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991.
Leung AA Keohane C Amato M Simon SR Coffey M Kaufman N Cadet B Schiff G Zimlichman E Seger DL Yoon C Song P Bates DW 《Journal of general internal medicine》2012,27(7):801-807
BACKGROUND
It is uncertain if computerized physician order entry (CPOE) systems are effective at reducing adverse drug event (ADE) rates in community hospitals, where mainly vendor-developed applications are used.OBJECTIVE
To evaluate the impact of vendor CPOE systems on the frequency of ADEs.DESIGN AND PATIENTS
Prospective before-and-after study conducted from January 2005 to September 2010 at five Massachusetts community hospitals. Participants were adults admitted during the study period. A total of 2,000 charts were reviewed for orders, medication lists, laboratory reports, admission histories, notes, discharge summaries, and flow sheets.MAIN MEASURES
The primary outcome measure was the rate of preventable ADEs. Rates of potential ADEs and overall ADEs were secondary outcomes.KEY RESULTS
The rate of preventable ADEs decreased following implementation (10.6/100 vs. 7.0/100 admissions; p?=?0.007) with a similar effect observed at each site. However, the associated decrease in preventable ADEs was balanced against an increase in potential ADEs (44.4/100 vs. 57.5/100 admissions; p?0.001). We observed a reduction of 34.0% for preventable ADEs, but an increase of 29.5% in potential ADEs following implementation. The overall rate of ADEs increased (14.6/100 vs. 18.7/100 admissions; p?=?0.03), which was driven by non-preventable events (4.0/100 vs. 11.7/100 admissions; p?0.001).CONCLUSIONS
Adoption of vendor CPOE systems was associated with a decrease in the preventable ADE rate by a third, although the rates of potential ADEs and overall ADEs increased. Our findings support the use of vendor CPOE systems as a means to reduce drug-related injury and harm. The potential ADE rate could be reduced by making refinements to the vendor applications and their associated decision support. 相似文献992.
Kong MC Nahata MC Lacombe VA Seiber EE Balkrishnan R 《Journal of general internal medicine》2012,27(9):1159-1164
Background
Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist.Objective
To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients.Design
Retrospective cohort study.Setting
Multi-state Medicaid database (Thomson Reuters MarketScan®).Participants
Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed.Main Measures
Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables.Key Results
In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63–0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12–3.29).Conclusions
Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.KEY WORDS: HIV, adherence, depression, race, Medicaid 相似文献993.
Madaras-Kelly KJ Remington RE Sloan KL Fan VS 《Journal of general internal medicine》2012,27(7):845-852
Background
Guidelines recommend administration of antibiotics with activity against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa for treatment of healthcare-associated pneumonia (HCAP). It is unclear if this therapy improves outcomes for patients with HCAP.Objective
To determine if administration of guideline-similar therapy (GST) was associated with a reduction in 30-day mortality for HCAP.Design
Multi-center retrospective study.Participants
Thirteen hundred and eleven admissions for HCAP in six Veterans Affairs Medical Centers.Interventions
Each admission was classified as receiving GST, anti-MRSA or anti-pseudomonal components of GST, or other non-HCAP therapy initiated within 48 hours of hospitalization. Association between 30-day mortality and GST was estimated with a logistic regression model that included GST, propensity to receive GST, probability of recovering an organism from culture resistant to antibiotics traditionally used to treat community-acquired pneumonia (CAP-resistance), and a GST by CAP-resistance probability interaction.Main Measures
Odds ratios and 95% confidence intervals [OR (95% CI)] of 30-day mortality for patients treated with GST and predicted probability of recovering a CAP-resistant organism, and ratio of odds ratios [ROR (95% CI)] for treatment by CAP-resistance probability interaction.Key Results
Receipt of GST was associated with increased odds of 30-day mortality [OR?=?2.11 (1.11, 4.04), P?=?0.02)] as was the predicted probability of recovering a CAP-resistant organism [OR?=?1.67 (1.26, 2.20), P?0.001 for a 25% increase in probability]. An interaction between predicted probability of recovering a CAP-resistant organism and receipt of GST demonstrated lower mortality with GST at high probability of CAP resistance [ROR?=?0.71(??1.00) for a 25% increase in probability, P?=?0.05].Conclusions
For HCAP patients with high probability of CAP-resistant organisms, GST was associated with lower mortality. Consideration of the magnitude of patient-specific risk for CAP-resistant organisms should be considered when selecting HCAP therapy. 相似文献994.
