Bilateral emphysematous pyelonephritis (EPN) is an extremely uncommon, life-threatening gas-forming infection of renal parenchyma and its surrounding areas. Surgical treatment, including percutaneous catheter drainage and nephrectomy, has been advocated as the treatment of choice in most of the patients. However, nephrectomy is itself a hazardous intervention in an unstable septic ...

BACKGROUND/AIMS: Acute Kidney Injury (AKI) is a common clinical problem. An increase in the severity of AKI is associated with increased mortality and worse prognosis. Many patients presenting with AKI also take long term medications which may potentially exacerbate or precipitate AKI. However no study has examined the role of ...

BACKGROUND: Despite the frequent occurrence of acute kidney injury (AKI) associated with meticillin-resistant Staphylococcus aureus (MRSA) infection during treatment, the adverse impact of renal injury on clinical and economic outcomes has not been evaluated. AIM: To study the clinical and economic burdens of MRSA bacteraemia and the impact of AKI ...

Cigarette smoking is a leading cause of preventable death in the world. Medical students play a role in smoking prevention especially as future physicians, but also as role models in society. Their approach, although influenced by medical education, is based on cultural and socio-economic background. The aim of this study ...

To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) ≤40 ml/min/1.73 m(2)) and the effectiveness of automatic eGFR ≤40-alerts relayed to community pharmacists. Clinical survey. The city of Zwolle, The Netherlands, in a primary care setting including 22 community ...

The 19th century was a period of momentous scientific discoveries, technological achievements, and societal changes. A beneficiary of these revolutionary upheavals was medical empiricism that supplanted the rationalism of the past giving rise to early modern scientific medicine. Continued reliance on sensory data now magnified by technical advances generated new ...

OBJECTIVE: Examine the mediating effect of injectable drugs in the relationship between dialysis facility organizational status and patient mortality. STUDY SETTING: Medicare dialysis population. STUDY DESIGN: Data from the U.S. Renal Data System (USRDS) were used to identify 3,884 freestanding dialysis facilities and 37,942 Medicare patients incident to end-stage renal ...

Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002-2008 were enrolled. ...

To examine relationships among applicant personality, Multiple Mini-Interview (MMI) performance, and medical school acceptance offers. The authors conducted an observational study of applicants who participated in the MMI at the University of California, Davis, School of Medicine during the 2010-2011 admissions cycle and responded to the Big Five Inventory measuring ...

OBJECTIVE:To study the effect of a neurohospitalist service on length of stay, cost, patient satisfaction, and education at an academic medical center. METHODS:This was a retrospective cohort study using administrative data, educational surveys, and standardized patient satisfaction surveys to compare outcomes in the 21 months before (n = 343) and ...

ABSTRACT: BACKGROUND: No national study has investigated whether immigrant workers are less likely than U.S.-workers to seek medical treatment after occupational injuries and whether the payment source differs between two groups. METHODS: Using the 2004-2009 Medical Expenditure Panel Survey (MEPS) data, we estimated the annual incidence rate of nonfatal occupational ...

BACKGROUND: The aim of this study was to assess the impact of a short message service (SMS)-based strategy on adherence to antipsychotic treatment. METHODS: A multicentre, randomised, open-label, controlled, 6-month study with clinically stabilised outpatients with schizophrenia was conducted. The patients assigned to the intervention received daily SMS reminders to ...

AIM: To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency. DESIGN: Prospective cohort survey. SETTING: United Kingdom, Canada, Australia and the United States. PARTICIPANTS: A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed ...

Modest or even occasional nonadherence to combined antiretroviral therapy (cART) can result in adverse clinical outcomes. African Americans demonstrate lower rates of adherence than Caucasians or Latinos. Identifying factors that influence medication adherence among African Americans is a critical step toward reducing HIV/AIDS disease progression and mortality. In a sample ...

BACKGROUND: Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics. OBJECTIVE: To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics. DESIGN: An observational study of asthma beliefs and ...

Background. Use of asthma medication is common among athletes. In 2009, the World Anti-Doping Committee (WADA) and the International Olympic Committee removed the need to document asthma by lung function tests before the use of inhaled β2-agonists. Methods. We assessed the changes in asthma medication use in Finnish Olympic athletes ...

PURPOSE: We examined the extent of concurrent use of antiplatelets, anticoagulants, or digoxin with Chinese medications (CMs) and identified its associated factors. METHODS: A retrospective cohort study was conducted using one million random samples from the Longitudinal Health Insurance Database 2005 in Taiwan. High-risk Western medications (HRWMs) focused on in ...

BACKGROUND: One-third of patients who receive cardiac resynchronization therapy (CRT) are classified as nonresponders. Characteristics of responders to CRT have been studied in multiple clinical trials. HYPOTHESIS: Independent predictors of CRT response may be identified by studying a series of patients in routine clinical practice. METHOD: One hundred twenty-five patients ...

BACKGROUND: Nonadherence to chronic disease medications is important. A growing body of literature suggests that better delivery of established therapies would save more lives than would discovery of innovations. Our first objective was to quantify the proportion of adherence to statin medications. The second objective was to provide estimates of ...

OBJECTIVE: In this study we tested the association of the medical home with family functioning for children without and with special health care needs (CSHCN). METHODS: We used data from the 2007 National Survey of Children's Health to run multivariate logistic regressions to test the association between having a medical ...

BACKGROUND: Patients with peripheral artery disease (PAD) are at high risk of cardiovascular events and benefit from aggressive secondary prevention; however, changes in use of cardioprotective medications after incident diagnosis of PAD have not been well-described. METHODS AND RESULTS: We used Danish nationwide administrative registries (2000-2007) to identify 2 groups ...

