Medications and Patient Factors Associated With Increased Readmission for Alcohol-Related Diagnoses

AimsPsychiatric polypharmacy refers to the prescription of two or more psychotropic medications to any one patient. This definition is purely quantitative and does not take into account whether such a prescription is detrimental, or unnecessary. In many cases, polypharmacy has been implemented in challenging illnesses, and some studies have shown that it can improve overall outcomes for certain patients. Evidence suggests that the prevalence of psychotropic polypharmacy is increasing, despite advances in psychosocial interventions. The aim of this study was to assess the current prevalence of polypharmacy among patients being treated by a community mental health team (CMHT), and the patient factors associated with its use.MethodWe performed a cross-sectional study of all patients registered with a CMHT in a mixed urban/rural area on a single date. Case records were examined to determine the most recently prescribed drug regimen for each patient. Clinical chart diagnoses were recorded and each one independently verified by the team consultant using ICD-10. A number other sociodemographic variables were recorded. Using Microsoft Excel, we analysed the medications prescribed as well as rates and levels of polypharmacy based on multiple different patient characteristics.ResultOf the 245 patients, the mean age was 56.3 and 51.2% (n = 126) were female. Psychotropic polypharmacy was seen in 62% (n = 152) of patients. 33% (n = 82) of patients were on two psychotropic medications, and of this subset, a combination of one antipsychotic and one antidepressant was the most common drug regimen, seen in 16.7% (n = 41) of all patients. Polypharmacy was more prevalent in females, with 68% (n = 85) being on two or more psychotropics, in comparison to 58% of male patients. In relation to age, patients aged between 51 to 65 years had the highest prevalence of polypharmacy, at a rate of 71% (n = 49). Among all primary diagnoses, polypharmacy was most common in patients with affective disorders, with 80% (n = 40) of this patient cohort on two or more medications. Second to this was psychotic disorders, with polypharmacy seen in 65% (n = 62) of this group.ConclusionWe found that psychotropic polypharmacy is highly prevalent in psychiatric patients being treated in a community setting. Certain demographics and patient factors, such as age, gender and psychiatric diagnosis influenced the rate of polypharmacy and certain drug combinations were more commonly prescribed than others.

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Use of radiotherapy for bladder cancer: A population-based study of evolving referral and practice patterns

Canadian Urological Association Journal ◽

10.5489/cuaj.5447 ◽

2018 ◽

Vol 13 (4) ◽

Author(s):

Xuejiao Wei ◽

D. Robert Siemens ◽

William J. Mackillop ◽

Christopher M. Booth

Keyword(s):

Bladder Cancer ◽

Geographic Location ◽

Multidisciplinary Care ◽

Population Based ◽

Definitive Treatment ◽

Case Volume ◽

Patient Factors ◽

Curative Intent ◽

Factors Associated ◽

Radical Treatment

Introduction: Definitive treatment for muscle-invasive bladder cancer includes either cystectomy or radiotherapy (RT). We describe use of RT and radiation oncology (RO) referral patterns in the contemporary era. Methods: The Ontario Cancer Registry and linked records of treatment were used to identify all patients who received cystectomy or RT for bladder cancer from 1994–2013. Physician billing records were linked to identify RO consultation before radical treatment. Multilevel logistic regression models were used to examine patient factors and physician-level variation in referral to RO and use of RT. Results: A total of 7461 patients underwent cystectomy or RT for bladder cancer from 1994–2013; 5574 (75%) had cystectomy and 1887 (25%) had RT. Use of RT decreased from 43% (126/289) in 1994 to 23% (112/478) in 2008 and remained stable from 2009– 2013 (23%, 507/2202). RO referral rate among all cases decreased from 46% (134/289) in 1994 to 30% (143/478) in 2008; however, the rates began to rise in the contemporary era from 31% (137/442) in 2009 to 37% (165/448) in 2013 (p=0.03). Patient factors associated with use of RT include older age, greater comorbidity, and geographic location. Surgeon-level factors associated with greater preoperative referral to RO include higher surgeon case volume and practicing in a teaching hospital. Conclusions: One-quarter of patients treated with curative intent therapy for bladder cancer receive RT. While referral rates to RO are increasing, future data will identify the extent to which this has altered practice. Collaborative efforts promoting multidisciplinary care and RO consultation before radical treatment are warranted.

