting penalized logistic regression models to a physician-annotated training set. Algorithms were applied to a candidate patient cohort, and performance was evaluated using a separate set of 136 records and 179 registry patients. We compared clinical and demographic

2017 Journal of Pediatrics

4267. A survey of inpatient practitioner knowledge of penicillin allergy at 2 community teaching hospitals. Full Text available with Trip Pro

A survey of inpatient practitioner knowledge of penicillin allergy at 2 community teaching hospitals. The negative effect of the penicillin allergy label on antibiotic use and patient outcomes has brought to light the need for thorough penicillin allergy assessments and heightened practitioner education.To evaluate practitioner knowledge of penicillin allergy and the clinical approach to the patients with penicillin allergy.An electronic survey was distributed to attending physicians, residents (...) understanding of the natural history of penicillin allergy and antibiotic cross-reactivity (P < .05).There is an overall limited understanding of the management of patients with a history of penicillin allergy in the hospital setting, where collaborative efforts between allergy and nonallergy health care practitioners are sparse. The expansion of a multidisciplinary approach may optimize antimicrobial prescribing in this subset of patients.Copyright © 2017 American College of Allergy, Asthma & Immunology

2017 Asthma & Immunology

4268. Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports. Full Text available with Trip Pro

primary care for older adults, include: the timely electronic tools for prescribing, dispensing and administering medication in the community; electronic transfer of information between healthcare settings; and, better clinical decision-making support and guidance.© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com (...) sample were due to: medication-related incidents e.g. prescribing, dispensing and administering (n = 486, 31%; 15% serious patient harm); communication-related incidents e.g. incomplete or non-transfer of information across care boundaries (n = 390, 25%; 12% serious patient harm); and clinical decision-making incidents which led to the most serious patient harm outcomes (n = 203, 13%; 41% serious patient harm).priority areas for further research to determine the burden and preventability of unsafe

2017 Age and ageing

4269. Comorbidity-adjusted relative survival in newly hospitalized heart failure patients: A population-based study. Full Text available with Trip Pro

prescriptions and disease-specific exemptions. A Cox model was fit for the one-year relative survival from HF.The cohort consisted of 51,061 HF patients (53% women; median age 80years). After integrating information from all sources, the prevalence rates of diabetes, chronic pulmonary disease and renal disease were 27.6%, 26.2% and 14.2%, respectively. The prevalence of comorbidity increased to 78%. Survival in the HF cohort was worse with increasing number of comorbidities and was inferior (...) to that in the reference population. Notably, the overall performance of the relative survival models was similar regardless of the strategy used to ascertain comorbidity.Comorbidities cluster in hospitalized HF patients, and increasing comorbidity burden is associated with worse survival. Integration of a comprehensive search of electronic records to supplement HDA improves the prevalence estimates of comorbidities, although it does not improve discrimination of the risk prediction models.Copyright © 2017 Elsevier

2017 International journal of cardiology

4270. Influences on Patient Satisfaction Among Patients Who Use Emergency Departments Frequently for Pain-Related Complaints. (Abstract)

Influences on Patient Satisfaction Among Patients Who Use Emergency Departments Frequently for Pain-Related Complaints. The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief.A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users (...) with high ED utilization for pain complaints. Responses were compared with an age-matched control group (n = 305) of nonfrequent ED users. Patient satisfaction survey responses and electronic medical records were used to model relationships between patient satisfaction and predictor variables.ED frequent users with pain complaints were 75% less likely to return a satisfaction survey compared with other patients (odds ratio = 0.2488; P < .0001). Patient satisfaction with physician behavior was largely

2017 Journal of Emergency Nursing

4271. Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. Full Text available with Trip Pro

between 2004 and 2013 in Tayside, Scotland were included. The electronic health record for diabetes which includes issued prescriptions was linked to laboratory biochemistry, hospital admission, death register and Scottish Renal Registry data. AKI events were defined using the Kidney Disease Improving Global Outcomes criteria with a rise in serum creatinine of at least  26.5 μmol/l or a rise of greater than 150% from baseline for all hospital admissions. Cox Regression Analyses were used to examine (...) Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury (AKI) as a proxy for lactic acidosis and whether survival among those with AKI varied by metformin exposure.All individuals with type 2 diabetes and available prescribing data

2017 BMC Nephrology

4272. The design of a theory-based intervention to improve medication adherence in chronic pain patients. (Abstract)

taking habits and use medication reminders. The intervention consists of three components in which relevant behavior change techniques are applied: (1) changes in the electronic patient data management systems to enable medical staff to apply target behaviors; (2) bi-annual education of medical staff to commit the team to the proposed intervention and provide feedback; (3) routine and mandatory education of chronic pain patients following prescription of pain medication.To improve medication (...) adherence in chronic pain patients, most interventions should be focused on providers of pain therapy. Prescribing chronic pain medication should be seen as part of a larger treatment regimen including adequate follow-up, adherence monitoring and patient education during the course of treatment.

