2,827 results match your criteria evidence-based prescribing

A retrospective study of antithrombotic therapy use in an outpatient haemodialysis unit.

J Clin Pharm Ther 2021 Jun 15. Epub 2021 Jun 15.

Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.

What Is Known And Objective: Patients on haemodialysis (HD) are at increased risk of both bleeding and thrombotic events, due to comorbidities and nature of dialysis treatment. However, there is a lack of research on evidence-based treatment strategies and prescribing patterns for antithrombotic therapies (ATT) in this population. To characterize ATT use and its main indications in an outpatient HD unit. Read More

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Enhanced recovery after surgery for sleeve gastrectomies: improved patient outcomes.

Surg Obes Relat Dis 2021 May 3. Epub 2021 May 3.

Department of Surgery, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey. Electronic address:

Background: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care and incorporates patient-centered, evidence-based, and multidisciplinary team-developed pathways for a surgical specialty. ERAS pathways aim to reduce the patient's surgical stress response, optimize their physiologic function, facilitate recovery, and reduce the length of stay. The bariatric program at our institution was previously managed by many surgeons with anecdotal preferences, resulting in increased costs, lengths of stay, and opioid prescribing. Read More

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Evidence-Based Recommendations for Opioid Prescribing after Endourological and Minimally Invasive Urological Surgery.

J Endourol 2021 Jun 9. Epub 2021 Jun 9.

Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;

Introduction: Procedure-specific guidelines for postsurgical opioid use can decrease overprescribing and facilitate opioid stewardship. Initial recommendations were based on feasibility data from limited pilot studies. This study aims to refine opioid prescribing recommendations for endourological and minimally invasive urological procedures by integrating emerging clinical evidence with a panel consensus. Read More

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Relational dynamics involved in therapeutic discordance among prescribers and patients: A Grounded Theory study.

Patient Educ Couns 2021 Jun 3. Epub 2021 Jun 3.

Azienda USL-IRCCS di Reggio Emilia, Italy.

Objective: No studies have explored the negative process of concordance: discordance in prescribing-medication-taking. This study provides a deeper understanding of discordance as a co-constructed process among patients and prescribers.

Methods: To explore the question "what psychological and relational processes are involved when therapeutic discordance among prescribers and receivers occurs?" a constructivist Grounded Theory study was carried out through semi-structured interviews with patients and their medical doctors. Read More

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Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan.

SN Compr Clin Med 2021 May 28:1-5. Epub 2021 May 28.

Department of Pharmacy, University of Huddersfield, Huddersfield, UK.

The discovery of different antimicrobial agents has revolutionized the treatment against a variety of infections for many decades, but the emergence of antimicrobial resistance require rigorous measures, even amid the coronavirus disease 2019 (COVID-19) pandemic. This retrospective study aimed to examine the consumption of antibiotics in patients with COVID-19 admitted into the five hospitals in the province of Punjab, Pakistan. We collected data on the consumption of antibiotics, classified using the World Health Organization (WHO) AWaRe (Access, Watch, and Reserve), within two months-August and September, 2020, and the corresponding months in 2019. Read More

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Industry-funded medical education is always promotion-an essay by Adriane Fugh-Berman.

BMJ 2021 06 4;373:n1273. Epub 2021 Jun 4.

Georgetown University Medical Center, USA.

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Project ECHO and primary care buprenorphine treatment for opioid use disorder: Implementation and clinical outcomes.

Subst Abus 2021 Jun 4:1-9. Epub 2021 Jun 4.

Bassett Medical Center, Bassett Research Institute, Cooperstown, NY, USA.

: Our rural health system sought to (1) increase the number of primary care clinicians waivered to prescribe buprenorphine for treatment of opioid use disorder (OUD) and (2) consequently increase the number of our patients receiving this treatment. : We used the Project for Extension for Community Health Outcomes (ECHO) tele-education model as an implementation strategy. We examined the number of clinicians newly waivered, the number of patients treated with buprenorphine, the relationship between clinician engagement with ECHO training and rates of buprenorphine prescribing, and treatment retention at 180 days. Read More

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Evidence-based update on Australasian pharmaceutical prescribing approaches for recurrent vulvovaginal candidiasis.

