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4381. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride Full Text available with Trip Pro

Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride 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 (...) source was the electronic medical record data repository for Northwestern Medicine.The analysis cohorts comprised all men exposed to finasteride or dutasteride or combination products containing one of these drugs, and the subgroup of men 16-42 years old and exposed to finasteride ≤1.25 mg/day.Our main outcome measure was diagnosis of PED beginning after first 5α-RI exposure, continuing for at least 90 days after stopping 5α-RI, and with contemporaneous treatment with a phosphodiesterase-5 inhibitor

2017 PeerJ

4382. Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network Full Text available with Trip Pro

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals.An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better (...) of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K.Respondents from a national

2017 Academic pediatrics

4383. Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones Full Text available with Trip Pro

of fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention.Data were retrospectively collected by reviewing electronic medical records. All hospitalized patients aged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians' adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones, length of hospital stay, and medication costs.During 4 (...) months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescription volume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantly decreased in the intervention-adherent group.Intervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenous fluoroquinolones and length of hospital stay. With these findings, further implementations

2017 Infection & chemotherapy

4384. Medication Use among Veterans across Health Care Systems Full Text available with Trip Pro

target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing.Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate (...) Medication Use among Veterans across Health Care Systems Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient

2017 Applied clinical informatics

4385. Antihyperglycemic treatment in patients with type 2 diabetes in Italy: the impact of age and kidney function Full Text available with Trip Pro

Antihyperglycemic treatment in patients with type 2 diabetes in Italy: the impact of age and kidney function We describe AHA utilization pattern according to age and renal function in type 2 diabetes mellitus (T2DM), in real-life conditions. The analysis was performed using the data set of electronic medical records collected between 1 January and 31 December, 2011 in 207 Italian diabetes centers. The study population consisted of 157,595 individuals with T2DM. The AHA treatment regimens (...) , the proportion of patients on secretagogues or insulin increased with aging (i.e. 54.7% and 37% in the fourth age quartile, respectively). The percentage of patients with low eGFR (i.e. <30 ml/min/1.73m2) taking either metformin or sulphonilureas/repaglinide was particularly high (i.e. 15.3% and 34.3% respectively). In a large real-life cohort of T2DM, metformin or sulphonylureas/repaglinide, although not recommended, are frequently prescribed to elderly subjects with severe kidney disease.

2017 Oncotarget

4386. Variations in the practice of molecular radiotherapy and implementation of dosimetry: results from a European survey Full Text available with Trip Pro

microspheres of glass (84%) and resin (82%), 131I-mIBG for neuroblastoma (59%), and 131I-NaI for benign thyroid diseases (54%). The majority of therapies were prescribed based on fixed-activity protocols. The highest number of absorbed-dose based prescriptions were reported for 90Y microsphere treatments in the liver (64% and 96% of responses for resin and glass, respectively), 131I-NaI treatment of benign thyroid diseases (38% of responses), and for 131I-mIBG treatment of neuroblastoma (18% of responses (...) countries.An electronic questionnaire was distributed to European countries. This addressed 18 explicitly considered therapies, and for each therapy, a similar set of questions were included. Questions covered the number of patients and treatments during 2015, involvement of medical specialties and medical physicists, implementation of absorbed dose planning, post-therapy imaging and dosimetry, and the basis of therapy prescription.Responses were obtained from 26 countries and 208 hospitals, administering

2017 EJNMMI physics

4387. Why Antibiotic Use Data in Animals Needs to Be Collected and How This Can Be Facilitated Full Text available with Trip Pro

antibiotics are among the solutions that could help to overcome the current challenges. I here also argue that having mandatory electronic veterinary prescriptions and awareness campaings, funded via public-private partnerships, should also be considered as methods that could help for the control of societal problems like AMR. (...) of antibiotics, and the inexistence of user-friendly technologies for the collection of such data, despite the generalized use of Internet and electronic devices. Further development and adoption of the units proposed by the European Surveillance of Veterinary Antimicrobial Consumption will contribute to the long-desired harmonization. Rewarding the animal producers (via tax incentives, for example) that use less antibiotics and the development of an app, to which producers could orally report the used

