CDRHNew
Date: September 30, 2015
The following new items were added to the CDRH web pages on September 29, 2015. Previous CDRH New Items can be found on theCDRHNew Page.
miércoles, 30 de septiembre de 2015
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. - PubMed - NCBI
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. - PubMed - NCBI
Recent coronary stent placement and noncardiac surgery contribute to the risk of adverse cardiac events, but the relative contributions of these two factors have not been quantified. This research was designed to determine the incremental risk of noncardiac surgery on myocardial infarction (MI) and coronary revascularization following coronary stenting. A U.S. retrospective cohort study of patients receiving coronary stents at Veterans Affairs medical centers between 2000 and 2010 was used to match patients undergoing noncardiac surgery within 24 months of stent placement to two patients with stents not undergoing surgery. Patients were matched on stent type and cardiac risk factors present at the time of stent placement. A composite endpoint of MI and/or cardiac revascularization for the 30-day interval post-surgery was calculated. Adjusted risk differences (RD) were compared across time periods following stent implantation, using generalized estimating equations. We matched 20,590 surgical patients to 41,180 nonsurgical patients. During the 30-day interval following noncardiac surgery, the surgical cohort had higher rates of the composite cardiac endpoint (3.1% vs. 1.9%; RD: 1.3%; 95% confidence interval: 1.0% to 1.5%). The incremental risk of noncardiac surgery adjusted for surgical characteristics ranged from 3.5% immediately following stent implantation to 1% at 6 months, after which it remained stable out to 24 months. Factors associated with a significant reduction in risk following surgery more than 6 months post-stent included elective inpatient procedures (ΔRD: 1.8%; p = 0.01), high-risk surgery (ΔRD: 3.7%; p = 0.01), and drug-eluting stent (DES) (ΔRD: 1.3%; p = 0.01). The incremental risk of noncardiac surgery on adverse cardiac events among post-stent patients is highest in the initial 6 months following stent implantation and stabilizes at 1.0% after 6 months. Elective, high-risk, inpatient surgery, and patients with DES may benefit most from delay from a 6-month delay after stent placement.
J Am Coll Cardiol. 2014 Dec 30;64(25):2730-9. doi: 10.1016/j.jacc.2014.09.072.
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting.
Abstract
BACKGROUND:
OBJECTIVES:
METHODS:
RESULTS:
CONCLUSIONS:
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
adverse; coronary stent; post-operative; surgery
Comment in
- What to do when a patient with coronary stents needs surgery? [J Am Coll Cardiol. 2014]
- ACP Journal Club. Noncardiac surgery ≤ 2 y after coronary stent placement was linked to perioperative MI and all-cause mortality. [Ann Intern Med. 2015]
- PMID:
- 25541124
- [PubMed - indexed for MEDLINE]
Understanding safety in prehospital emergency medical services for children. - PubMed - NCBI
Understanding safety in prehospital emergency medical services for children. - PubMed - NCBI
For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services (EMS), particularly in regard to children. Roughly 27.7 million (or 27%) of the annual emergency department visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. We conducted four 8- to 12-person focus groups among paid and volunteer EMS providers to understand 1) patient safety issues that occur in the prehospital care of children, and 2) factors that contribute to these safety issues (e.g., patient, family, systems, environmental, or individual provider factors). Focus groups were conducted in rural and urban settings. Interview transcripts were coded for overarching themes. Key factors and themes identified in the analysis were grouped into categories using an ecological approach that distinguishes between systems, team, child and family, and individual provider level contributors. At the systems level, focus group participants cited challenges such as lack of appropriately sized equipment or standardized pediatric medication dosages, insufficient human resources, limited pediatric training and experience, and aspects of emergency medical services culture. EMS team level factors centered on communication with other EMS providers (both prehospital and hospital). Family and child factors included communication barriers and challenging clinical situations or scene characteristics. Finally, focus group participants highlighted a range of provider level factors, including heightened levels of anxiety, insufficient experience and training with children, and errors in assessment and decision making. The findings of our study suggest that, just as in hospital medicine, factors at the systems, team, child/family, and individual provider level system contribute to errors in prehospital emergency care. These factors may be modifiable through interventions and systems improvements. Future studies are needed to ascertain the generalizability of these findings and further refine the underlying mechanisms.
Prehosp Emerg Care. 2014 Jul-Sep;18(3):350-8. doi: 10.3109/10903127.2013.869640. Epub 2014 Mar 26.
Understanding safety in prehospital emergency medical services for children.
