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4321. 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

4322. 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

4323. 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

4324. 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

4325. 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

4326. 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

4327. 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

4328. 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

4329. 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

4330. 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

4331. Time to achieving therapeutic international normalized ratio increases hospital length of stay after heart valve replacement surgery. (Abstract)

underwent MCVR over a consecutive 42-month period were included. Clinical data were obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery database and electronic medical records. Therapeutic INR was defined as per standard guidelines. Warfarin dose was prescribed using an inpatient pharmacy-managed algorithm and computer-based dosing tool. International normalized ratio trajectory, procedural needs, and drug interactions were included in warfarin dose determination.There were 708 patients

2017 American Heart Journal

4332. Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network. Full Text available with Trip Pro

antibiotic exposure in children.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. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time (...) . Fourteen-day return visits for UTIs were monitored as a balancing measure.During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter.Implementation of a standard protocol for urine culture follow

2017 Pediatrics

4333. Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation. Full Text available with Trip Pro

Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation. 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. We adopted a sociotechnical approach that focuses on how complex social, organisational and institutional factors may impact upon the use of technology within work settings.We undertook a qualitative realist evaluation of the use of an electronic medicines optimisation system in one Clinical Commissioning Group in England. Five semi-structured

2017 BMC health services research

4334. Minor Injury Crashes: Prevalence of Driver-Related Risk Factors and Outcome. (Abstract)

interviews were conducted 6 months after the crash.We approached 123 injured drivers; baseline interviews were completed in 69 and follow-up interviews in 45. Prior to the index crash, 1.4% of drivers drank alcohol, 1.4% used illicit drugs, and 7.2% used sedating prescription medications. Nine drivers (13%) were distracted. In this sample, 5.8% met criteria for being aggressive drivers, 7.2% were risky drivers, and 11.6% drove while experiencing negative emotions. At 6-month follow-up, many drivers were (...) still having health problems, 53.3% were not fully recovered, 46.7% had not returned to usual activities, and 28.9% were off work. Of the 42 participants who resumed driving, 16.7% had a near miss and 4.8% had another crash. Nine (21.4%) reported drinking and driving, and 9.5% reported driving after cannabis use. Cell phone use (16.7%) and use of other electronics while driving (23.8%) were also common.Driver-related risk factors are common in drivers involved in minor injury crashes, and drivers

2017 Journal of Emergency Medicine

4335. Clarithromycin

offspring neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes (...) prescribing guidelines. If a macrolide is indicated, erythromycin is the preferred choice during pregnancy because there is more documented experience of its use than for other macrolides. Exposure to a macrolide antibiotic at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians

2014 UK Teratology Information Service

4336. Azithromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4337. Cyanoacrylates

such as the manufacture of plastics, electronics and scientific instruments. Exposure may therefore occur in both domestic and occupational settings including factories and during manicuring, dentistry and surgery. No published reports have been found on the possible adverse effects of cyanoacrylate on human reproductive function or following exposure in human pregnancy or lactation. An evidence-based assessment of the risk to the fetus following either acute or chronic exposure during pregnancy is thus not possible (...) reporting form. Please encourage all women to complete an . Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced

2014 UK Teratology Information Service

4338. Macrolides

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4339. Ionising Radiation

kinetic energy or sufficient charge to displace atomic electrons resulting in molecular ionisation. Key factors which influence the degree of ionising radiation exposure and the subsequent biological effects include the duration of exposure, the distance from the source, the degree of shielding and the type of radiation emitted. Adverse fetal effects following ionising radiation exposure during gestational development can include dose-related deterministic effects which arise as a result of damage (...) of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs

2014 UK Teratology Information Service

4340. Erythromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

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