Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.192
Filtrar
1.
J Urol ; 203(1): 128-136, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31361571

RESUMEN

PURPOSE: To our knowledge it is unknown whether stereotactic body radiation therapy of prostate cancer is a substitute for other radiation treatments or surgery, or for expanding the pool of patients who undergo treatment instead of active surveillance. MATERIALS AND METHODS: Using SEER (Surveillance, Epidemiology, and End Results)-Medicare we identified men diagnosed with prostate cancer between 2007 and 2011. We developed physician-hospital networks by identifying the treating physician of each patient based on the primary treatment received and subsequently assigning each physician to a hospital. We examined the relative distribution of prostate cancer treatments stratified by whether stereotactic body radiation therapy was performed in a network by fitting logistic regression models with robust SEs to account for patient clustering in networks. RESULTS: We identified 344 physician-hospital networks, including 30 (8.7%) and 314 (91.3%) in which stereotactic body radiation therapy was and was not performed, respectively. Networks in which that therapy was and was not done did not differ with time in the performance of robotic and radical prostatectomy, and active surveillance (all p >0.05). The relationship with intensity modulated radiation therapy did not show any consistent temporal pattern. In networks in which it was performed less intensity modulated radiation therapy was initially done but there were similar rates in later years. Brachytherapy trends differed among networks in which stereotactic body radiation therapy was vs was not performed with a lower brachytherapy rate in networks in which stereotactic body radiation therapy was done (p=0.03). CONCLUSIONS: Surgery and active surveillance rates did not differ in networks in which stereotactic body radiation therapy was vs was not performed but when that therapy was done there was a lower brachytherapy rate. Stereotactic body radiation therapy may represent more of an alternative to brachytherapy than to active surveillance.


Asunto(s)
Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias de la Próstata/radioterapia , Radiocirugia , Anciano , Humanos , Estudios Longitudinales , Masculino , Programa de VERF , Estados Unidos
2.
J Opioid Manag ; 15(6): 499-506, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31850512

RESUMEN

BACKGROUND: As determinants of the opioid epidemic are several, describing patterns of opioid prescription over time is of importance. OBJECTIVE: To characterize the prescribing patterns of opioids per US region and physician specialty from 2012 to 2015. METHODS: Truven Health Analytics MarketScan® Databases were used to obtain data on opioid prescription rates per US region and physician specialty for the years 2012-2015. Opioids included in the study are tramadol, hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl. RESULTS: Starting sample consisted of 5,860,096 individuals. An increase in prescriptions was seen for codeine (22.3 percent), oxycodone (22.4 percent), and tramadol (22.4 percent), while other opioids had decreases between 6.5 and 20.2 percent during this period. Family medicine physicians were the most frequent prescriber for all opioids except for oxycodone; nonphysician prescribers' share of prescriptions nearly doubled for all opioids. The share of oxycodone and of tramadol among all opioids increased in all regions, while the opposite was seen for hydrocodone. Codeine prescription share increased substantially in the South but not in other regions. When comparing the period of 2012-2015, differences were significant for all regions (p < 0.0001 for all regions). In 2015, the rate of prescription of oxycodone was nearly twofold higher in the Northeast vs North Central (38 percent vs 18.5 percent, p < 0.0001), while tramadol was substantially more frequently prescribed in the South, where it responded to nearly 20 percent of all opioid prescriptions (p < 0.0001). CONCLUSION: Patterns of prescription per opioid vary considerably per physician specialty and per US region. Although an overall decrease in prescriptions was seen, certain opioids were more frequently prescribed in 2015 than in 2012.


Asunto(s)
Analgésicos Opioides , Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Humanos , Hidrocodona , Oxicodona , Pautas de la Práctica en Medicina/estadística & datos numéricos , Tramadol , Estados Unidos
3.
BMJ ; 367: l6015, 2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690553

RESUMEN

OBJECTIVE: To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN: Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING: Primary care, France. PARTICIPANTS: 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES: The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS: The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION: The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION: OSF register OSF.IO/8M3QR.