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Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test

Journal of General Internal Medicine ◽

10.1046/j.1525-1497.2003.20525.x ◽

2003 ◽

Vol 18 (5) ◽

pp. 357-363 ◽

Cited By ~ 32

Author(s):

Barbara Turner ◽

Ronald E. Myers ◽

Terry Hyslop ◽

Walter W. Hauck ◽

David Weinberg ◽

...

Keyword(s):

Blood Test ◽

Fecal Occult Blood Test ◽

Occult Blood ◽

Fecal Occult Blood ◽

Occult Blood Test ◽

Patient Factors ◽

Factors Associated ◽

Fecal Occult

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Patient factors associated with identification of sepsis in the ED

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2014.06.014 ◽

2014 ◽

Vol 32 (10) ◽

pp. 1280-1281 ◽

Cited By ~ 4

Author(s):

D.K. Wilson ◽

C.C. Polito ◽

M.J. Haber ◽

A. Yancey ◽

G.S. Martin ◽

...

Keyword(s):

Patient Factors ◽

Factors Associated

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Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles

Annals of Pharmacotherapy ◽

10.1345/aph.1k041 ◽

2007 ◽

Vol 41 (6) ◽

pp. 929-936 ◽

Cited By ~ 19

Author(s):

Jeffrey J Fong ◽

Karen Cecere ◽

John Unterborn ◽

Erik Garpestad ◽

Mark Klee ◽

...

Keyword(s):

Severe Sepsis ◽

Quality Indicators ◽

Apache Ii ◽

Apache Ii Score ◽

Healthcare Organizations ◽

Patient Factors ◽

Sepsis Bundles ◽

Factors Associated ◽

Healthcare Improvement ◽

Bundle Compliance

BACKGROUND: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data. OBJECTIVE: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability. METHODS: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 ± 6, organ failure 2 ± 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital. RESULTS: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences. CONCLUSIONS: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care. TRANSFONDO: Tres diferentes organizaciones [“Voluntary Hospitals of America” (VHA), “Institute for Healthcare Improvement” (IHI), “Joint Commission on Accreditation of Healthcare Organizations” (JCAHO)] encargados con mejorar el cuidado médico en instituciones han desarrollado criterios de indicadores de calidad para el manejo apropiado de sepsis. Estas guiás de tratamiento han sido desarrollados con el propósito de proveer instituciones con un mecanismo para comparar la calidad de cuidado que ofrecen a sus pacientes que son admitidos con sepsis severa. Mientras que se han aprobado o propuesto tres diversos criterios de indicadores de calidad para evaluar las prácticas clínicas del manejo de sepsis severa, se sospecha que las diferencias entre estos indicadores pueden resultar en datos de comparación discrepantes.

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Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy

Journal of Clinical Pathology ◽

10.1136/jclinpath-2016-203995 ◽

2016 ◽

Vol 70 (7) ◽

pp. 584-592 ◽

Cited By ~ 16

Author(s):

Zhaomin Xu ◽

Mariana E Berho ◽

Adan Z Becerra ◽

Christopher T Aquina ◽

Bradley J Hensley ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Neoadjuvant Therapy ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiation ◽

