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4281. Quality measure and weight loss assessment in patients with type 2 diabetes mellitus treated with canagliflozin or dipeptidyl peptidase-4 inhibitors. Full Text available with Trip Pro

) inhibitors in the achievement of such quality measures. This study used recent electronic medical records (EMR) data to assess quality measure achievement of HbA1C, BP, and BW loss in patients treated with CANA versus DPP-4 inhibitors.Adult patients with ≥1 T2DM diagnosis and ≥12 months of clinical activity (baseline) before first CANA or DPP-4 prescription (index) were identified in the QuintilesIMS Health Real-World Data EMRs-US database (03/29/2012-10/30/2015). Patients were observed from the index

2017 BMC Endocrine Disorders

4282. The Challenge of Patient Notification and the Work of Follow-Up Generated by a 2-Step Testing Protocol for Group A Streptococcal Pharyngitis in the Pediatric Emergency Department. (Abstract)

with a confirmatory test performed. There were 234 patients with positive confirmatory testing and not prescribed antibiotics at the time of the initial visit. Of these, 90.1% were ultimately contacted and prescribed appropriate antibiotics, whereas 7.3% were lost to follow-up and 2.6% had potentially unnecessary repeat visits. Of those contacted, 43.1% were reached only after multiple telephone calls or a letter. The median time from the negative RADT to the submission of an electronic prescription was 19.6

2017 Pediatric Emergency Care

4283. Current and future perspectives on the management of polypharmacy. Full Text available with Trip Pro

enough to result in hospital admission and even death. Hence, having systems in place to ensure that medications are started only when there is a suitable indication, ensuring patients are fully aware of the benefits and complications that may arise from their treatment, and reviewing patients regularly to ensure their medication regime remains appropriate, are essential.The development and rapid uptake of electronic patient records - particularly in primary care settings where the majority (...) of prescribing takes place - makes monitoring of patients more straightforward than in the past; and allows identification of sub-groups of patients at particularly high risk of adverse drug events and complications. It also facilitates 'deprescribing' the process by which medications are reviewed and stopped if not clinically beneficial. In recent years, we have also seen the development of smartphone 'apps' to improve communication between patients and healthcare professionals, improve people's

2017 BMC Family Practice

4284. Provider type and management of common visits in primary care. (Abstract)

Provider type and management of common visits in primary care. Debate continues on whether nurse practitioners (NPs) and physician assistants (PAs) are more likely to order ancillary services, or order more costly services among alternatives, than primary care physicians (PCPs). We compared prescription medication and diagnostic service orders associated with NP/PA versus PCP visits for management of neck or back (N/B) pain or acute respiratory infection (ARI).Retrospective, observational study (...) of visits from January 2006 through March 2008 in the adult primary care practice of Kaiser Permanente in Atlanta, Georgia.Data were obtained from electronic health records. NP/PA and PCP visits for N/B pain or ARI were propensity score matched on patient age, gender, and comorbidities.On propensity score-matched N/B pain visits (n = 6724), NP/PAs were less likely than PCPs to order a computed tomography (CT)/magnetic resonance image (MRI) scan (2.1% vs 3.3%, respectively) or narcotic analgesic (26.9

2017 American Journal Of Managed Care

4285. Adherence and persistence of patients using oral bone sparing drugs in primary care. Full Text available with Trip Pro

and five years, respectively. Being adherent in the first year decreased the risk of long-term non-persistence [hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.3-0.57; P < 0.001]. Patients receiving the majority of their prescriptions by a specialist tended to be more non-persistent (HR 1.37; 96%; CI 0.96-1.94; P = 0.08). Adherence was 62.5% in the first year and 60.8% in the overall treatment period. Non-adherence was associated with the specialist being the main prescriber [odds ratio (...) (OR) 3.76; 95% CI 2.43-5.82; P < 0.001] and younger age (<65 years, OR 1.44; 95% CI 1.01-2.08; P = 0.04).Older age of the patients and the GP prescribing the majority of medication were associated with better adherence and persistence. Good adherence in the first prescription year was associated with better persistence.© The Author 2017. Published by Oxford University Press.

2017 Family Practice

4286. Healthcare Claims Data: An Underutilized Tool for Pediatric Outpatient Antimicrobial Stewardship. Full Text available with Trip Pro

odds ratio of treatment was 2.02 (95% CI, 1.96-2.07) for family physicians and 1.74 (95% CI, 1.68-1.79) for nurse practitioners. Residence in rural or high-poverty counties increased odds of treatment.Healthcare claims were useful to identify populations and providers with high antibiotic use. Claims data could be considered to track and report antibiotic prescribing frequency, especially where electronic medical records are not available.© The Author 2017. Published by Oxford University Press (...) Healthcare Claims Data: An Underutilized Tool for Pediatric Outpatient Antimicrobial Stewardship. Healthcare claims are underutilized to identify factors associated with high outpatient antibiotic use.We evaluated ambulatory encounter claims of Medicaid-insured children in 34 Ohio counties in 2014. Rates of total antibiotic and azithromycin prescriptions dispensed were determined by county of patient residence. Standardized treatment rates by county were estimated for uncomplicated upper

