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4401. Treatment Patterns and Outcomes in Elderly Patients with Metastatic Breast Cancer: A Multicenter Retrospective Study Full Text available with Trip Pro

with MBC between 2003 and 2015, were identified from the databases of three academic hospitals in South Korea. A total of 161 cases were eligible for inclusion. We assessed clinicopathologic features, treatment patterns, and outcomes, using the available electronic medical records. Based on age at MBC diagnosis, patients were divided into three groups: 65 to 69, 70 to 74, and ≥75 years.Most patients had received active treatment according to biologic subtype as in younger patients, although frequent (...) likely to have a poor ECOG PS and advanced comorbidity, and tended to receive less intensive treatments compared to the other age groups.Elderly patients with MBC should not be excluded from receiving standard treatments prescribed for younger patients. Future research plans for elderly patients, especially aged ≥75 years with breast cancer, should include a geriatric assessment for identifying individuals at risk for treatment-related toxicity. Overall, this analysis will provide a better

2017 Journal of breast cancer

4402. Development and use of a clinical decision support tool for behavioral health screening in primary care clinics Full Text available with Trip Pro

Development and use of a clinical decision support tool for behavioral health screening in primary care clinics Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools (...) screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including

2017 Applied clinical informatics

4403. Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients Full Text available with Trip Pro

Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential negative outcomes associated with their use.The electronic health record of 250 medicine patients hospitalized (...) and diastolic blood pressure (DBP) <110 mmHg (cut-point for acute severe hypertension). No serious adverse events were related to PRN antihypertensive administration. Despite receiving at least one PRN antihypertensive medication during hospitalization, 40.8% of patients were not continued on their home antihypertensive medication(s) while hospitalized, and 62.4% of patients did not have their home regimens intensified at discharge.As-needed oral hydralazine is frequently prescribed for acute blood pressure

2017 Therapeutic advances in cardiovascular disease

4404. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial Full Text available with Trip Pro

a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral prescription by the physician to drug delivery by the nurse in each allocation group. TDD includes TDP. Stress level during the resuscitation scenario will be assessed for each participant by questionnaire and recorded by the heart rate monitor of a fitness watch. The study is formatted according to the Consolidated (...) Standards of Reporting Trials Statement for Randomized Controlled Trials of Electronic and Mobile Health Applications and Online TeleHealth (CONSORT-EHEALTH) and the Reporting Guidelines for Health Care Simulation Research.Enrollment and data analysis started in March 2017. We anticipate the intervention will be completed in late 2017, and study results will be submitted in early 2018 for publication expected in mid-2018. Results will be reported in line with recommendations from CONSORT-EHEALTH

2017 JMIR Research Protocols Controlled trial quality: predicted high

4405. Obesity and healthcare resource utilization: comparative results from the UK and the USA Full Text available with Trip Pro

Obesity and healthcare resource utilization: comparative results from the UK and the USA To estimate the differences between individuals with and without obesity on healthcare resource utilization using two large electronic medical record databases.Data from the UK Clinical Practice Research Datalink and US General Electric Centricity database of adults (≥18 years) with registration date before 01/01/2010. Differences between individuals with and without obesity on 5-year rates of Primary Care (...) Physician (PCP) contacts, prescriptions and hospitalizations were analysed.The study contained 1,878,017 UK and 4,414,883 US individuals. Compared with body mass index (BMI) (18.5-24.9 kg m-2), significant (p < 0.0001) increases in healthcare usage were observed with increasing BMI. Individuals with BMI 30-34.9 kg m-2 had higher PCP contact rate (rate ratios [RR] 1.27 and 1.28 for UK and USA, respectively), higher prescription rate (RR 1.61 and 1.51) and higher hospitalization rate (RR 1.10 and 1.13

2017 Obesity science & practice

4406. Characterization of a novel scale maille contralateral breast shield: SMART Armor Full Text available with Trip Pro

Characterization of a novel scale maille contralateral breast shield: SMART Armor During breast radiotherapy treatment, the contralateral breast receives radiation doses to the skin and subcutaneous tissue caused mainly from incident electron contamination and low energy photon scatter radiation. Measurements have shown that for a typical hybrid tangential treatment, these dose levels can be up to 17% of maximum applied prescription dose if no shielding is used during the treatment process

2017 Journal of Applied Clinical Medical Physics

4407. Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data Full Text available with Trip Pro

Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup (...) of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender

2017 Substance abuse and rehabilitation

4408. Challenges facing the veterinary profession in Ireland: 2. On-farm use of veterinary antimicrobials Full Text available with Trip Pro

management'.Five main recommendations arose from this study based on the perspectives of the study participants including: a) the potential for regulatory change to facilitate an increase in the number of yearly visits of veterinarians to farms and to implement electronic prescribing and shorter validity of prescriptions; b) a 'One Health' education plan; c) improved professional guidance on responsible use of veterinary antimicrobials; d) improved on-farm herd health management practices; and e