BACKGROUND:Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications ...

Background: Duration of thromboprophylaxis beyond hospital discharge for medically ill patients has been controversial. So an evaluation was made for the evidence currently available. Methods: A search was made of the Pub Med, CENTRAL and EMBASE databases for randomized controlled trials from 1966 through 2011. Interventions included thromboprophylaxis administered over an ...

Admission to an anesthesiology residency in the United States is competitive, and the odds associated with a successful match based on the applicants' characteristics have not been determined. The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. The study was ...

To measure the effect of nurse practitioner and pharmacist consultations on the appropriate use of medications by patients. We studied patients in the intervention arm of a randomized controlled trial. The main trial intervention was provision of multidisciplinary team care and the main outcome was quality and processes of care ...

Background/Aims Weight gain is an undesirable side effect of treatment with 2nd/3rd generation antipsychotic drugs which may have genetic determinants. A number of candidate genes have been analyzed but no genome-wide association studies (GWAS) have yet been reported. The purpose of this study was to determine the rate of extreme ...

The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary ...

Visual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients' problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management of medication. To compare issues relating to medication self-management between older people with and ...

Background/Aims Identifying factors related to readmission is important for successfully targeting appropriate interventions to groups at risk for readmission. The objective of this study was to investigate the association of long-term medication adherence with hospital readmission in a cohort of beneficiaries enrolled in a Medicare cost plan. Methods The study ...

BACKGROUND: As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients prescribed a medication that could interact with ...

BACKGROUND: Exchange of prescription medications is a significant public health problem particularly among substance abusing populations. Little is known about the extent of medication sharing and receiving behaviors in methadone maintenance treatment (MMT) populations and the factors associated with such behaviors. METHODS: We examined rates, and factors associated with past ...

Objectives.  The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses ...

PURPOSE: The need to develop effective tools to measure professionalism continues to challenge medical educators; thus, as a follow-up to a recent examination of the "Conscientiousness Index" (CI, a novel measure of one facet of professionalism) in one setting with preclinical medical students, the authors aimed to investigate the validity ...

BACKGROUND: To determine the incidence of electrographic seizures during continuous electroencephalography (cEEG) in the medical and surgical ICU. METHODS: We retrospectively reviewed the records of all adults who underwent cEEG in our medical and surgical ICU over a 4.5 year period. Patients with acute brain injury were excluded. Our primary outcome ...

OBJECTIVE:: To investigate the association between opioid utilization and catastrophic claim (≥$100,000) cost. METHOD:: A total of 12,226 workers' compensation indemnity claims that were opened and closed from January 1, 2006 to February 28, 2010 in the State of Michigan were selected for multivariate logistic regression analyses. RESULT:: Controlling for ...

Objective: The study's objective was to assess self-awareness and medical recognition of migraine and their determinants in Germany.Methods: We conducted a nationally representative study of the general population of Germany (N = 7341, aged ≥18 years) by means of computer-assisted telephone interviews. Migraine was diagnosed based on the International Classification of Headache ...

BACKGROUND: Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. METHODS: We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of ...

Purpose The implementation and effects of an initiative to refer patients to receive medication therapy management (MTM) services after hospital discharge are described. Methods A check box to order an MTM appointment was added to the discharge medication order form printed for hospitalized patients in an integrated health system. Hospitalists ...

Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course ...

Increasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications. Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in ...

Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. Prospective cohort study Patients over 64 years of age admitted with heart failure, acute coronary ...

BACKGROUND: Up to 50 % of patients do not take medications as prescribed. Interventions to improve adherence are needed, with an understanding of which patients benefit most. OBJECTIVE: To test the effect of two low-literacy interventions on medication adherence. DESIGN: Randomized controlled trial, 2 × 2 factorial design. PARTICIPANTS: Adults with coronary heart ...

BACKGROUND: Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied. OBJECTIVE: To evaluate the impact of localizing general medical teams to a single nursing unit. DESIGN: Quasi-experimental study using historical and concurrent controls. SETTING: A 490-bed academic medical center ...

OBJECTIVE: To determine how often serious or life-threatening medication administration errors with the potential to cause harm (potential adverse drug events) result in actual harm (adverse drug events (ADEs)) in the hospital setting. DESIGN: Retrospective chart review of clinical events following observed medication administration errors. BACKGROUND: Medication errors are common ...

OBJECTIVE: Treatment of schizophrenia (SCZ) was revolutionized with the development of the antipsychotic medications. Although imaging studies have linked antipsychotic D(2) receptor occupancy and clinical response in SCZ, heterogeneity between cohorts and methods has made it challenging to generalize findings across studies. The main objective of this meta-analysis was to ...

BACKGROUND: Factors contributing to medication nonadherence among patients with chronic obstructive pulmonary disease (COPD) are poorly understood. OBJECTIVES: To identify patient characteristics that are predictive of adherence to inhaled medications for COPD and, for patients on multiple inhalers, to assess whether adherence to one medication class was associated with adherence ...

BACKGROUND:The elderly population is at a high risk of medication misadventure, with many studies reporting a high number of medication-related problems (MRPs) in this group.OBJECTIVE:To quantify MRPs in residential facilities routinely reviewed by pharmacists and compare these RESULTS: This cross-sectional study included deidentified residents' health and medication data from 6 ...

Abstract The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from ...

Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs). To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after ...

Abstract Objective Generic medicines are often used in public hospitals. However, data on the quality of generic alendronate, its efficacy, side effects and medication adherence in clinical practice is scarce. Therefore, this study aimed to compare the side effects and medication adherence of generic (Apo-alendronate * ) and proprietary alendronate ...