2017 Clinical Infectious Diseases

4287. Demographic and Clinical Profiles of Type 2 Diabetes Mellitus Patients Initiating Sitagliptin in the Real-world Setting. (Abstract)

States.Quintiles electronic medical records database was used to identify adults with a new prescription of sitagliptin over two 5 year time periods: 2006-2010 (n = 57,604), and 2011-2015 (n = 147,326). In addition, we also evaluated how the most recent (year 2015) profile of sitagliptin initiators (n = 29,295) compares to the treated T2D patients (N = 474,877) in 2015.No outcomes were assessed. Descriptive statistics were used to summarize baseline patient characteristics.The overall demographics and clinical

2017 Current medical research and opinion

4288. Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison. Full Text available with Trip Pro

Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison. Despite federal policies put in place by the Office of the National Coordinator (ONC) to promote safe and usable electronic health record (EHR) products, the usability of EHRs continues to frustrate providers and have patient safety implications. This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies (...) review and analysis revealed several consistencies within each agency's usability policies. Critical differences emerged in the usability standards and policy enforcement mechanisms utilized by the 3 agencies. The FAA and FDA look at evidence of usability processes and are more prescriptive when it comes to testing final products as compared to the ONC, which relies on attestation and is less prescriptive.A comparison of usability policies across industries illustrates key differences between the ONC

2017 Journal of the American Medical Informatics Association

4289. Learning from errors: analysis of medication order voiding in CPOE systems. Full Text available with Trip Pro

) and order type (inpatient, prescription, home medications by history). An estimated 70 ± 10% of voided orders were due to medication ordering errors. Clinician-provided reasons for voiding were reasonably predictive of the actual cause of error for duplicate orders (72%), but not for other reasons.Medication safety initiatives require availability of error data to create repositories for learning and training. The voiding function is available in several electronic health record systems, so order

2017 Journal of the American Medical Informatics Association

4290. Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab. Full Text available with Trip Pro

Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab. Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety (...) the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis

2017 Medicine

4291. Identification of drug combinations administered by continuous subcutaneous infusion that require analysis for compatibility and stability. Full Text available with Trip Pro

an electronic database over a 12-month period. In addition, a separate Delphi study with a panel of 15 expert healthcare professionals was completed to identify a maximum of five combinations of drugs used to treat more complex, but less commonly encountered symptoms unlikely to be identified by the national survey.A total of 57 individuals representing 33 separate palliative care services entered 1,945 drug combinations suitable for analysis, with 278 discrete combinations identified. The top 40 drug (...) that a prescribed combination will be both safe and efficacious.

2017 BMC Palliative Care

4292. Single Institute Experience With Methylphenidate and American Ginseng in Cancer-Related Fatigue. Full Text available with Trip Pro

(NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy.We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents.We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply (...) with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue

2017 American Journal of Hospice and Palliative Medicine

4293. Retrospective analysis of the overt proteinuria diabetic kidney disease in the treatment of modified Shenzhuo formula for 2 years. Full Text available with Trip Pro

, chief complaint, present illness, past history, allergic history, personal history, family history, test results, tongue images, pulse information, and prescription information at 1, 1.5, and 2 years of follow-up were analyzed. EpiData3.1 was used to establish the electronic database of this research and SPSS v20.0 (SPSS Inc, Chicago, IL) was used for performing statistical analyses.The patients' common main symptoms of overt proteinuria DKD were weak breath and fatigue, numbness of limbs, insomnia

2017 Medicine

4294. GAS-FOVEAL CONTACT: A New Approach to Evaluating Positioning Regimens in Macular Hole Surgery. (Abstract)

, calculated by analyzing positioning in relation to intraocular gas fill. Positioning was measured with an electronic device recording positioning for 72 hours postoperatively.Positioning data were available for 33/35 in the FDP group and 35/37 in the NSP group, thus results are based on 68 analyzed participants. Median gas-foveal contact was 99.82% (range 73.6-100.0) in the FDP group and 99.57% (range 85.3-100.0) in the NSP group (P = 0.22). In a statistical model, gas fill had a significant relation (...) to gas-foveal contact (P < 0.0001), whereas whether the surgeon prescribed FDP or NSP was not significant (P = 0.20). Of clinical relevance, gas-foveal contact seemed to influence idiopathic macular hole closure (P = 0.02).We found no significant difference in gas-foveal contact between the positioning groups. The role of positioning after idiopathic macular hole surgery seems to be better characterized from examining both patient positioning and gas fill objectively. We propose gas-foveal contact

2017 Retina Controlled trial quality: uncertain

4295. Retrieval and clinical analysis of distraction-based dual growing rod constructs for early onset scoliosis. (Abstract)

analyzed with microscopic imaging (optical and scanning electron microscopy) for areas of mechanical failure, damage, and corrosion. Failure analyses were conducted on the fracture surfaces to identify failure mechanism(s). Statistical analyses were performed to determine significant differences between the failed and intact groups.The failed rods fractured due to bending fatigue under flexion motion. Construct configuration and loading dictate high bending stresses at three distinct locations along (...) that rod fractures are due to bending fatigue, and that stress concentrations play an important role in rod fractures. Recommendations are made on surgical techniques, such as the use of torque-limiting wrenches or not exceeding the prescribed torques. Additional recommendations include frequent rod replacement in select patients during scheduled surgeries.Published by Elsevier Inc.

