Pregnancy outcome following gestational exposure to azithromycin

BACKGROUND: Azithromycin is an azalide antibiotic with an extensive range of indications and has become a common treatment option due to its convenient dosing regimen and therapeutic advantages. Human studies addressing gestational use of azithromycin have primarily focused on antibiotic efficacy rather than fetal safety. Our primary objective was to evaluate the possibility of teratogenic risk following gestational exposure to azithromycin. METHODS: There were 3 groups of pregnant women enrolled in our study: 1) women who took azithromycin. 2) women exposed to non-teratogenic antibiotics for similar indications, and 3) women exposed to non-teratogenic agents. They were matched for gestational age at time of call, maternal age, cigarette and alcohol consumption. Rates of major malformations and other endpoints of interest were compared among the three groups. RESULTS: Pregnancy outcome of 123 women in each group was ascertained. There were no statistically significant differences among the three groups in the rates of major malformations; 3.4% (exposed) versus 2.3% (disease matched) and 3.4% (non teratogen) or any other endpoints that were examined. In the azithromycin group, 88 (71.6%) women took the drug during the first trimester CONCLUSION: Results suggest that gestational exposure to azithromycin is not associated with an increase in the rate of major malformations above the baseline of 1–3%. Our data adds to previous research showing that macrolide antibiotics, as a group, are generally safe in pregnancy and provides an evidence-based option for health professionals caring for populations with chlamydia

Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score =1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs. TRIAL REGISTRATION: ANZ Clinical Trials Registry: U1111-1164-0572

Where Wellness Meets the Road: Taking Population Health from Theory to Practice

“Where Wellness Meets the Road: Taking Population Health from Theory to Practice” will discuss how population health and wellness principles are being applied in the workplace to enhance quality and reduce medical costs. Organizations across all industries are working together to focus on the quality and cost of medical care in the United States. The nationwide mindset is shifting from interventions that can cure disease to prevention, wellness and chronic care management — work that requires tighter coordination across the continuum of care and a more active role for patients and caregivers. Payors are encouraging and supporting innovation in health care delivery systems, helping them adopt new technologies and methodologies to care for patients. Finally, economic necessity is motivating the government and the private sector to bend the health care cost curve, while achieving and sustaining better clinical outcomes. Agenda 6:00pm Welcome Edmund L. (Ned) Lafer, MD, MBA, FACHE,CPE Medical Director Healthcare Management, HealthPartners President, Healthcare Leadership Network of the Delaware Valley (HLNDV) Introduction to Lee White Innovation Institute Doug Hughes, RN, BSN, MBA, FACHE, NE-BC Vice President Administration, Paoli Hospital-President Elect HLNDV Tribute to Lee White Barbara Tachovsky Retired, Former President, Paoli Hospital 6:30pm Program Introduction Joel Port, MHSA, CHE, CMPE Chief Operating Officer at Accountable Care Organization of Pennsylvania Jefferson Health System “Setting the Stage” David B. Nash, MD, MBA Dean Jefferson University School of Population Health 6:45pm Panel Discussion Diane S. Harlow, MEd Assistant Director Geisinger Health System Wellness Program Brian J. Silverstein, MD President HC Wisdom Jim Wilton, JD, M.Div Administrator, Group Health & Wellness Cardone Industries 7:45pm Q&A from Audience 8:00pm Summary and Adjournment Event Sponsor DGA PARTNERS Location Sponsor Main Line Healt