Asunto(s)
Industria Farmacéutica/economía , Prescripciones de Medicamentos/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Donaciones , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Industria Farmacéutica/estadística & datos numéricos , Prescripciones de Medicamentos/economía , Medicamentos Genéricos/economía , Femenino , Francia , Médicos Generales/economía , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Medicamentos bajo Prescripción/economía , Estudios Retrospectivos , Adulto Joven
5.
Gynecol Oncol ; 155(2): 359-364, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31575391

RESUMEN

OBJECTIVE: To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS: We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS: The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION: The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.


Asunto(s)
Educación de Postgrado en Medicina/tendencias , Becas/tendencias , Procedimientos Quirúrgicos Ginecológicos/educación , Ginecología/educación , Oncología Médica/educación , Becas/estadística & datos numéricos , Femenino , Florida , Procedimientos Quirúrgicos Ginecológicos/tendencias , Ginecología/tendencias , Humanos , Histerectomía/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Escisión del Ganglio Linfático/estadística & datos numéricos , Oncología Médica/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos
6.
Medicine (Baltimore) ; 98(38): e17265, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31568003

RESUMEN

BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]). CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.


Asunto(s)
Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Religión y Medicina , Adulto , Australia , Brasil , Dinamarca , Femenino , Alemania , Humanos , India , Indonesia , Masculino , Médicos/psicología , Religión , Encuestas y Cuestionarios , Estados Unidos
7.
J Opioid Manag ; 15(4): 333-341, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637685

RESUMEN

BACKGROUND: The use of opioid analgesics in the United States has increased nearly fourfold since 1999 resulting in a similar increase in opioid-related overdose deaths. Although the Centers for Disease Control published guidelines for prescribing chronic opioids, there is a lack of guidance for prescribing postoperative opioids. OBJECTIVE: To offer an evidence-based approach to prescribing opioids for post-operative pain management in the orthopedic setting. METHODS: A narrative review was performed of studies evaluating and quantifying opioid use in orthopedic patients in the postoperative setting, as well as studies analyzing patient satisfaction and perception with regards to opioid use. RESULTS: Studies show that postoperative pain may not be the largest contributing factor to developing an opioid use disorder, but rather patient factors such as tobacco and substance use disorder, mental health disorders, anxiety, mood disorders, pre-existing chronic pain, and recent opioid use may play a role. The review also found that most patients do not utilize significant portions of prescribed opioids and most do not require a refill. This trend leaves patients with thousands of unused pills, which are either retained, shared, or diverted. Although there is no guideline for prescribing opioids postoperatively, data suggest that clinicians can prescribe smaller dosages and fewer quantities of opioids initially. There are also non-opioid strategies that can be employed to reduce opioid consumption. CONCLUSION: There is a need for more high quality research to be conducted to standardize postoperative opioid prescribing patterns and create best practice guidelines to guide clinicians. Orthopedic practices should consider creating institutional guidelines to reduce the amount of opioids prescribed.


Asunto(s)
Analgésicos Opioides , Prescripciones de Medicamentos/estadística & datos numéricos , Trastornos Relacionados con Opioides , Pautas de la Práctica en Medicina , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Humanos , Trastornos Relacionados con Opioides/prevención & control , Procedimientos Ortopédicos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estados Unidos
8.
Sante Publique ; Vol. 31(3): 395-404, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31640327

RESUMEN

OBJECTIVE: The aim of this research is, on the one hand, to describe the customs and attitudes of Swiss general practitioners (GP) considering cardiovascular risk, and on the other, to put into perspective with the national recommendation Eviprev (summary representations of the primary and secondary preventions recommendations for patients aged between 18 and 70 years old). METHODS: The study was based on an online survey sent to general practitioners belonging to the same research network and who were randomly selected. The sample was made of 200 Swiss GP. This article focuses on the frequency with which GP give advice related to consumption of tobacco and alcohol, exercising and nutrition during a regular meeting with their patient or a first visit. The results were analyzed according to age, sex, linguistic area and the extent to which they lived in a city or in the countryside. RESULTS: Results suggest that the majority (97.6%) of GP show concern about informing patients on cardiovascular risk factors. Nonetheless most of the advice given are usually related to the patient's case and not given in a systematic way. Tobacco addiction is the most systematically discussed theme during a first visit (33.9%), exercise comes second (25.6%), then nutrition (16.1%), and finally alcohol consumption (18.5%). Differences in numbers based on the different languages are little, except dealing with exercise. CONCLUSIONS: Recommendations on prevention are followed by a majority of GP. Improvements could be made considering the training given and the remuneration of these counseling activities.