2017 Frontiers in veterinary science

4388. Characteristics of the use of cold combination products among older ambulatory patients at the National Hospital Organization Tochigi Medical Center in Japan: a retrospective single-center observational study Full Text available with Trip Pro

Characteristics of the use of cold combination products among older ambulatory patients at the National Hospital Organization Tochigi Medical Center in Japan: a retrospective single-center observational study This study aimed to determine the frequency and characteristics of prescriptions of cold combination products among older ambulatory patients. A retrospective observational study was conducted using electronic medical records. All patients aged 65 years or older who continued visiting (...) internal medicine physicians for at least 1 year were included. The primary outcome was the prescription of cold combination products by any physicians in National Hospital Organization Tochigi Medical Center during a 1-year follow-up.Seven hundred fifty-six patients were included. The mean age was 75.4 years, 392 (51.9%) were men, the mean Charlson Comorbidity Index was 1.8, and the mean number of medications was 4.9. The proportion of patients who were prescribed cold combination products during

2017 BMC research notes

4389. A case report of proliferative glomerulonephritis with monoclonal immunoglobulin M-kappa deposits without associated lymphoproliferative disorder or detectable paraproteinemia Full Text available with Trip Pro

. Immunofluorescence revealed deposition of immunoglobulin (Ig) M heavy chain, kappa (κ) light chain, and complement component C3 along capillary walls in the glomeruli. Light chain staining indicated significant restriction, because only κ chain, not lambda chain, was present in glomeruli. Aggregated electron dense deposits were observed in the subepithelial area and within the lamina densa on electron-microscopic examination. Cryoglobulinemia and amyloidosis were ruled out. Clinically, steroid therapy (...) was not initiated due to patient preference, and the only prescribed medication was an angiotensin II receptor blocker. At the approximately 3-year follow-up, estimated glomerular filtration rate had decreased very mildly. The present case demonstrates that deposition of monoclonal IgM-κ may be associated with membranoproliferative glomerulonephritis-like changes in the glomeruli. Although no underlying hematological abnormality or paraproteinemia was observed in this case within the range of limited clinical

2017 CEN Case Reports

4390. A Case of Crescentic Glomerulonephritis Complicated with Hypocomplementemic Urticarial Vasculitis Syndrome and ANCA-Associated Vasculitis Full Text available with Trip Pro

A Case of Crescentic Glomerulonephritis Complicated with Hypocomplementemic Urticarial Vasculitis Syndrome and ANCA-Associated Vasculitis Systemic urticaria in a 64-year-old woman was diagnosed as leukocytoclastic vasculitis by a punch biopsy of the skin. Her physical findings improved after prescription of prednisolone at a dose of 20 mg/day, but the skin rash relapsed with renal dysfunction, proteinuria, and hematuria when the dose of prednisolone was reduced over a period of 9 months to 1 mg (...) erythematosus. Cellular crescentic glomerulonephritis was observed by light microscopy, and immunofluorescent studies showed positive staining for IgG, IgM, C3, C4, and C1q. Electron microscopy showed mesangial and subendothelial deposits with circumferential mesangial interposition. She fulfilled the diagnostic criteria for hypocomplementemic urticarial vasculitis syndrome (HUV), and ANCA-associated vasculitis (AAV) was also indicated by small vessel vasculitis and positive MPO-ANCA. Steroid pulse therapy