2017 Current medical research and opinion

4273. Travellers' diarrhoea-a survey of practice. Full Text available with Trip Pro

Travellers' diarrhoea-a survey of practice. Travellers' diarrhoea (TD) is a common problem, affecting millions of tourists each year and creating a large economic burden. Risk factors for TD are known and guidelines exist to assist practitioners in advising travellers on how to prevent and treat TD. However, data are lacking regarding actual prescribing practices or approaches used in TD management. This study aims to establish a baseline which identifies uniformities and diversities (...) in practice.An online survey created using the SurveyMonkey tool was developed to test respondent approaches to TD pre-travel management. An invitation to participate in the survey was distributed early 2016 through selected Australian and New Zealand speciality travel medicine centres and through the electronic mailing list of the International Society of Travel Medicine (ISTM). Descriptive statistics and analyses using Chi Square analysis and two-sided Fishers exact tests for significance were used.Three

2017 Journal of Travel Medicine

4274. Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED). (Abstract)

Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED). EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQUiPPED to reduce the use of potentially inappropriate medications (PIMs), as defined by the American (...) Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department (ED) discharge. This evaluation represents a pre- and post-intervention comparison of PIM prescriptions at 4 urban Veteran Affairs (VA) Medical Center EDs. Poisson regression was used to compare the number of PIMs prescribed to Veterans 65 years or older discharged from the ED for at least 6 months prior to the first EQUiPPED intervention at each site and for at least 12 months following the final

2017 Journal of the American Geriatrics Society

4275. Use of Ocular Hypotensive Medications in Portugal: PEM Study: A Cross-sectional Nationwide Analysis. (Abstract)

electronic drug prescription system used by all hospitals and clinics in Portugal. Demographic data, medications prescribed (number and formulation), physician specialty, and costs of medications were provided in an encrypted and anonymous form. Statistical analyses were performed using STATA.A total of 231,634 participants (57% women) were prescribed IOP-lowering medications in 2015, representing 4.0% of the population older than 40 years of age and 2.2% of the Portuguese total population. Mean age (...) Use of Ocular Hypotensive Medications in Portugal: PEM Study: A Cross-sectional Nationwide Analysis. There is scarcity of European data about intraocular pressure (IOP)-lowering prescribing patterns. We aimed to describe and discuss the nationwide prescription of these medications in Portugal.This was a cross-sectional study including all patients who were prescribed at least 1 IOP-lowering medication in 2015 in Portugal. All ocular hypotensive drug prescriptions were gathered from the common

2017 Journal of Glaucoma

4276. Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder. Full Text available with Trip Pro

it varies by sex, licensing age, and/or being prescribed ADHD medication at licensure.This retrospective cohort study was conducted at 6 primary care practices of the Children's Hospital of Philadelphia, a large pediatric health care network in southeastern Pennsylvania and southern New Jersey. Using electronic health records, we defined a cohort of 2479 adolescents and young adults with ADHD and 15 865 without ADHD who were (1) born from 1987 to 1997; (2) residents of New Jersey and patients at 1 of 6 (...) New Jersey primary care practices at age 12 years or older; and (3) age-eligible to obtain a driver's license from 2004 through 2014. Electronic health records data were then linked with New Jersey's statewide driver licensing and crash databases for 2004 through 2014.Acquisition of a driver's license and first involvement as a driver in a police-reported crash. Survival analysis was used to estimate adjusted hazard ratios for licensing and crash outcomes through age 25 years.The median age

2017 JAMA pediatrics

4277. Selective Serotonin Reuptake Inhibitors and Cataract Risk: A Case-Control Analysis. (Abstract)

Selective Serotonin Reuptake Inhibitors and Cataract Risk: A Case-Control Analysis. Use of selective serotonin reuptake inhibitors (SSRIs) has been associated with an increased cataract risk. We aimed to assess cataract risk after exposure to SSRI or to other antidepressant drugs in a large electronic primary care database.Case-control study.The study population was derived from the UK-based Clinical Practice Research Datalink (CPRD). We included patients with first-time cataract aged ≥40 years (...) between 1995 and 2015 and an equal number of cataract-free controls matched on age, sex, general practice, date of cataract recording (i.e., index date), and years of history in the CPRD before the index date.We conducted conditional logistic regression analyses adjusted for body mass index, smoking, hypertension, diabetes, and systemic steroid use. Exposure of interest was the number of SSRI prescriptions and prescriptions for other antidepressant drugs. We further explored mutually exclusive use

2017 Ophthalmology

4278. Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative. (Abstract)

) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months.Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools.Adherence to CVD risk screening and prescribing guidelines.Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline (...) rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller

2017 Medical Journal of Australia Controlled trial quality: uncertain

4279. Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care. Full Text available with Trip Pro

, Shropshire, or Staffordshire UK.General practitioners and nurses with patients consulting with clinical OA.Following six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged ≥45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators.Quality of OA care over (...) ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38).The intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care.ISRCTN06984617.Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

2017 Osteoarthritis and Cartilage Controlled trial quality: predicted high

4280. Substance Use Disorder Treatment Following Clinician-Initiated Discontinuation of Long-Term Opioid Therapy Resulting from an Aberrant Urine Drug Test. Full Text available with Trip Pro

differences in SUD treatment referral and engagement based on the substances that led to discontinuation.From a sample of 600 patients selected from a national cohort of Veterans Health Administration patients who were discontinued from LTOT, we used manual chart review to identify 169 patients who were discontinued because of a UDT that was positive for alcohol, cannabis, or other illicit or non-prescribed controlled substances.We extracted sociodemographic, clinical, and health care utilization data (...) from patients' electronic medical records.Forty-three percent of patients (n = 73) received an SUD treatment referral following LTOT discontinuation and 20% (n = 34) engaged in a new episode of SUD treatment in the year following discontinuation. Logistic regression models controlling for sociodemographic and clinical variables demonstrated that patients who tested positive for cannabis were less likely than patients who tested positive for non-cannabis substances to receive referrals for SUD

2017 Journal of General Internal Medicine

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