Using an Electronic Reminder to Improve Physician Practices at Yale-New Haven Hospital

The inappropriate use of diphenhydramine (Benadryl™) can lead to iatrogenic complications, such as cognitive decline. Electronic reminders can be effective in implementing clinical guidelines, providing decision support to clinicians, and reducing medical errors. The purpose of this study was to determine the effect of an electronic reminder screen on physicians\u27 routine use of diphenhydramine as a pretreatment prior to blood transfusions, and to assess their attitudes regarding this reminder. The researchers reviewed diphenhydramine use in adult inpatients before, immediately after, and one year after implementation of the reminder screen. A total of 752 transfusion episodes (467 patients) were reviewed, with 253 in the pre-screen group, 249 in the post-screen group, and 250 in the post-screen comparison group. The mean age in each group was 66 years (SD=15), 64 years (SD=15), and 69 years (SD=12), respectively. Diphenhydramine use decreased significantly after screen implementation from 41% to 20% (p\u3c0.005) the first year and down to 12% (p\u3c0.005) the second year. An analysis in the medical, surgical, and obstetrics/gynecology services demonstrated significant absolute reductions over time (38.6%, 28.1%, and 4.6% reductions, respectively, p\u3c0.05). Only 17% of all treated patients had a documented indication for diphenhydramine. Treated patients had higher rates of mental status change than non-treated patients--32/83 (39%) vs. 92/513 (18%, p\u3c030005). Fifty-six house staff completed a questionnaire regarding the electronic reminder (estimated response rate 53%). Sixty-nine percent reported ordering diphenhydramine less that 25% of the time (SD=0.9), 71% were aware of blood bank pretreatment recommendations (SD=0.5), 55% had seen the reminder (SD=0.5), 59% changed their behavior due to the reminder (SD=0.7), and 65% felt the reminder was helpful and should remain in the system (SD=0.9). Diphenhydramine use significantly declined immediately and over time with the implementation of an electronic reminder, supporting the use of this mechanism to impact physician practice patterns

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

Background: Increasing numbers of older patients with advanced cancer live alone but there is little research on how well health services meet their needs. The aim of this study was to compare the experiences and future preferences for care between two groups of older people with cancer in their last year of life; those who live alone, and those who live with co-resident carers. Methods: In-depth qualitative interviews were conducted with 32 people aged between 70 and 95 years who were living with cancer. They were recruited from general practices and hospice day care, when the responsible health professional answered no to the question, of whether they would be surprised if the patient died within twelve months. Twenty participants lived alone. Interviews were recorded and transcribed and the data analysed using a Framework approach, focussing on the differences and commonalities between the two groups. Results: Many experiences were common to all participants, but had broader consequences for people who lived alone. Five themes are presented from the data: a perception that it is a disadvantage to live alone as a patient, the importance of relational continuity with health professionals, informal appraisal of care, place of care and future plans. People who lived alone perceived emotional and practical barriers to accessing care, and many shared an anxiety that they would have to move into a care home. Participants were concerned with remaining life, and all who lived alone had made plans for death but not for dying. Uncertainty of timescales and a desire to wait until they knew that death was imminent were some of the reasons given for not planning for future care needs. Conclusions: Older people who live alone with cancer have emotional and practical concerns that are overlooked by their professional carers. Discussion and planning for the future, along with continuity in primary care may hold the key to enhancing end-of-life care for this group of patients

Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the second Latinos & Alzheimer\u27s Symposium

The Alzheimer\u27s Association hosted the second Latinos & Alzheimer\u27s Symposium in May 2021. Due to the COVID-19 pandemic, the meeting was held online over 2 days, with virtual presentations, discussions, mentoring sessions, and posters. The Latino population in the United States is projected to have the steepest increase in Alzheimer\u27s disease (AD) in the next 40 years, compared to other ethnic groups. Latinos have increased risk for AD and other dementias, limited access to quality care, and are severely underrepresented in AD and dementia research and clinical trials. The symposium highlighted developments in AD research with Latino populations, including advances in AD biomarkers, and novel cognitive assessments for Spanish-speaking populations, as well as the need to effectively recruit and retain Latinos in clinical research, and how best to deliver health-care services and to aid caregivers of Latinos living with AD

Hipertensión arterial pulmonar y deterioro renal en pacientes del Instituto Nacional de Cardiología Ignacio Chávez, México