2017 Case Reports in Nephrology and Dialysis

4391. Mycobacteremia from Crushed Hydromorphone Tablet Injection Full Text available with Trip Pro

of her electronic medical chart revealed multiple hospitalizations with drug seeking behavior. This is the first reported case of crushed oral opioid injection resulting in mycobacteremia. Injecting crushed opioids has become more prevalent. Many opioid abusers resort to injecting them in order to achieve the psychotropic effects quicker. A heightened awareness about nontraditional modes of prescription drug abuse and surveillance by prescribers is necessary. This case raises an ethical question (...) deep vein thrombosis presented to the hospital with proximal right leg deep vein thrombosis. On day nine of admission, the patient spiked a fever. Blood cultures revealed Mycobacterium abscessus bacteremia. The patient was observed to be crushing oral hydromorphone and injecting it into her ash catheter using needles retrieved from the sharps disposal container in her room. Although the Michigan Automated Prescription System (MAPS) report for narcotic abuse was unremarkable, a thorough review

2017 Cureus

4392. Estimating the effects of second-line therapy for type 2 diabetes mellitus: retrospective cohort study Full Text available with Trip Pro

of electronic health records of US-based patients in the Explorys database using causal inference methodology to adjust for patient censoring and confounders.Our cohort consisted of more than 40 000 patients with type 2 diabetes, prescribed metformin along with a drug out of four second-line drug classes-sulfonylureas, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide-1 agonists-during the years 2000-2015. Roughly, 17 000 of these patients were followed for 12 months (...) Estimating the effects of second-line therapy for type 2 diabetes mellitus: retrospective cohort study Metformin is the recommended initial drug treatment in type 2 diabetes mellitus, but there is no clearly preferred choice for an additional drug when indicated. We compare the counterfactual drug effectiveness in lowering glycated hemoglobin (HbA1c) levels and effect on body mass index (BMI) of four diabetes second-line drug classes using electronic health records.Retrospective analysis

2017 BMJ open diabetes research & care

4393. Medication use and falls: Applying Beers criteria to medication review in Parkinson’s disease Full Text available with Trip Pro

, or physician's visits were included in the study. Electronic medical records were utilized to perform chart reviews, and medications were analyzed to identify prescription medications, combination preparations, over-the-counter medications, and dietary supplements. The goal of this study was to test the following hypothesis: elderly individuals with Parkinson's disease who take multiple potentially inappropriate medications are more likely to experience a fall compared to elderly individuals with Parkinson's (...) disease who do not take multiple potentially inappropriate medications.A higher mean number of prescription medications were associated with falls in elderly Parkinson's disease patients (6.53 vs 5.21, p < 0.01). Polypharmacy (taking five or more prescription and nonprescription medications) was not significantly associated with falls. Patients taking potentially inappropriate medications specifically contraindicated for those with a history of falls and fractures were more likely to report falls (p

2017 SAGE open medicine

4394. A PLGA-reinforced PEG in situ gel formulation for improved sustainability of hypoglycaemic activity of glimepiride in streptozotocin-induced diabetic rats Full Text available with Trip Pro

A PLGA-reinforced PEG in situ gel formulation for improved sustainability of hypoglycaemic activity of glimepiride in streptozotocin-induced diabetic rats Glimepiride (GMD) is a third-generation sulfonylurea derivative and one of the top three most-prescribed oral antidiabetic drugs. The need for a depot formulation exists, and a safe and effective antidiabetic therapy is the goal of this study. The aims were to design a depot in situ gel (ISG) formulation and investigate the main factors (...) that control the initial burst and sustain the GMD effect using the Box-Behnken design. The studied factors were polymer percent (X1), plasticizer percent (X2) and benzyl benzoate percent in N-methyl-2-pyrrolidone (X3). The results revealed that X2 is the only factor that showed significant effects on all investigated responses. Scanning electron microscopy images showed that an increase in PEG % improved the smoothness and reduced the porosity of the ISG formulation surface. The GMD plasma levels