2017 Irish veterinary journal

4409. Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer Full Text available with Trip Pro

Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments.Using electronic primary (...) care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined

2017 Annals of family medicine

4410. Examining patterns in medication documentation of trade and generic names in an academic family practice training centre Full Text available with Trip Pro

of pharmaceutical products in clinical documentation in a large, urban academic family practice centre.A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed.Among 9763 (...) Examining patterns in medication documentation of trade and generic names in an academic family practice training centre Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number

2017 BMC medical education

4411. Patients with psychological ICPC codes in primary care; a case-control study investigating the decade before presenting with problems Full Text available with Trip Pro

Patients with psychological ICPC codes in primary care; a case-control study investigating the decade before presenting with problems Recognizing patients with psychological problems can be difficult for general practitioners (GPs). Use of information collected in electronic medical records (EMR) could facilitate recognition.To assess relevant EMR parameters in the decade before patients present with psychological problems.Exploratory case-control study assessing EMR parameters of 58 228 (...) ratio (OR): 3.3); fatigue/sleeping (OR: 1.6), neurological (OR: 1.5), rheumatic (OR: 1.5) and substance abuse problems (OR: 1.5); prescriptions of opioids (OR: 1.3), antimigraine preparations (OR: 1.5), antipsychotics (OR: 1.7), anxiolytics (OR: 1.4), hypnotics and sedatives (OR: 1.4), antidepressants (OR: 1.7), and antidementia drugs (OR: 2.1); treatment with minimal interventions (OR: 2.2) and physical exercise (OR: 3.3), referrals to psychology (OR: 1.5), psychiatry (OR: 1.6), and psychosocial

2017 The European journal of general practice

4412. Family Practice Notebook Updates 2018

cleansers and oral supplements No evidence of benefit in consumer products and risks of prescribed medication malabsorption, s, (neuro, ) cost grows to $6900 for s with similar efficacy to their cheaper counterparts (e.g. TCA, , topomax) (id, pharm) Biosimilar agents are similar but not identical to their reference biologic agents (e.g. Nivestym is biosimilar to Neupogen) III. Updates: November 2018 (cv, htn, peds) diagnostic criteria in children have changed as of 2017 AAP guidelines is underdiagnosed (...) as prescription items Obrexza is an expensive ($550/month) second-line adjunct for axillary sweating refractory to other topicals IV. Updates: October 2018 (prevent, hme, peds) Screen for at visits for infants <6 months of age Perform at 9, 18 and 30 months (minimum) and screening at 18 and 24 months screening at least once at age 3-5 years (hemeonc, ) Mechanisms include immune ( ), microangiopathic ( ), oxidative (e.g. ) Initial testing includes a CBC, , , Total and , Basic metabolic panel, , may be useful

2019 FP Notebook

4413. Evaluation of a pain assessment procedure in long-term care residents with pain and dementia. Full Text available with Trip Pro

of the electronic patient file and pharmacy files and physical examination of LTC residents with pain and dementia.Communication of the assessment results to the attending physician including guideline-based treatment recommendations.After three months, complete follow-up data were obtained for 64 residents. Pain intensity was significantly reduced (P < 0.001). The proportion of residents with persistent pain was 58% and the total number of analgesic prescriptions did not change significantly.There is room

2017 Journal of pain and symptom management

4414. Association between race and receipt of counselling or medication for smoking cessation in primary care. Full Text available with Trip Pro

Association between race and receipt of counselling or medication for smoking cessation in primary care. Previous evidence of race disparities in smoking cessation treatment has been limited to mostly survey studies which increase the potential for recall bias. We examined if African American versus white patients in primary care are less likely to receive any treatment or if race disparities are specific to the type of treatment offered using data pulled from a large electronic health record (...) , and a prescription for smoking cessation medication was offered to 12.3% of African American and 16.4% of white patients. After adjusting for covariates in logistic regression models, whites were significantly less likely than African American patients to receive smoking cessation counselling [odds ratio (OR) = 0.81; 95% confidence interval (CI) = 0.65-0.99] and were significantly more likely to receive a prescription for a smoking cessation medication (OR = 1.23; 95% CI = 1.03-1.47).Less than 20% of smokers

2017 Family Practice

4415. Long-term Trends in Antidiabetes Drug Usage in the U.S.: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes. Full Text available with Trip Pro