Objective. The objective of the study was to describe the clinical characteristics and the evolution of the severity of pulmonary arterial hypertension (PAH) and the degree of renal failure. Material and methods. A retrospective observational study was carried out in which the physical and electronic medical records of 60 patients older than 18 years with a diagnosis of pulmonary arterial hypertension were analyzed. Results. In our study, 11.4% of the severe PAH group worsened renal function at six months, and 13.6% of the participants worsened it at one year. In contrast, in the group with moderate PAH, 18.8% worsened at six months, and 12.5% worsened at one year. Also, the GFR at one year was 54.15 mL/min/1.73 m2 in the moderate PAH group and in the severe PAH group was 73.55 mL/min/1.73 m2. Conclusion. The results of this research suggest that the deterioration of kidney function is related to the severity of pulmonary arterial hypertension.Objetivos. El objetivo del estudio fue describir las características clínicas y la relación entre la severidad de la hipertensión arterial pulmonar (HAP) y el grado de insuficiencia renal. Materiales y métodos. Se realizó un estudio observacional retrospectivo en el cual se analizaron las historias clínicas físicas y electrónicas de 60 pacientes mayores de 18 años con diagnóstico de hipertensión arterial pulmonar. Resultados. El 11,4% de pacientes con HAP severa empeoraron su función renal a los 6 meses y el 13,6% al año. En contraste, en el grupo de pacientes con HAP moderada, 18,8% empeoraron a los 6 meses y el 12,5% empeoraron al año. La TFG al año fue de 54,15 mL/min/1,73 m2 en pacientes con HAP moderada y en la HAP severa de 73,55 mL/min/1,73 m2. Conclusiones. Los resultados de esta investigación sugieren que el deterioro de la función renal tendría relación con la severidad de la hipertensión arterial pulmonar

Risks of myeloid malignancies in patients with autoimmune conditions

Autoimmune conditions are associated with an elevated risk of lymphoproliferative malignancies, but few studies have investigated the risk of myeloid malignancies. From the US Surveillance Epidemiology and End Results (SEER)-Medicare database, 13 486 myeloid malignancy patients (aged 67+ years) and 160 086 population-based controls were selected. Logistic regression models adjusted for gender, age, race, calendar year and number of physician claims were used to estimate odds ratios (ORs) for myeloid malignancies in relation to autoimmune conditions. Multiple comparisons were controlled for using the Bonferroni correction (P<0.0005). Autoimmune conditions, overall, were associated with an increased risk of acute myeloid leukaemia (AML) (OR 1.29) and myelodysplastic syndrome (MDS, OR 1.50). Specifically, AML was associated with rheumatoid arthritis (OR 1.28), systemic lupus erythematosus (OR 1.92), polymyalgia rheumatica (OR 1.73), autoimmune haemolytic anaemia (OR 3.74), systemic vasculitis (OR 6.23), ulcerative colitis (OR 1.72) and pernicious anaemia (OR 1.57). Myelodysplastic syndrome was associated with rheumatoid arthritis (OR1.52) and pernicious anaemia (OR 2.38). Overall, autoimmune conditions were not associated with chronic myeloid leukaemia (OR 1.09) or chronic myeloproliferative disorders (OR 1.15). Medications used to treat autoimmune conditions, shared genetic predisposition and/or direct infiltration of bone marrow by autoimmune conditions, could explain these excess risks of myeloid malignancies

Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the Second Latinos and Alzheimer's Symposium

The Alzheimer's Association hosted the second Latinos & Alzheimer's Symposium in May 2021. Due to the COVID-19 pandemic, the meeting was held online over 2 days, with virtual presentations, discussions, mentoring sessions, and posters. The Latino population in the United States is projected to have the steepest increase in Alzheimer's disease (AD) in the next 40 years, compared to other ethnic groups. Latinos have increased risk for AD and other dementias, limited access to quality care, and are severely underrepresented in AD and dementia research and clinical trials. The symposium highlighted developments in AD research with Latino populations, including advances in AD biomarkers, and novel cognitive assessments for Spanish-speaking populations, as well as the need to effectively recruit and retain Latinos in clinical research, and how best to deliver health-care services and to aid caregivers of Latinos living with AD

Determinants of preventable readmissions in the United States: a systematic review

<p>Abstract</p> <p>Background</p> <p>Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.</p> <p>Methods</p> <p>We conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.</p> <p>Results</p> <p>The review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.</p> <p>Conclusions</p> <p>The current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.</p