Pettyovergaard5813

s in real time into electronic health records, along with pharmacist interventions within a team-based care model, may result in improved BP control and patient outcomes. OBJECTIVES The study aim was to characterize the Indiana community-based pharmacist preceptors' knowledge and perceptions of medication-assisted treatment (MAT) for opioid use disorder (OUD). The secondary objectives were to explore the desired resources, dispensing concerns, and preceptors' involvement in precepting students. DESIGN A 38-item survey was used to collect respondent demographics, knowledge, and perceptions of MAT for OUD. Perception questions were developed using the social cognitive theory and were adapted from previously published surveys with investigators' permission. SETTING Community-based Indiana pharmacist preceptors were eligible to complete an electronic survey in February and March 2019. OUTCOME MEASURES Descriptive statistics were used to characterize preceptor knowledge and perceptions of MAT for OUD. Desired MAT resources, dispensing concerns, and level of involvement in precepting students were collected. Respondent demographics were collected to characterize the study sample. REtunities exist to fill identified gaps in knowledge, enhance perceptions, and provide desired continuing education for community-based pharmacist preceptors on MAT for OUD. OBJECTIVE Psychiatric medications are among the drugs affected by cigarette smoke, and because of the high prevalence of smoking in the psychiatric community, psychiatric patients are particularly at risk when entering the smoke-free environment of a hospital. CASE SUMMARY Polycyclic aromatic hydrocarbons present in cigarette smoke are well-known inducers of cytochrome P450 (CYP) enzymes. CYP1A2 induction by cigarette smoking increases metabolic clearance of substrates of this enzyme; smoking cessation results in a decrease in CYP1A2 activity, which causes an increase in serum substrate levels. Although these effects are well documented, the effect of smoking cessation remains a hidden danger, in part, because computerized drug interaction surveillance systems are not designed to alert clinicians when an offending agent is discontinued. PRACTICE IMPLICATION To raise awareness and demonstrate the importance of a thorough assessment of smoking status, we present a case in which the temporal relationship of smoking cessation to the emergence of nausea, vomiting, and tachycardia 3 days later (day 3); the development of myoclonic jerks by day 5; and the resolution of symptoms on reduction of duloxetine dosage on day 44 implicates duloxetine toxicity in a patient with ischemic cardiomyopathy awaiting implantation of a left ventricular assist device. BACKGROUND Low health literacy has been associated with worse health outcomes, but little is known about the effectiveness of health literacy interventions developed for pregnant women. AIM To assess the effectiveness of health literacy interventions on pregnancy outcomes through a systematic review of randomised controlled trials. METHODS Randomised controlled trials that assessed health literacy interventions designed to improve pregnancy outcomes were included. The study protocol was registered with PROSPERO (CRD42018094958). FINDINGS Of the 1512 records initially identified, 13 studies were included. Three reported on decision-aid interventions, six on face-to-face interventions and four on written interventions (including computer-based interventions or information leaflets). The primary outcomes of interest for this systematic review were knowledge (10/13 studies) and health literacy (2/13 studies) with one study not reporting either primary outcome. A significant improvement in knowledge was found across the 10 studies, however the two studies which measured health literacy only assessed health literacy at a single time-point. Secondary outcomes including health behaviours, fetal outcomes and health-service utilisation were reported in 11 studies, with inconsistent results. DISCUSSION Few health literacy interventions have been developed specifically for pregnant women. Although health literacy interventions have the potential to improve knowledge and pregnancy outcomes, current evidence is limited by inconsistent outcomes and measurement, and limited use of health literacy theory to inform intervention design and content. Few studies directly measured health literacy. CONCLUSION More research is needed to properly assess the effect of health literacy interventions on pregnancy outcomes. This research should include consideration of health literacy theory in the development of the interventions. BACKGROUND Sweden, along with other countries, is facing rising intrapartum intervention rates. AIM To explore the medicalisation of childbirth through women's preferences for and use of pain relief, and to investigate whether the presence of a birth plan had any impact on use of pain relief, rate of intervention, and satisfaction with the birth experience. METHODS The study was cross-sectional, and included 129 women with birth plans and 110 without, all of whom gave birth in one hospital in Sweden between March and June 2016. Data from birth plans and medical records was analysed