Clinicobacteriological evaluation of leprosy patients with 1-5 skin lesions.

Background: Mycobacterium leprae is a noncultivable mycobacteria, and diagnosis of the disease is based on its clinical and histopathological characteristics and finding the bacteria in skin scrapings and in biopsies taken from the patients. The aim of this study was to shed light on the clinical classification (based on the number of skin lesions) used extensively in the field where patients classified as paucibacillary (PB) were positive on skin smears and histopathology leading to treatment failure and drug resistance. Methods: In this study, we enrolled untreated 62 leprosy patients with 1-5 skin lesions and did a detailed bacterio-histopathological analysis by slit-skin smears (SSSs) and histopathology. Results: Of 62 patients analyzed, 15 patients came out to be multibacillary (MB) and 47 were PB by SSS and histopathology. Conclusion: The findings of the present study showed that the WHO classification of leprosy based on the number of lesions seems to be inappropriate as it considers a number of MB lesions as PB only, thus misleading the treatment strategies. Hence, it is essential that a comprehensive clinicobacteriological assessment of leprosy cases should be done to ensure the appropriate bacillary status and guiding the appropriate treatment strategy.

The evaluation of efficacy and safety of methotrexate and pioglitazone in psoriasis patients: A randomized, open-labeled, active-controlled clinical trial.

OBJECTIVES: Psoriasis is a chronic inflammatory disease showing co-existence with metabolic syndrome (MS), as has been confirmed by numerous epidemiologic studies in recent times. In this study, the aim was to ascertain the beneficial effects of pioglitazone in psoriasis, simultaneously targeting the improvement of MS parameters. MATERIALS AND METHODS: We conducted a prospective randomized open-labeled parallel-group interventional study in patients of moderate-to-severe chronic plaque psoriasis. A total of 90 patients were inducted in study and divided into three groups of standard treatment (methotrexate 7.5 mg/week for 12 weeks), active treatment (pioglitazone 15 mg tablets once daily for 12 weeks), and their combination. Primary outcome was taken as percentage Psoriasis Area and Severity Index (PASI) improvement from baseline; secondary outcomes were PASI-75, safety profile, and MS parameters. RESULTS: Intergroup evaluation of PASI score showed that standard treatment methotrexate and active treatment pioglitazone were comparable. Combination of methotrexate and pioglitazone proved superior in efficacy from both standard and active treatment in 8 and 12 weeks. Adverse drug reactions were mild and treated symptomatically. Pioglitazone and combination group also demonstrated beneficial efficacy in parameter of MS hence establishing it as a potential therapy in psoriasis with MS. CONCLUSIONS: Pioglitazone alone or in combination with standard treatment may be a safe alternative drug for psoriasis coexisting with MS proving beneficial for both.

Provider Adoption of Speech Recognition and its Impact on Satisfaction, Documentation Quality, Efficiency, and Cost in an Inpatient EHR.

This study utilizes qualitative and quantitative methods to measure the adoption of speech recognition (SR) and its impact ON provider satisfaction, documentation quality, efficiency, and cost when used for clinical documentation within the electronic health record (EHR). Qualitative surveys gauged providers' expectations and experiences regarding documentation before and after SR implementation. A new methodology was developed to measure SR adoption as a proportion of total documentation volume. Quantitative data was collected from the EHR, medical transcription and SR solutions to measure SR adoption and cost savings. Study results revealed significant improvements in satisfaction, documentation quality, and efficiency among providers as a direct result of SR use. An improved provider experience correlated to an 81% reduction in monthly medical transcription costs, an increase from 20% to 77% in electronic clinical documentation adoption, and a 74% SR adoption rate.

Improving patient safety by modifying provider ordering behavior using alerts (CDSS) in CPOE system.

Medication errors are not unusual in acute care settings. This prospective time series analysis/study evaluates the use of Clinical Decision Support System (CDSS)/alerts in helping providers not to make errors, when putting in orders in a CPOE system. We reviewed electronic health records for all the inpatients coming to 5 community hospitals for a 6 months duration (July 2010 - December 2010). Responses to 9 synchronous alerts (CDSS tools) were studied, that were prompted on computer screens when providers were putting in medication orders in EMR. These alerts guided the providers regarding any drug duplications, interactions, contraindications of the prescribed medicine with patient's clinical condition etc. The CDSS system in place changed the physician behavior & patient therapy 41.75% of the times when medication orders were placed. These alerts substantially decreased the medication error rate/adverse drug events (ADE's) in the patients receiving care at these 5 hospitals.