Asunto(s)
Actitud del Personal de Salud , Enfermedades Cardiovasculares/prevención & control , Médicos Generales/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Suiza , Adulto Joven
9.
Sante Publique ; Vol. 31(3): 459-467, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31640334

RESUMEN

INTRODUCTION: Patient education is an important component in the management and monitoring of chronic diseases. It plays an important role in the decline of the disease severity, mortality and socioeconomic burden and the complications of these chronic diseases. In Côte d'Ivoire, there are few studies to evaluate the reality of this activity. OBJECTIVE: To explore the practice of patient education in Ivory Coast. METHOD: This qualitative study has been carried out by means of semi-structured interviews with 24 healthcare professionals including 14 health managers for individual interviews and 10 care providers for focus group discussion. RESULTS: There are various representations of therapeutic patient education among health professionals. There was no real distinction between patient education and the broader concept of health education. Absence of national patient education policy, the lack of training in TPE and lack of experience of educational practice lead health professionals to realize an unstructured educational activity. CONCLUSION: These results show the need for Côte d'Ivoire to have a national policy of patient education to educate patients in accordance with international recommendations.


Asunto(s)
Enfermedad Crónica/terapia , Personal de Salud/psicología , Educación del Paciente como Asunto/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Costa de Marfil , Humanos , Investigación Cualitativa
10.
Medicine (Baltimore) ; 98(40): e17411, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577753

RESUMEN

Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. ß-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while ß-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.


Asunto(s)
Antihipertensivos/clasificación , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Adolescente , Factores de Edad , Beijing , Niño , Preescolar , Femenino , Humanos , Hipertensión/epidemiología , Lactante , Masculino , Pautas de la Práctica en Medicina/estadística & datos numéricos , Factores Sexuales , Población Urbana/estadística & datos numéricos
11.
BMJ ; 367: l5205, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578187

RESUMEN

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , /métodos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Medicina Estatal/estadística & datos numéricos , Antiinfecciosos/uso terapéutico , Conjuntos de Datos como Asunto , Sustitución de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Inglaterra , Medicina General/organización & administración , Medicina General/normas , Medicina General/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , /estadística & datos numéricos , Medicina Estatal/normas , Factores de Tiempo , Infecciones Urinarias/tratamiento farmacológico
12.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31584776

RESUMEN

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Asunto(s)
Dermatitis Atópica/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Nivel de Atención/estadística & datos numéricos , Administración Cutánea , Adolescente , Adulto , Antibacterianos/uso terapéutico , Niño , Preescolar , Estudios Transversales , Dermatólogos/estadística & datos numéricos , Femenino , Glucocorticoides/uso terapéutico , Encuestas de Atención de la Salud/estadística & datos numéricos , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Lactante , Recién Nacido , Masculino , Visita a Consultorio Médico/estadística & datos numéricos , Estados Unidos , Adulto Joven
13.
J Drugs Dermatol ; 18(9): 880-886, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31524343

RESUMEN

BACKGROUND: Poly-L-lactic acid (PLLA) is increasingly used for a range of indications, from HIV lipodystrophy to gluteal augmentation; however, there is no clear consensus on appropriate product preparation and use. OBJECTIVE: To establish current practices for PLLA reconstitution and usage in the USA. METHODS AND MATERIALS: A 19-question survey pertaining to the reconstitution and use of PLLA was distributed to members of the American Board of Cosmetic Surgery and American Board of Facial Cosmetic Surgery and at several cosmetic conferences. 410 questionnaires were returned anonymously over a 3-month period. The results were collated and analyzed. RESULTS: The commonest indication for PLLA was HIV lipodystrophy (46.8%), followed by gluteal augmentation (42.4%). For the face, the majority used a dilution of 9-10 mL (60.4%). For the gluteal region, the majority used a dilution greater than 21 mL (51.3%). Most respondents reconstituted PLLA in sterile water (59.8%) more than 21 hours before use (51.0%) and added lidocaine to the solution (94.7%). Most physicians used topical anesthetic cream (83.2%), manual agitation (85.8%) and recommended self-massage post-treatment (99.6%). CONCLUSION: There is considerable variation in PLLA reconstitution and use. Further well-designed studies are needed to establish the safest, most effective ways to use this product. J Drugs Dermatol. 2019;18(9):880-886.