through descriptive statistics and logistic regression. FINDINGS Parity rather than birth plan was a greater determinant for use of pain relief, frequency of interventions, and level of satisfaction; primiparas used more pain relief, had more interventions, and were less satisfied with their birth experiences than multiparas. Epidural analgesia was associated with a two to threefold increase in interventions, but 79.5% of all women had some form of intervention during birth, regardless of having an epidural or not. Women were generally highly satisfied with their birth experiences, women without epidural analgesia and interventions slightly more so. CONCLUSION Contrary to their initial plans, especially primiparas used more pharmacological pain relief than intended, and nearly all (94.6%) had some form of intervention during labour and birth. More interventions were associated with lower levels of satisfaction. The high rate of intervention in a healthy population of birthing women is disquieting and requires further attention. BACKGROUND The underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake. AIM To explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan. METHODS Using a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth. FINDINGS We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women's risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays. DISCUSSION Efforts are needed at the community-level to facilitate care-seeking and raise awareness of stillbirth risk factors and the facility-level to strengthen antenatal and childbirth care quality, ensure culturally appropriate and respectful care, and reduce treatment delays. INTRODUCTION Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine characterized among other features by spinal boney proliferation, back pain, loss of flexibility, and increased fracture risk. Golvatinib Overlying bone limits the utility of bone mineral density (BMD) by dual X-ray absorptiometry (DXA) in the spine. Trabecular bone score (TBS) is a bone texture measurement derived from the spine DXA image that indicates bone quality and fracture risk independent of BMD. METHODOLOGY Using the Manitoba Bone Density Program database, patients with diagnosis codes for ankylosing spondylitis, baseline DXA and lumbar spine TBS were identified. Incident nontraumatic fractures (major osteoporotic [MOF], clinical spine, hip, and all fracture) were identified from population based databases. Cox-proportional hazard models are presented. RESULTS We identified 188 patients with diagnosed AS. TBS was lower in those with incident MOF (1.278 ± 0.126, compared to 1.178 ± 0.136, p less then 0.001). Unadjusted TBS and FRAX-MOF-BMD adjusted predicted major osteoporotic fracture (N = 19) (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.28-2.26, p = 0.003; HR 1.81, 95% CI 1.11-2.96, p = 0.018). TBS unadjusted and FRAX-MOF-BMD adjusted also predicted clinical spine fracture (N = 7) (HR 2.50, 95% CI 1.17-5.37; p = 0.019; HR 2.40 95% CI 1.1-5.25; p = 0.028). Higher HRs were observed for prediction of hip fracture (N = 6), but these did not achieve statistical significance (FRAX-adjusted HR 1.74, 95% 0.73-4.17; p = 0.211). Unadjusted models show TBS was predictive of all fracture (N = 27) (HR 1.60, 95% CI 1.08-2.39; p = 0.020), which was borderline significant after adjustment for FRAX-MOF-BMD (HR 1.51, 95% CI 1.00-2.29; p = 0.052). CONCLUSION We report the first analysis of TBS for fracture prediction as an incident event in AS. TBS independently predicted major osteoporotic and clinical spine fracture in AS independent of FRAX. RATIONALE AND OBJECTIVES To evaluate the quality and value of contrast-enhanced (CE) chest- and abdominal computed tomography (CT) and CT angiography in neonates, children, and adults undergoing extracorporeal membrane oxygenation (ECMO) using a customized protocol for contrast delivery. MATERIALS AND METHODS All patients admitted for CE thoracic- and/or abdominal CT while on ECMO were prospectively included in the study. A protocol for contrast delivery adapted for the type of ECMO circulation, cannulation sites, anatomy of interest, and desired contrast phase was applied. Clinical information, ECMO and CT technique, including contrast administration strategy, was noted for each patient. Two radiologists separately evaluated the quality of the scan. The value of the examination was decided in consensus with the referring ECMO physician. RESULTS One hundred thirty CE thoracoabdominal scans were performed at 103 different occasions during the study time. Eighty-nine scans were performed during veno-arterial ECMO and 41 during veno-venous ECMO. In the majority, contrast was delivered to the oxygenator with preserved ECMO flow. A peripheral or central venous line with reduced flow was utilized in the remaining cases. Mean scan quality was graded 4.2 on a five-grade scale. In 56% of the examinations, the findings affected the immediate treatment of the patient. CONCLUSION High-quality CT and CT angiography can be achieved in ECMO patients of different ages and clinical issues considering the type of ECMO circulation, ECMO cannulation sites, preferred contrast phase and anatomy of interest. CT diagnoses affect the treatment of the patient.