Schwarz EB Postlethwaite D Hung YY Lantzman E Armstrong MA Horberg MA 《Journal of general internal medicine》2012,27(2):196-201
BACKGROUND
Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes. 相似文献995.
Rothberg MB Steele JR Wheeler J Arora A Priya A Lindenauer PK 《Journal of general internal medicine》2012,27(2):185-189
BACKGROUND
Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes. 相似文献996.
Bond WF Schwartz LM Weaver KR Levick D Giuliano M Graber ML 《Journal of general internal medicine》2012,27(2):213-219
Background
Differential diagnosis (DDX) generators are computer programs that generate a DDX based on various clinical data. 相似文献997.
Asqual Getaneh MD MPH Laney S. Light MS David J. Brillon MD Jorge Calles Escandón MD MPH James Felicetta MD Gregory W. Evans MA Carlos R. Lopez-Jimenez MD MS Robert Cuddihy MD J. Thomas Bigger MD 《Journal of general internal medicine》2012,27(11):1499-1505
BACKGROUND
Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care.OBJECTIVE
To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.DESIGN
Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0?%, and standard, targeting glycated hemoglobin between 7.0?% and 7.9?%.PARTICIPANTS
Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States.MAIN MEASURE
Glycated hemoglobinRESULTS
Compared to Puerto Ricans, Mexicans were more likely (HR?=?1.38, CI:0.90?C2.10) and Dominicans as likely (HR?=?1.01, CI:0.66?C1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR?=?1.57, CI:0.99?C2.51 in the intensive arm, HR?=?1.51, CI:0.95?C2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR?=?0.47, CI:0.31?C0.71), and Dominicans (OR?=?0.41, CI:0.26?C0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR?=?0.66, CI:0.43?C1.02).CONCLUSIONS
Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies. 相似文献998.
Kun‐Hua Sam Lee MS Sarah Bowen PhD Tian P. S. Oei PhD Cheng‐Fang Yen MD PhD 《The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions》2012,21(Z1):S43-S48
Background: This study proposed and examined an expanded self‐medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self‐efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self‐efficacy between negative emotional states and heroin use. Methods: A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self‐efficacy. Structural equation modeling was used to examine the eSMH model. Results: Results showed that the eSMH model displayed proper goodness‐of‐fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self‐efficacy was not a significant predictor. Additionally, positive self‐efficacy was a mediator between negative emotional status and heroin use. Conclusion: Results support a reduced eSMH model and suggest a significant role of positive self‐efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states. (Am J Addict 2012;21:S43–S48) 相似文献
999.
Michael R. Jaff DO Mark Bates MD Timothy Sullivan MD Jeffrey Popma MD Xingyu Gao MS Margo Zaugg RN BSN Patrick Verta MS Stat DVM MD 《Catheterization and cardiovascular interventions》2012,80(3):343-350
Background : Atherosclerotic renal artery stenosis (ARAS) causes hypertension (HTN) and threatens renal function (RF). The HERCULES Trial is a prospective, multicenter trial of renal stenting in patients with uncontrolled HTN and ARAS evaluating the safety and effectiveness of the RX Herculink Elite Renal Stent System (Abbott Vascular, Santa Clara, CA). Results : Mean systolic blood pressure (SBP) at baseline was 162 mm Hg. Nearly 70% of patients were receiving three or more antihypertensive medications (mean 3.4 medications per patient). Baseline serum creatinine was 1.2 ± 0.4 and 61.5% of subjects had estimated glomerular filtration <60. The restenosis rate was 10.5% at 9 months. The study device, procedure, and clinical success rates were 96.0, 99.2, and 98.0%, respectively. Freedom from major adverse events was 94.8%. At 9 months, the mean SBP significantly decreased (mean 145, paired t test P < 0.0001) after stenting with no change in medications. There was no correlation between SBP reduction and baseline BNP or BNP reduction. 相似文献