Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality

2018 ◽  
Vol 19 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Ashley N. Fox ◽  
Grant H. Skrepnek ◽  
Jamie L. Miller ◽  
Nicholas C. Schwier ◽  
Toni L. Ripley
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Medical Therapy ◽  
Acute Coronary Syndromes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prescribing Patterns ◽  
Academic Medical ◽  
Coronary Syndromes ◽  
Related Mortality

scholarly journals Prior Beta-Blocker Therapy for Hypertension and Sex-Based Differences in Heart Failure Among Patients With Incident Coronary Heart Disease

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 819-826 ◽  
Author(s):  
Raffaele Bugiardini ◽  
Jinsung Yoon ◽  
Sasko Kedev ◽  
Goran Stankovic ◽  
Zorana Vasiljevic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Odds Ratio ◽  
Acute Coronary Syndromes ◽  
Relative Risk Ratio ◽  
Blocker Therapy ◽  
Coronary Syndromes ◽  
Β Blocker ◽  
Β Blockers

The usefulness of β-blockers has been questioned for patients who have hypertension without a prior manifestation of coronary heart disease or heart failure. In addition, sex-based differences in the efficacy of β-blockers for prevention of heart failure during acute myocardial ischemia have never been evaluated. We explored whether the effect of β-blocker therapy varied according to the sex among patients with hypertension who have no prior history of cardiovascular disease. Data were drawn from the ISACS (International Survey of Acute Coronary Syndromes)-Archives. The study population consisted of 13 764 patients presenting with acute coronary syndromes. There were 2590 patients in whom hypertension was treated previously with β-blocker (954 women and 1636 men). Primary outcome measure was the incidence of heart failure according to Killip class classification. Subsidiary analyses were conducted to estimate the association between heart failure and all-cause mortality at 30 days. Outcome rates were assessed using the inverse probability of treatment weighting and logistic regression models. Estimates were compared by test of interaction on the log scale. Among patients taking β-blockers before admission, there was an absolute difference of 4.6% between women and men in the rate of heart failure (Killip ≥2) at hospital presentation (21.3% versus 16.7%; relative risk ratio, 1.35 [95% CI, 1.10–1.65]). On the opposite, the rate of heart failure was approximately similar among women and men who did not receive β-blockers (17.2% versus 16.1%; relative risk ratio, 1.09 [95% CI, 0.97–1.21]). The test of interaction identified a significant ( P =0.034) association between sex and β-blocker therapy. Heart failure was predictive of mortality at 30-day either in women (odds ratio, 7.54 [95% CI, 5.78–9.83]) or men (odds ratio, 9.62 [95% CI, 7.67–12.07]). In conclusion, β-blockers use may be an acute precipitant of heart failure in new-onset coronary heart disease among women, but not men. Heart failure increases the risk of death. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT04008173.

scholarly journals Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center

2021 ◽  
Author(s):  
Jennifer L Jaskiewicz ◽  
Conor B Garry ◽  
Andrew J Ernst ◽  
Jacob H Cole ◽  
Miranda L Allen ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Therapy ◽  
Prescribing Patterns ◽  
Therapy Outcomes ◽  
Academic Medical ◽  
Anonymized Data ◽  
Systematic Education ◽  
Safety Metrics

ABSTRACT Objective In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics. Design This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines. Methods Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period. Results Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence. Conclusion Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.

Relationship between dental loss and health outcomes among hospitalized patients with and without diabetes

2018 ◽  
Vol 67 (3) ◽  
pp. 669-673
Author(s):  
Kenneth Izuora ◽  
Ammar Yousif ◽  
Gayle Allenback ◽  
Civon Gewelber ◽  
Michael Neubauer
Keyword(s):  
Diabetes Mellitus ◽  
Heart Disease ◽  
Health Outcomes ◽  
Medical Center ◽  
Dental Health ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Academic Medical ◽  
Patients With Diabetes ◽  
The Impact

There is mixed evidence regarding the impact of poor dental health on cardiovascular disease and other health outcomes. Our objective was to determine the outcomes associated with poor dental health among hospitalized patients with and without diabetes mellitus (DM) at our institution. We enrolled a consecutive sample of adult patients admitted to an academic medical center. We gathered demographic, health and dental information, reviewed their medical records and then examined their teeth. We analyzed data using SPSS V.24. There was a high prevalence of dental loss among all hospitalized patients. Older age (p<0.001), smoking (p=0.034), having DM (p=0.001) and lower frequency of teeth brushing (p<0.001) were predictors of having a lower number of healthy teeth. Among DM and non-DM patients, fewer remaining healthy teeth was associated with presence of heart disease (p=0.025 and 0.003, respectively). Patients with diabetes mellitus (DM) had a higher prevalence of stroke (p=0.006) while patients without DM had a higher number of discharge medications (p=0.001) associated with having fewer number of healthy teeth. There was no correlation between number of healthy teeth and the length or frequency of hospitalization. Patients with DM are more likely to have fewer number of healthy teeth compared with non-DM patients. Fewer number of healthy teeth was associated with higher prevalence of heart disease in both DM and non-DM patients and with more discharge medications in non-DM patients.

scholarly journals Evaluation of intramuscular olanzapine and ziprasidone in the medically ill

2021 ◽  
Vol 11 (1) ◽  
pp. 6-11
Author(s):  
Seema M. Patel ◽  
Ericka L. Crouse ◽  
James L. Levenson
Keyword(s):  
Second Generation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Torsades De Pointes ◽  
Prescribing Patterns ◽  
Medically Ill ◽  
White Males ◽  
Academic Medical ◽  
Second Generation Antipsychotics ◽  
Record Review