Aust N Z J Obstet Gynaecol 2021 Jun 3. Epub 2021 Jun 3.

School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia.

Recurrent vulvovaginal candidiasis (RVVC) is a subtype of vulvovaginal candidiasis, with debilitating effects on physical and emotional well-being affecting up to 10% of Australian women. Current evidence suggests that the induction and maintenance approach for RVVC is not particularly effective with post-treatment relapse rates as high as 57%. Frequently accessed Australasian RVVC prescribing resources and guidelines were examined showing a variety of adaptations of current evidence-based induction and maintenance therapies, making it difficult to select best treatment in clinical practice. Read More

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Dental pain management with prescription opioids by nondental healthcare professionals in a healthcare system network.

J Public Health Dent 2021 Jun 3. Epub 2021 Jun 3.

Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.

Objectives: Patients with dental pain seek treatment in Urgent and Emergency Care settings by physicians and advanced practice practitioners (APPs) unable to provide definitive care, often relying on prescriptions for pain management including opioids. In the face of an opioid epidemic, this study assessed the impact of an electronic health record (EHR) clinical decision support tool to identify patients at high risk for opioid misuse using objective, evidence-based criteria, and guide safer prescribing.

Methods: Dental pain encounters occurring between January 2016 and June 2018 within our healthcare system were identified and linked to the database supporting a real-time clinical decision support intervention, Prescription Reporting with Immediate Medication Utilization Mapping (PRIMUM), to characterize opioid prescribing patterns and prescribers' response to alert. Read More

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Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond.

J Pain Res 2021 24;14:1371-1387. Epub 2021 May 24.

Department of Diagnostic Sciences, Craniofacial Pain and Headache Center, Tufts University School of Dental Medicine, Boston, MA, USA.

Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. Read More

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A Systematic Review of Complex Polypharmacy in Bipolar Disorder: Prevalence, Clinical Features, Adherence, and Preliminary Recommendations for Practitioners.

J Clin Psychiatry 2021 Jun 1;82(3). Epub 2021 Jun 1.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.

Extensive combination pharmacotherapy regimens for bipolar disorder have gained increasing use in routine practice in ways that outpace data from evidence-based clinical trials. The present review examined the prevalence of complex pharmacotherapy regimens in bipolar disorder patients and sought to characterize factors that most influence polypharmacy prescribing patterns.

The authors independently systematically searched the MEDLINE, PsycINFO, and Embase databases for English-language observational/naturalistic or randomized controlled polypharmacy trials, using the keywords and or and and . Read More

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Opioid-Induced In-Hospital Deaths: A 10-Year Review of Australian Coroners' Cases Exploring Similarities and Lessons Learnt.

Pharmacy (Basel) 2021 May 7;9(2). Epub 2021 May 7.

UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.

Although opioids are the cornerstone of moderate-to-severe acute pain management they are appropriately recognised as high-risk medicines. Patient and health service delivery factors can contribute to an increased risk of death associated with excessive sedation and respiratory impairment. Despite increasing awareness of opioid-induced ventilation impairment (OIVI), no reliable method consistently identifies individual characteristics and factors that increase mortality risk due to respiratory depression events. Read More

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The integrated management of childhood illness (IMCI) and its potential to reduce the misuse of antibiotics.

J Glob Health 2021 May 22;11:04030. Epub 2021 May 22.

WHO, Regional office for Europe, Copenhagen, Denmark.

Background: The Strategy of the Integrated Management of Childhood Illness (IMCI) was introduced in Central Asia and Europe to address the absence of evidence-based guidelines, the misuse of antibiotics, polypharmacy and over-hospitalization of children. A study carried out in 16 countries analysed the status and strengths of as well as the barriers to IMCI implementation and investigated how different health systems affect the problems IMCI aims to address. Here we present findings in relation to IMCI's effects on the rational use of drugs, particularly the improved rational use of antibiotics in children, the mechanisms through which these were achieved as well as counteracting system factors. Read More

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Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy.

Mil Med 2021 May 22. Epub 2021 May 22.

Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA.

Introduction: Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Read More

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Prevalence of Prescription Opioids for Nonoperative Treatment of Rotator Cuff Disease Is High.