2017 Scientific reports

4395. Perspectives on Root Causes of High Utilization that Extend Beyond the Patient Full Text available with Trip Pro

University of Utah Health Care , Salt Lake City, Utah. Olgren Michael M 1 Trinity Health-Michigan d/b/a Mercy Health Saint Mary's , Grand Rapids, Michigan. eng Journal Article 2016 09 13 United States Popul Health Manag 101481266 1942-7891 0 Narcotics 12794-10-4 Benzodiazepines IM Benzodiazepines administration & dosage therapeutic use Delivery of Health Care economics statistics & numerical data Electronic Health Records Emergency Service, Hospital economics statistics & numerical data Humans (...) Inappropriate Prescribing Narcotics administration & dosage therapeutic use Patient Care economics statistics & numerical data 2016 9 14 6 0 2018 8 16 6 0 2016 9 14 6 0 ppublish 27623540 10.1089/pop.2016.0088 PMC5709694 J Am Board Fam Med. 2015 Sep-Oct;28 Suppl 1:S63-72 26359473

2017 Population health management

4396. The effects of using the PReDicT Test to guide the antidepressant treatment of depressed patients: study protocol for a randomised controlled trial Full Text available with Trip Pro

The effects of using the PReDicT Test to guide the antidepressant treatment of depressed patients: study protocol for a randomised controlled trial Antidepressant medication is commonly used to treat depression. However, many patients do not respond to the first medication prescribed and improvements in symptoms are generally only detectable by clinicians 4-6 weeks after the medication has been initiated. As a result, there is often a long delay between the decision to initiate (...) an antidepressant medication and the identification of an effective treatment regimen. Previous work has demonstrated that antidepressant medications alter subtle measures of affective cognition in depressed patients, such as the appraisal of facial expression. Furthermore, these cognitive effects of antidepressants are apparent early in the course of treatment and can also predict later clinical response. This trial will assess whether an electronic test of affective cognition and symptoms (the Predicting

2017 Trials Controlled trial quality: uncertain

4397. Effects of an antimicrobial restriction system on appropriate carbapenem use in a hospital without infectious diseases consultation Full Text available with Trip Pro

study was conducted in Lamphun Hospital to limit the prescription of carbapenems. Data were obtained by a review of the medical records and electronic databases from the period September 2014 to January 2015 (before) and from September 2015 to January 2016 (after).A total of 360 antibacterial prescriptions were analyzed. The appropriateness of prescribing was higher after using the antimicrobial restriction (55.0%) than before using the antimicrobial restriction system (38.3%; p=0.001). The amount (...) Effects of an antimicrobial restriction system on appropriate carbapenem use in a hospital without infectious diseases consultation Gram-negative bacteria are becoming increasingly resistant to carbapenems and are related to the use of carbapenems. Thus, the main objective of this study was to compare the appropriateness of prescribing carbapenem before and after using an antimicrobial restriction system without infectious diseases consultation.A retrospective cross-sectional before and after

2017 International journal of general medicine

4398. Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice Full Text available with Trip Pro

Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the prevalence of comorbid disorders and prescribed medication (...) for obstructive airway disease, in patients with mild to moderate COPD. Data were used from electronic health records of 380 Dutch general practices in 2014. In total, we identified 4938 patients with mild or moderate COPD based on spirometry data, and a recorded body mass index (BMI) of ≥21 kg/m2. Outcomes in overweight (BMI ≥ 25 and <30 kg/m2) and obese (BMI ≥30 kg/m2) patients with COPD were compared to those with a normal weight (BMI ≥ 21 and <25 kg/m2), by logistic multilevel analyses. Compared to COPD

2017 NPJ primary care respiratory medicine

4399. Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies Full Text available with Trip Pro

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective (...) DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so.To describe and synthesize the methodologies used

2017 American health & drug benefits

4400. Impact on process results of clinical decision support systems (CDSSs) applied to medication use: overview of systematic reviews Full Text available with Trip Pro

through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 - 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 (...) - 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used.CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.

2017 Pharmacy Practice

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