2017 The Spine Journal

4296. Magnetic resonance only workflow and validation of dose calculations for radiotherapy of prostate cancer. Full Text available with Trip Pro

Magnetic resonance only workflow and validation of dose calculations for radiotherapy of prostate cancer. Current state of the art radiotherapy planning of prostate cancer utilises magnetic resonance (MR) for soft tissue delineation and computed tomography (CT) to provide an electron density map for dose calculation. This dual scan workflow is prone to setup and registration error. This study evaluates the feasibility of an MR-only workflow and the validity of dose calculation from an MR (...) derived pseudo CT.Thirty prostate cancer patients were CT and MR scanned. Clinical treatment plans were generated on CT using a single 18 MV arc volumetric modulated arc therapy (VMAT) with a prescription of 78 Gy/39 fractions. Dose was recalculated on pseudo CT and assuming uniform water density. Pseudo CT and uniform density based dose calculations were compared to CT dose calculations by gamma analysis. One patient was treated with a plan based solely on MR and pseudo CT including daily image

2017 Acta Oncologica

4297. Epidemic Use of Benzodiazepines among Older Adults in Israel: Epidemiology and Leverage Points for Improvement. Full Text available with Trip Pro

national electronic medical data to assess a 10% random sample of adults receiving care in Clalit Health Services, which serves half of Israel's population. The sample included 267,221 adults, of whom 56,808 (21%) were age 65 and older.Medication use from 2013 to 2015 was ascertained using pharmacy dispensing data.In 2014, 7% of adults age 21-64 and 32% of adults age 65 and older received at least one benzodiazepine/BDZRA, including 49% of adults age 85 and older (P < 0.001). The majority of older (...) users (59%) were long-term users of the drugs, and 21% of older adults who were short-term users in 2014 transitioned to medium- or long-term use in 2015. Older Arab Israelis were much less likely to receive benzodiazepine/BDZRAs than older Jewish Israelis (adjusted OR 0.28, 95% 0.25-0.31), but within each community there was no major variation in prescribing rates across clinics. Depression diagnosis was associated with particularly high rates of benzodiazepine/BDZRA use: 17% of older adults

2017 Journal of General Internal Medicine

4298. Risk factors for developing acute kidney injury in older people with diabetes and community-acquired pneumonia: a population-based UK cohort study. Full Text available with Trip Pro

patients with diabetes and community-acquired pneumonia (CAP) in England, and whether the impact of underlying kidney function varied with age.This was a population-based retrospective cohort study over 7 years (01/04/2004-31/3/2011) using electronic health records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. The study population comprised individuals with diabetes aged ≥65 years with CAP. Associations between demographic, lifestyle factors, co-morbidities (...) and medications and development of AKI within 28 days of CAP were explored in a logistic regression model.Among 3471 patients with CAP and complete covariate data, 298 patients developed subsequent AKI. In multivariable analyses, factors found to be independently associated with AKI included: male sex (adjusted odds ratio, aOR: 1.56 95% confidence interval (CI): 1.20-2.04), hypertension (aOR1.36 95% CI 1.01-1.85), being prescribed either angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor

2017 BMC Nephrology

4299. Effect of psychiatric illness on acute care utilization at end of life from serious medical illness. Full Text available with Trip Pro

Effect of psychiatric illness on acute care utilization at end of life from serious medical illness. Little is known about psychiatric illness and utilization of end-of-life care.We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation.We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions (...) based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation.Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk

2017 Journal of pain and symptom management

4300. How does autism spectrum disorder affect the risk and severity of childhood asthma? (Abstract)

-control and retrospective longitudinal cohort) using a multistate electronic health records database to assess the odds of new asthma and asthma severity among children with ASD. In both designs, children with ASD were matched with children without ASD according to sex, age, race, ethnicity, location, and insurance status. Pulmonary function, controller medication prescriptions, asthma exacerbations, and asthma-related hospitalizations were collected. The effects of ASD on asthma risk and severity (...) were assessed using multivariable linear and logistic regression.Among children with asthma, ASD was associated with reduced exacerbations (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.54-0.92), better forced expiratory volume in 1 second/forced vital capacity ratio (0.876 vs 0.841, P < .001), and lower odds of airflow obstruction (OR, 0.53; 95% CI, 0.31-0.90) but had higher odds of asthma controller prescription (OR, 2.18; 95% CI, 1.62-2.93). In a longitudinal analysis of children

2017 Asthma & Immunology

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