Mixed Effects ◽

Patient Factors ◽

Lymph Node Yield ◽

Factors Associated ◽

Node Yield

AimsLymph node yield (LNY) is used as a marker of adequate oncological resection. The American Joint Committee on Cancer (AJCC) currently recommends that at least 12 nodes are necessary to confirm node-negative disease for rectal cancer. A LNY of 12 is not always achieved, particularly in patients who have undergone neoadjuvant treatment. This study attempts to examine factors associated with LNY and its prognostic impact following neoadjuvant chemoradiation in rectal cancer.MethodsThe 2006–2011 National Cancer Data Base was queried for patients with clinical stage I–III rectal cancer who underwent a proctectomy. Suboptimal LNY was defined as <12 lymph nodes examined. A mixed-effects multinomial logistic regression model was used to identify independent factors associated with LNY. Mixed-effects Cox proportional hazards models were used to estimate the adjusted effect of LNY on 5-year overall survival.Results25 447 patients met inclusion criteria. Overall, 62% of the cohort received neoadjuvant chemoradiation and 32% had suboptimal LNY. The median LNY for patients who received neoadjuvant therapy was 13 (IQR: 9–18) and for patients who did not receive neoadjuvant therapy was 15 (IQR: 12–21). After risk adjustment, there was a 3.5-fold difference in the rate of suboptimal LNY among individual hospitals (27%–95%). Suboptimal LNY was independently associated with an 18% increased hazard of death among patients who did not receive neoadjuvant treatment and a 20% increased hazard of death among those who did receive neoadjuvant treatment when controlled for adjuvant treatment, staging, proximal/distal margins and other patient factors.ConclusionsSuboptimal LNY is independently associated with worse overall survival regardless of neoadjuvant therapy, pathological staging and patient factors in rectal cancer. This finding underlies the importance and challenge of an optimal lymph node evaluation for prognostication, especially for patients receiving neoadjuvant therapy.

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Obstetrician-gynecologist and patient factors associated with intimate partner violence screening in a clinical setting

Women & Health ◽

10.1080/03630242.2020.1784368 ◽

2020 ◽

Vol 60 (9) ◽

pp. 1000-1013

Author(s):

Katherine M. Jones ◽

Michele M. Carter ◽

Ann L. Bianchi ◽

Robert J. Zeglin ◽

Jay Schulkin

Keyword(s):

Intimate Partner Violence ◽

Clinical Setting ◽

Partner Violence ◽

Intimate Partner ◽

Patient Factors ◽

Intimate Partner Violence Screening ◽

Factors Associated

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Patient Factors Associated With Prolonged Postoperative Opioid Use After Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.03.068 ◽

2018 ◽

Vol 33 (8) ◽

pp. 2449-2454 ◽

Cited By ~ 53

Author(s):

Robert S. Namba ◽

Anshuman Singh ◽

Elizabeth W. Paxton ◽

Maria C.S. Inacio

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Opioid Use ◽

Patient Factors ◽

Factors Associated ◽

Total Knee

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Variation in Surgeons’ Requests for General Anesthesia When Scheduling Carpal Tunnel Release

Hand ◽

10.1177/1558944719828006 ◽

2019 ◽

Vol 15 (5) ◽

pp. 608-614

Author(s):

Alex H. S. Harris ◽

Esther L. Meerwijk ◽

Robin N. Kamal ◽

Erika D. Sears ◽

Mary Hawn ◽

...

Keyword(s):

General Anesthesia ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Veterans Health Administration ◽

Mixed Effects ◽

Veterans Health ◽

Health Administration ◽

Patient Factors ◽

Factors Associated ◽

Future Clinical Practice

Background: Carpal tunnel release (CTR) can be performed with a variety of anesthesia techniques. General anesthesia is associated with higher risk profile and increased resource utilization, suggesting it should not be routinely used for CTR. The purpose of this study was to examine the patient factors associated with surgeons’ requests for general anesthesia for CTR and the frequency of routine use of general anesthesia by Veterans Health Administration (VHA) surgeons and facilities. Methods: National VHA data for fiscal years 2015 and 2017 were used to identify patients receiving CTR. Mixed-effects logistic regression was used to evaluate patient, procedure, and surgeon factors associated with requests by the surgeon for general anesthesia versus other anesthesia techniques. Results: In all, 18 145 patients underwent CTR performed by 780 surgeons in 113 VHA facilities. Overall, there were 2218 (12.2%) requests for general anesthesia. Although some patient (eg, older age, obesity), procedure (eg, open vs endoscopic), and surgeon (eg, higher volume) factors were associated with lower odds of requests for general anesthesia, there was substantial facility- and surgeon-level variability. The percentage of patients with general anesthesia requested ranged from 0% to 100% across surgeons. Three facilities and 28 surgeons who performed at least 5 CTRs requested general anesthesia for more than 75% of patients. Conclusions: Where CTR is performed and by whom appear to influence requests for general anesthesia more than patient factors in this study. Avoidance of routine use of general anesthesia for CTR should be considered in future clinical practice guidelines and quality measures.

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