Abstract Introduction Despite the paucity of studies evaluating short-acting parenteral second-generation antipsychotics in the medically ill, their use in this population has increased. The purpose of this study was to characterize the use of IM olanzapine and ziprasidone in the medically ill at an academic medical center. Methods This is a retrospective medical record review of all patients who received IM olanzapine or ziprasidone on nonpsychiatric inpatient units at a large academic medical center from August 1, 2015 to July 31, 2017. The primary endpoint characterized the indication for use. Secondary endpoints included safety, effectiveness, and prescribing patterns. Results After exclusion criteria, a total of 100 patients were included in this study, predominantly white males with a mean age of 56 years. Seventy-four percent of patients received IM ziprasidone and 26% received IM olanzapine. The most common indications for use were agitation of nonpsychotic origin (40%) and delirium (33%). Patients received IM olanzapine and ziprasidone when their use was contraindicated (26.9% vs 9.5%, respectively). Discussion Intramuscular second-generation antipsychotics are increasingly being used in the medically ill for delirium and agitation. Our study confirms these were the most common indications for IM second-generation antipsychotic use in this population. Additionally, their use appeared to be well-tolerated, and no patient developed Torsades de Pointes even when combined with other agents that putatively increase QTc. Given the retrospective, single-center, nonrandomized design of this study, the safety and effectiveness of these parenteral second-generation antipsychotics in common causes of acute agitation should continue to be further evaluated.

Evaluation of Inhaled Dornase Alfa Administration in Non-Cystic Fibrosis Patients at a Tertiary Academic Medical Center

2016 ◽  
Vol 29 (5) ◽  
pp. 480-483 ◽  
Author(s):  
Heather Torbic ◽  
Gaspar Hacobian
Keyword(s):  
Cystic Fibrosis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Data ◽  
Prescribing Patterns ◽  
Chronic Obstructive ◽  
Dornase Alfa ◽  
Academic Medical ◽  
Cystic Fibrosis Population ◽  
Inhaled Therapy

Purpose: The use of dornase alfa in a non-cystic fibrosis population has been proposed to help improve atelectasis and secretions. Data evaluating dornase alfa in a non-cystic fibrosis population are limited, and the prescribing practices at a tertiary academic medical center are unknown. Methods: Adult patients ≥18 years of age were included if they received inhaled dornase alfa. Patients were excluded if they had cystic fibrosis. Data collected included demographic data, dornase alfa prescribing patterns, concomitant inhaled therapy, blood gas data, and documented efficacy and safety data. Results: Seventy-six orders for dornase alfa therapy were included in the analysis. Of the patients, 18% had asthma and 19% had chronic obstructive pulmonary disease. Seventy-seven percent of the patients received concomitant inhaled therapy. Eighty-three percent of orders were for 2.5 mg of dornase alfa twice daily. The median (interquartile range [IQR]) number of doses received per patient was 6 (4-13) with a median (IQR) duration of 3 (2-7) days. After inhaled dornase alfa administration, 11% of patients were able to cough productively. No safety issues related to inhaled dornase alfa therapy were noted. Conclusions: Inhaled dornase alfa is commonly prescribed to improve atelectasis and secretions in a non-cystic fibrosis patient population at a tertiary academic medical center.

scholarly journals The Culture of Carbapenem Overconsumption: Where Does It Begin? Results of a Single-Center Survey

2018 ◽  
Vol 54 (3) ◽  
pp. 175-179
Author(s):  
Bryan T. Mogle ◽  
Robert W. Seabury ◽  
Zachary Jones ◽  
Christopher D. Miller ◽  
Jeffrey M. Steele
Keyword(s):  
Infectious Diseases ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Prescribing Patterns ◽  
Negative Consequences ◽  
Local Resistance ◽  
Single Center ◽  
Academic Medical ◽  
Resistance Rates

Purpose: The United States has seen an increased consumption of carbapenem antibiotics in recent years. The increased utilization of these agents has potential negative consequences, including the increasing incidence of carbapenem-resistant Enterobacteriaceae. Reasons for the rise in carbapenem use among providers in acute care hospitals are not well elucidated in literature. The objectives of this study were to identify factors that influence empiric carbapenem use among providers in a single academic medical center, and to assess therapeutic knowledge pertaining to carbapenem use. Methods: A cross-sectional, single-center, 9-item electronic research survey was developed independently and validated by an infectious diseases pharmacist and infectious diseases physician. The survey was distributed to email accounts of providers at a single academic medical center. Demographic data, factors affecting carbapenem prescription, and baseline therapeutic knowledge were assessed. Results: Ninety-five of 416 providers responded to the survey (response rate of 22.8%). Respondents were well distributed across all levels of training with primary roles in internal medicine and surgery. The most important factors influencing empiric carbapenem use were suspected pathogens at the site of infection, drug allergies, history of multidrug resistant organisms, severity of illness, type of infection, and local resistance rates. A recommendation from a pharmacist was selected as the most likely factor for deterring carbapenem use. Misconceptions pertaining to penicillin drug allergy and beta-lactam cross reactivity, knowledge of local resistance rates according to the institutional antibiogram, and comparative efficacy data for carbapenems were apparent across all levels of training. Conclusions: Provider misconceptions regarding several factors appear to contribute to unnecessary use of carbapenems. An opportunity exists for hospital pharmacists to improve the prescribing patterns of carbapenems by correcting provider misconceptions through education.

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