Arthrosc Sports Med Rehabil 2021 Apr 3;3(2):e373-e379. Epub 2021 Feb 3.

Department Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, U.S.A.

Purpose: To quantify the prevalence of opioid and benzodiazepine prescriptions for patients with rotator cuff disease across a large health care system and to describe evidence-based risk factors for opioid use within this population.

Methods: We conducted a retrospective cohort study at a major health care system of all patients with qualifying diagnostic codes. Emergency department, urgent care, and outpatient encounters between January and December 2016 for an acute rotator cuff tear, listed as the primary diagnosis, were included. Read More

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Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence.

Plast Surg (Oakv) 2021 May 2;29(2):132-138. Epub 2021 Mar 2.

Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada.

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. Read More

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Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery.

BMC Musculoskelet Disord 2021 May 22;22(1):471. Epub 2021 May 22.

Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.

Background: Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy. Read More

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Development and feasibility testing of an evidence-based training programme for pharmacist independent prescribers responsible for the medicines-related activities within care homes.

Int J Pharm Pract 2021 May 21. Epub 2021 May 21.

Leicester Medical School, University of Leicester, Leicester, UK.

Introduction: The UK pharmacists with independent prescribing rights (pharmacist independent prescribers [PIPs]) are authorised to prescribe within their areas of competence. To enable PIPs to provide pharmaceutical care to residents in care homes and assume responsibility for medicines management, a process for development and assessment of competence is required. The aim of this research was to develop a training and accreditation process (training programme) to enable PIPs to operate safely and effectively within care homes. Read More

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Trends in Medication Prescribing in Patients With PTSD From 2009 to 2018: A National Veterans Administration Study.

J Clin Psychiatry 2021 May 4;82(3). Epub 2021 May 4.

San Francisco Veterans Affairs Health Care System, San Francisco, California.

Objective: To evaluate longitudinal prescription practice trends for patients diagnosed with posttraumatic stress disorder (PTSD) using a national cohort of veterans who engaged in Veterans Health Administration (VHA) care from 2009 to 2018.

Methods: Using ICD-9 and ICD-10 codes to determine diagnoses, 1,353,416 patients diagnosed with PTSD in VHA care were retrospectively identified who were not diagnosed with bipolar or psychotic spectrum disorder. Veterans were included in the analytic sample starting in the year of their first PTSD diagnosis for each year that they were active in VHA care. Read More

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Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters.

Addiction 2021 May 17. Epub 2021 May 17.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Aims: To identify implementation barriers and facilitators to the adoption and implementation of programs that provide opioid agonist treatments (OAT) with methadone and buprenorphine to treat opioid use disorder in jails and prisons in the United States.

Design: Qualitative analysis: semi-structured interviews were conducted and thematic analyses of transcripts and notes were performed using a hybrid inductive/deductive coding approach.

Setting: Jails and prisons in the United States. Read More

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Correction to: Impact of safety warnings for fluoroquinolones on prescribing behaviour. Results of a cohort study with outpatient routine data.

Infection 2021 May 17. Epub 2021 May 17.

Division of Infectious Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.

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Diabetes prevention in the Caribbean using Lifestyle Intervention and Metformin Escalation (LIME): Protocol for a hybrid Type-1 effectiveness-implementation trial using a quasi-experimental study design.

Contemp Clin Trials Commun 2021 Jun 11;22:100750. Epub 2021 Mar 11.

Yale School of Medicine, New Haven, CT, USA.

Background: Globally, several diabetes prevention interventions have been shown to be cost-effective, yet they have had limited adaptation, implementation, and evaluation in the Caribbean and among Caribbean-descent individuals, where the burden of type 2 diabetes is high. We report on the protocol for the Lifestyle Intervention with Metformin Escalation (LIME) study - an evidence-based diabetes prevention intervention to reduce the incidence of diabetes among Caribbean-descent individuals with prediabetes.

Methods: LIME is a hybrid type-I effectiveness-implementation quasi-experimental study taking place in 4 clinical sites in Barbados, Trinidad, the U. Read More

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General practice responses to opioid prescribing feedback: a qualitative process evaluation.

Br J Gen Pract 2021 May 11. Epub 2021 May 11.

University of Leeds, Academic Unit of Primary Care, Leeds, United Kingdom.