Abstract
OBJECTIVE:
METHODS:
RESULTS:
CONCLUSIONS:
KEYWORDS:
child health services; delivery of care; emergency medicine; health services research; safety
Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes. - PubMed - NCBI
Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes. - PubMed - NCBI
Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the "prescription origin code" in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider's panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations.
AHRQ Study: Electronic Prescribing Linked to Fewer Adverse Drug Events Among Patients With Diabetes
Physicians who primarily issue prescriptions electronically have lower rates of adverse drug events (ADEs) among their patients with diabetes, according to an AHRQ study in the Journal of the American Medical Informatics Association. The study used 2011 Medicare Part D drug claims data, representing nearly 28 million Medicare beneficiaries, to investigate ADE rates of physicians who used e-prescribing for 50 percent or more of prescriptions (and therefore met the CMS meaningful use stage 2 threshold for e-prescribing). Those physicians were compared with physicians who prescribed primarily in writing, by telephone or in other ways. Of nearly 130,000 physicians included in the study, 25 percent were considered high e-prescribers because they met the meaningful use threshold in 2011. Five percent of high e-prescribers had at least one patient with an ADE, compared with 6.5 percent of low e-prescribers. High e-prescribing was associated with a reduced risk of hospital or emergency department visits for hypoglycemia or ADEs related to anti-diabetes medications. The study, “Meaningful Use Stage 2 E-Prescribing Threshold and Adverse Drug Events in the Medicare Part D Population With Diabetes,” and abstract were published May 6. Co-authors included AHRQ’s William Encinosa, Ph.D.
J Am Med Inform Assoc. 2015 Sep;22(5):1094-8. doi: 10.1093/jamia/ocv036. Epub 2015 May 6.
Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes.
Abstract
© The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
KEYWORDS:
Medicare Part D; adverse drug events; electronic prescribing
- PMID:
- 25948698
- [PubMed - in process]
Behavioral Programs for Diabetes Mellitus - Research Review - Final | AHRQ Effective Health Care Program
Behavioral Programs for Diabetes Mellitus - Research Review - Final | AHRQ Effective Health Care Program
AHRQ Issues New Report on Behavioral Programs for Diabetes
A new report from AHRQ examined how effective behavioral programs can be in helping type 1 and type 2 diabetes patients control glucose levels. For those with type 1 diabetes, behavioral programs improve glycemic control when follow-up with patients from health care providers lasts up to six months. Type 2 diabetes patients received limited benefit in controlling glucose levels from diabetes self-management education programs that provided 10 hours or less of interaction with a health care provider. Both diabetes self-management education and lifestyle programs – such as structured weight loss and physical activity interventions – can have benefits in terms of glycemic control. However, lifestyle programs appear better for reducing body mass index than programs that focus only on diabetes self-management. Select to access the full report. The studies on behavioral interventions for type 1 and type 2 diabetes were published online in the September 29 issue of Annals of Internal Medicine.
Population Health: Behavioral and Social Science Insights | Agency for Healthcare Research & Quality
Population Health: Behavioral and Social Science Insights | Agency for Healthcare Research & Quality
AHRQ, NIH Release Book on Population Health
A new book, titled Population Health: Behavioral and Social Science Insights and produced jointly by AHRQ and NIH’s Office of Behavioral and Social Sciences Research, is a collection of papers that highlight the varied contributions of the behavioral and social sciences to population health. While much health research seeks to improve the health of an individual, there is much to be learned by understanding the context in which individual and community health problems develop. This understanding may lead to interventions developed from collaborations from the behavioral and social sciences that improve health and well-being both to individuals and to populations with common systemic risk factors. Each chapter in the newly released book considers an area of investigation and ends with suggestions for future research and implications of current research for policy and practice. In the foreword, AHRQ Director Richard Kronick, Ph.D., states that health care by itself is limited in its capacity to remedy all the challenges of poor health outcomes. Both agencies hope this book stimulates rigorous and relevant research that will improve the health of the nation.
Population Health: Behavioral and Social Science Insights
Edited by Robert M. Kaplan, Michael L. Spittel, Daryn H. David
The Agency for Healthcare Research and Quality's mission is to produce evidence to make health care safer, improve health care quality, and make it more accessible, equitable, and affordable; a parallel goal is to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. The agency has a strong commitment to disseminate the best available evidence to improve health outcomes from the patient perspective. AHRQ publishes reports that are relevant to improving population health. This report focuses on factors within the health care delivery system, including where health disparities are improving and where they have stayed the same or gotten worse.