Long-term Trends in Antidiabetes Drug Usage in the U.S.: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes. To explore temporal trends in antidiabetes drug (ADD) prescribing and intensification patterns, along with glycemic levels and comorbidities, and possible benefits of novel ADDs in delaying the need for insulin initiation in patients diagnosed with type 2 diabetes.Patients with type 2 diabetes aged 18-80 years, who initiated any ADD, were selected (n = 1,023,340) from (...) the U.S. Centricity Electronic Medical Records. Those who initiated second-line ADD after first-line metformin were identified (subcohort 1, n = 357,482); the third-line therapy choices were further explored.From 2005 to 2016, first-line use increased for metformin (60-77%) and decreased for sulfonylureas (20-8%). During a mean follow-up of 3.4 years post metformin, 48% initiated a second ADD at a mean HbA1c of 8.4%. In subcohort 1, although sulfonylurea usage as second-line treatment decreased (60-46

2017 Diabetes Care

4416. Proton pump inhibitors are associated with accelerated development of cirrhosis, hepatic decompensation and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection: results from ERCHIVES. Full Text available with Trip Pro

Proton pump inhibitors are associated with accelerated development of cirrhosis, hepatic decompensation and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection: results from ERCHIVES. Proton pump inhibitors are among the most commonly prescribed medications in the United States. Their safety in cirrhosis has recently been questioned, but their overall effect on disease progression in noncirrhotic patients with chronic liver disease remains unclear.To determine (...) the impact of proton pump inhibitors on the progression of liver disease in noncirrhotic patients with hepatitis C virus (HCV) infection.Using the electronically retrieved cohort of HCV-infected veterans (ERCHIVES) database, we identified all subjects who received HCV treatment and all incident cases of cirrhosis, hepatic decompensation and hepatocellular carcinoma. Proton pump inhibitor use was measured using cumulative defined daily dose. Multivariate Cox regression analysis was performed after

2017 Alimentary Pharmacology & Therapeutics

4417. Series: Pragmatic trials and real world evidence :Paper 8 Data collection and management Data collection in Pragmatic Trials. Full Text available with Trip Pro

the operational and methodological challenges of data collection in pragmatic trials. A more pragmatic data collection needs to balance the delivery of highly accurate and complete data with minimizing the level of interference that data entry and verification induce with clinical practice. Furthermore, it should allow for the involvement of a representative sample of practices, physicians, and patients who prescribe/receive treatment in routine care. This paper discusses challenges that are related (...) identified as main challenges for the usage of routinely collected data in pragmatic trials. A first step should be to determine to what extent existing health care databases provide the necessary study data and can accommodate data collection and management. When more elaborate or detailed data collection or more structured follow-up is required, data collection in a pragmatic trial will have to be tailor-made, often using a hybrid approach using a dedicated electronic case report form (eCRF

2017 Journal of Clinical Epidemiology

4418. Economic burden of pneumococcal infections in children under 5 years of age Full Text available with Trip Pro

Economic burden of pneumococcal infections in children under 5 years of age The present study aimed to determine the cost of childhood pneumococcal infections under 5 years of age and to provide further data for future health economy studies. Electronic medical records of children diagnosed with meningitis caused by S. pneumoniae and all-cause pneumonia, and acute otitis media (AOM) between January 2013-April 2014 were retrospectively evaluated. Direct costs for the treatments of hospitalized (...) patients (pneumonia and pneumococcal meningitis) including costs of healthcare services consisted of costs of hospital bed, examination, laboratory analyses, scanning methods, consultation, vascular access procedures, and infusion and intravenous treatments. Direct costs for patients (AOM) treated in outpatient setting included constant price paid for the examination and cost of prescribed antibiotics. Indirect costs included cost of work loss of parents and their transportation expenses. Data of 130

2017 Human vaccines & immunotherapeutics

4419. Vaccinations in immunosuppressive-dependent pediatric inflammatory bowel disease Full Text available with Trip Pro

Vaccinations in immunosuppressive-dependent pediatric inflammatory bowel disease To determine the vaccination rates in pediatric immunosuppression-dependent inflammatory bowel disease (IBD) and review the safety and efficacy of vaccinations in this population.The electronic medical records from October 2009 to December 2015 of patients diagnosed with IBD at 10 years of age or younger and prescribed anti-tumor necrosis factor alpha (anti-TNF-α) therapy were reviewed for clinical history

2017 World Journal of Gastroenterology

4420. Providers Against Cavities in Children's Teeth

) prescription to visit the dentist and a list of dentists accepting Medicaid; 2. Integration of oral health assessments into EMR for the provider to document in the child's medical record; versus B) Control arm of medical providers receiving the American Academy of Pediatrics (AAP) based oral health education and providing usual AAP-based care for oral health. Each arm will consist of 9 practices. Children will be followed for 24 months to determine dental utilization and changes in oral health status (...) Intervention/treatment Experimental: CSM theory-based Arm CSM theory-based didactic education and skills training Practice EMR changes Behavioral: CSM theory-based didactic education and skills training Common-Sense Model of Self-Regulation (CSM) theory-based education and skills training for the provider to teach him/her to communicate core oral health facts to parents, provide a prescription to take their child to the dentist together with a list of Medicaid-accepting dentists in the area, and document

2017 Clinical Trials

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