Background: The rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations and mortality. We developed and implemented an evidence-based bi-monthly feedback intervention to reduce opioid prescribing targeting 316 general practices in West Yorkshire over one year.

Aim: To understand how general practice staff received and responded to the feedback intervention. Read More

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Examining current patterns of opioid prescribing and use after bariatric surgery.

Surg Endosc 2021 May 12. Epub 2021 May 12.

Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.

Background: Evidence-based guidelines on the appropriate amount of opioid medications to prescribe following bariatric surgery are lacking. We sought to determine our current opioid-prescribing practices, patient utilization, and satisfaction with pain control following elective bariatric surgery.

Methods: A retrospective chart review and phone survey were conducted on patients who underwent laparoscopic or robotic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from April 2018 to March 2019 at a single academic medical center. Read More

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Changes in Provider Prescribing Behavior for Infants with Single Ventricle Physiology After Evidence-Based Publications.

Pediatr Cardiol 2021 Jun 11;42(5):1224-1232. Epub 2021 May 11.

University of Utah Division of Pediatric Cardiology and Primary Children's Hospital, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.

Background: The impact of published evidence on clinical practice has been understudied in pediatric cardiology.

Objective: We sought to assess changes in prescribing behavior for angiotensin-converting enzyme inhibitor (ACEI) and digoxin at discharge after initial palliation of infants with single ventricle (SV) physiology following the publication of two large studies: The Pediatric Heart Network Infant Single Ventricle (PHN-ISV) trial showing no benefit with routine ACEI use and the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) analysis showing an association between digoxin and survival.

Methods: ICD-9-10 codes identified SV infants from the Pediatric Health Information System (1/2004 to 1/2018) and charge codes identified medications at discharge. Read More

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Antimicrobial Stewardship: A Review for Internal Medicine Physicians.

Cureus 2021 Apr 9;13(4):e14385. Epub 2021 Apr 9.

Infectious Diseases, Staten Island University Hospital, Staten Island, USA.

Antimicrobial stewardship is the need of the hour to prevent the collapse of our health care system at the hands of a pandemic of resistant pathogens. Inappropriate and indiscriminate abuse of antibiotics has left very few options for prescribing physicians as most of the pathogens, particularly gram-negative, are resistant to the major antibiotics. This article reviews the importance of Antimicrobial Stewardship Programs (ASP) for internal medicine physicians and residents. Read More

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Clinical management of severe infections caused by carbapenem-resistant gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations.

Clin Microbiol Infect 2021 May 8. Epub 2021 May 8.

Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy; Division of Infectious Diseases, Department of Internal Medicine I, German Centre for Infection Research, University of Tübingen, Tübingen, Germany; German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen, Germany.

Objectives: Optimal treatment of carbapenem-resistant Gram-negative bacteria (CR-GNB) infections is uncertain because of the lack of good-quality evidence and the limited effectiveness of available antibiotics. The aim of this survey was to investigate clinicians' prescribing strategies for treating CR-GNB infections worldwide.

Methods: A 36-item questionnaire was developed addressing the following aspects of antibiotic prescribing: respondent's background, diagnostic and therapeutic availability, preferred antibiotic strategies and rationale for selecting combination therapy. Read More

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Genitourinary symptoms in women with breast cancer: what do oncology health professionals think and do about them?

Breast Cancer 2021 May 11. Epub 2021 May 11.

NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.

Objectives: We aimed to improve understanding of health professional knowledge and management of genitourinary symptoms (GUS) in women with early breast cancer (EBC).

Methods: A survey was sent to 872 health professionals caring for women with EBC. Questions addressed most common GUS seen, experience treating GUS, and attitudes to treatment options. Read More

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Effectiveness of Trainings of General Practitioners on Antibiotic Stewardship: Methods of a Pragmatic Quasi-Experimental Study in a Controlled Before-After Design in South-East-Lower Saxony, Germany (WASA).

Front Pharmacol 2021 22;12:533248. Epub 2021 Apr 22.

Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.

Antibiotic resistance is a serious threat to global public health. It reduces the effectiveness of treatments for serious bacterial infections and thus increases the risk of fatal outcomes. Antibiotic prescriptions are often not in line with clinical evidence-based guidelines. Read More

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