Download Information
- Population Health: Behavioral and Social Science Insights [
PDF File - 21.8 MB].
Persons using assistive technology may not be able to fully access information in the above files. For assistance, contact Mary Grady at (301) 427-1891 or Mary.Grady@ahrq.hhs.gov. The accessible version will be available by October 2015.
This report has been jointly produced by the Agency for Healthcare Research and Quality (AHRQ) and the Office of Behavioral and Social Sciences Research, National Institutes of Health (NIH). The findings and conclusions presented herein are those of the authors, who are responsible for the content; the findings and conclusions do not necessarily represent the views of AHRQ, NIH, or the U.S. Department of Health and Human Services.
This document is in the public domain and may be used and reproduced without permission, except for those materials that are subject to copyright. Such materials are clearly identified herein; further use of these materials will require permission from the third-party copyright holders.
Suggested citation: Kaplan R, Spittel M, David D (Eds). Population Health: Behavioral and Social Science Insights. AHRQ Publication No. 15-0002. Rockville, MD: Agency for Healthcare Research and Quality and Office of Behavioral and Social Sciences Research, National Institutes of Health; July 2015.
Page last reviewed July 2015
Internet Citation: Population Health: Behavioral and Social Science Insights. July 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/population-health/index.html
Reducing Preconception Risks Among African American Women with Conversational Agent Technology. - PubMed - NCBI
Reducing Preconception Risks Among African American Women with Conversational Agent Technology. - PubMed - NCBI
Systems and tools are needed to identify and mitigate preconception health (PCH) risks, particularly for African American (AA)women, given persistent health disparities. We developed and tested "Gabby," an online preconception conversational agent system. One hundred nongravid AA women 18-34 years of age were screened for over 100 PCH risks and randomized to the Gabby or control group. The Gabby group interacted with the system for up to six months; the control group received a letter indicating their health risks with a recommendation to talk with their clinician. The numbers, proportions, and types of risks were compared between groups. There were 23.7 (SD 5.9) risks identified per participant. Eighty-five percent (77 of 91) provided 6 month follow up data. The Gabby group had greater reductions in the number (8.3 vs. 5.5 risks, P < .05) and the proportion (27.8% vs 20.5%, P < 0.01) of risks compared to controls. The Gabby group averaged 63.7 minutes of interaction time. Seventy-eight percent reported that it "was easy to talk to Gabby" and 64% used information from Gabby to improve their health. Gabby was significantly associated with preconception risk reduction. More research is needed to determine if Gabby can benefit higher risk populations and if risk reduction is clinically significant.
Online Interactive System Helps Lower Women’s Health Risks Before Pregnancy, AHRQ-Funded Study Finds
African-American women who interacted with an online “conversational agent” to discuss health risks before becoming pregnant had significantly lower risks than women who didn’t use the system, according to results of a new AHRQ-funded study. The “Gabby System” was developed to help young (ages 18-34), college-attending African American women identify and learn about preconception health risks and get information about behavior change. Women who interacted with Gabby over a six-month period through biweekly emails with links to information had a higher proportion (28 percent vs. 21 percent) and a greater average number (8.3 vs. 5.5) of risks that were resolved compared with women who did not interact with Gabby. Interactions included a greeting from Gabby, a review of identified health risks, a discussion of risks selected by women and a review and update of their health to-do list. The most common content area requested by participants was nutrition and activity, followed by infectious disease, environmental issues and immunization and vaccines. The Gabby system holds promise for improving access to the primary and preventive care assessments that women need to prepare for pregnancy, study authors concluded. “Reducing Preconception Risks Among African American Women With Conversational Agent Technology” and abstract were published in the July/August issue of the Journal of the American Board of Family Medicine.
J Am Board Fam Med. 2015 Jul-Aug;28(4):441-51. doi: 10.3122/jabfm.2015.04.140327.
Reducing Preconception Risks Among African American Women with Conversational Agent Technology.
Jack B1, Bickmore T2, Hempstead M2, Yinusa-Nyahkoon L2, Sadikova E2, Mitchell S2, Gardiner P2, Adigun F2, Penti B2, Schulman D2, Damus K2.
Abstract
BACKGROUND:
METHODS:
RESULTS:
CONCLUSION:
© Copyright 2015 by the American Board of Family Medicine.
KEYWORDS:
Health Care Disparities; Health Information Technology; Health Promotion; Preconception Care; Reproductive Health
- PMID:
- 26152434
- [PubMed - in process]
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