Beattybolton5432

BACKGROUND Most women are prescribed an opioid after hysterectomy. The goal of this study was to determine the association between initial opioid prescribing characteristics and chronic opioid use after hysterectomy. METHODS This study included women enrolled in a commercial health plan who had a hysterectomy between 1 July 2010 and 31 March 2015. We used trajectory models to define chronic opioid use as patients with the highest probability of having an opioid prescription filled during the 6 months post-surgery. A multivariable logistic regression was applied to examine the association between initial opioid dispensing (amount prescribed and duration of treatment) and chronic opioid use after adjusting for potential confounders. RESULTS A total of 693 of 50 127 (1.38%) opioid-naïve women met the criteria for chronic opioid use following hysterectomy. The baseline variables and initial opioid prescription characteristics predicted the pattern of long-term opioid use with moderate discrimination (c statistic = 0.70). Significant predictors of chronic opioid use included initial opioid daily dose (≥60 MME vs less then 40 MME, aOR 1.43, 95% CI 1.14-1.79) and days' supply (4-7 days vs 1-3 days, aOR 1.28, 95% CI 1.06-1.54; ≥8 days vs 1-3 days, aOR 1.41, 95% CI 1.05-1.89). Other significant baseline predictors included older age, abdominal or laparoscopic/robotic hysterectomy, tobacco use, psychiatric medication use, back pain, and headache. CONCLUSION Initial opioid prescribing characteristics are associated with the risk of chronic opioid use after hysterectomy. Prescribing lower daily doses and shorter days' supply of opioids to women after hysterectomy may result in lower risk of chronic opioid use. © 2020 John Wiley & Sons Ltd.BACKGROUND  Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing. OBJECTIVES AND METHODS  To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics. RESULTS  During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p  less then  0.001). CONCLUSION  This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Early electronic identification of patients at the highest risk for heart failure (HF) readmission presents a challenge. Data needed to identify HF patients are in a variety of areas in the electronic medical record (EMR) and in different formats. OBJECTIVE  The purpose of this paper is to describe the development and data validation of a HF dashboard that monitors the overall metrics of outcomes and treatments of the veteran patient population with HF and enhancing the use of guideline-directed pharmacologic therapies. METHODS  We constructed a dashboard that included several data points care assessment need score; ejection fraction (EF); medication concordance; laboratory tests; history of HF; and specified comorbidities based on International Classification of Disease (ICD), ninth and tenth codes. Data validation testing with user test scripts was utilized to ensure output accuracy of the dashboard. Nine providers and key senior management participated in data validation. RESULTS  A total of 43ds that will help improve care of individual patients and populations. Georg Thieme Verlag KG Stuttgart · New York.in English, German EINLEITUNG Verglichen mit herkömmlichen Betreuungsmodellen bietet die hebammengeleitete Geburtshilfe den Hebammen mehr Möglichkeiten ihre Kompetenzen einzusetzen. Dies wirkt sich positiv auf ihre Berufszufriedenheit aus. Ziel dieser Erhebung war eine Übersicht über die Berufssituation der Hebammen in den Geburtenabteilungen eines Schweizer Kantons zu erlangen und die Situation in Einrichtungen mit und ohne hebammengeleitete Geburtshilfe zu vergleichen. METHODIK Ein Online-Fragebogen wurde literaturbasiert entwickelt. click here Alle 17 Institutionen des Kantons Zürich, die über eine Geburtenabteilung verfügten, waren teilnahmeberechtigt. Die Daten wurden mit Stata 15 deskriptiv ausgewertet. ERGEBNISSE 16 Geburtenabteilungen (94,1%) nahmen an der Umfrage teil 12 öffentliche Kliniken, 2 Privatkliniken und 2 Geburtshäuser. Insgesamt 5 Einrichtungen (31,3%) boten hebammengeleitete Geburten an oder waren Geburtshäuser. In Institutionen mit hebammengeleiteter Geburtshilfe kannten sich die Frauen und die Hebamme häufiger schon vor Aufnahme zur Geburt als in solchen ohne (60,0 vs. 9.1%, p=0,063), es wurden weniger routinemässige Massnahmen durchgeführt (z. B. venöser Zugang 20,0 vs. 81,8%, p=0,036), die Hebammen hatten mehr Entscheidungskompetenzen sowie Verantwortung (z. B. selbständige Austrittsuntersuchung 60,0 vs. 9,1%, p=0,063) und nahmen häufiger Supervisionen in Anspruch (60,0 vs. 9,1%, p=0,013). FAZIT Das Fördern von hebammengeleiteten Betreuungsmodellen erhöht die Kontinuität in der Betreuung, senkt das Einsetzen von routinemässigen Massnahmen und fördert die eigenverantwortliche Übernahme von Aufgaben.