Asunto(s)
Técnicas Cosméticas/estadística & datos numéricos , Rellenos Dérmicos/administración & dosificación , Revisión de la Utilización de Medicamentos/estadística & datos numéricos , Poliésteres/administración & dosificación , Anestésicos Locales , Nalgas , Rellenos Dérmicos/efectos adversos , Composición de Medicamentos/métodos , Composición de Medicamentos/estadística & datos numéricos , Cara , Humanos , Inyecciones Subcutáneas , Médicos/estadística & datos numéricos , Poliésteres/efectos adversos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Envejecimiento de la Piel/efectos de los fármacos , Soluciones , Solventes , Encuestas y Cuestionarios/estadística & datos numéricos
14.
Z Gastroenterol ; 57(9): 1059-1066, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31525798

RESUMEN

BACKGROUND: In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians' experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection. METHODS: At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10-15 minutes were conducted. RESULTS: Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative. CONCLUSIONS: The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.


Asunto(s)
Actitud del Personal de Salud , Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo/métodos , Médicos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Sigmoidoscopía , Colonoscopía , Detección Precóz del Cáncer , Alemania , Humanos , Sangre Oculta
15.
Br J Anaesth ; 123(5): 627-636, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31563269

RESUMEN

BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.


Asunto(s)
Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Trastornos Relacionados con Opioides/prevención & control , Dolor Postoperatorio/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Humanos , Manejo del Dolor/métodos , Cuidados Posoperatorios/métodos
16.
BMC Infect Dis ; 19(1): 768, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481023

RESUMEN

BACKGROUND: Bacterial ophthalmic infections are common. Empirical treatment with topical broad-spectrum antibiotics is recommended for severe cases. Antimicrobial resistance (AMR) to agents used for bacterial ophthalmic infections make it increasingly important to consider changing resistance patterns when prescribing, however UK data in this area are lacking. We evaluate the epidemiology and antimicrobial susceptibilities of ophthalmic pathogens across care settings and compare these with local and national antimicrobial prescribing guidelines. METHODS: A retrospective, multi-centre observational analysis was undertaken of ophthalmic microbiology isolates between 2009 and 2015 at a centralised North-West London laboratory (incorporating data from primary care and five London teaching hospitals). Data were analysed using descriptive statistics with respect to patient demographics, pathogen distribution (across age-groups and care setting), seasonality, and susceptibility to topical chloramphenicol, moxifloxacin, and fusidic acid. RESULTS: Two thousand six hundred eighty-one isolates (n = 2168 patients) were identified. The commonest pathogen in adults was Staphylococcus spp. across primary, secondary, and tertiary care (51.7%; 43.4%; 33.6% respectively) and in children was Haemophilus spp. (34.6%;28.2%;36.6%). AMR was high and increased across care settings for chloramphenicol (11.8%;15.1%;33.8%); moxifloxacin (5.5%;7.6%;25.5%); and fusidic acid (49.6%;53.4%; 58.7%). Pseudomonas spp. was the commonest chloramphenicol-resistant pathogen across all care settings, whilst Haemophilus spp. was the commonest fusidic acid-resistant pathogen across primary and secondary care. More isolates were recorded in spring (31.6%) than any other season, mostly due to a significant rise in Haemophilus spp. CONCLUSIONS: We find UK national and local antimicrobial prescribing policies for ophthalmic infections may not be concordant with the organisms and antimicrobial susceptibilities found in clinical samples. We also find variations in microbial incidence related to patient age, clinical setting, and season. Such variations may have further important implications for prescribing practices and modification of antimicrobial guidelines.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Bacterianas del Ojo/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , Estaciones del Año , Staphylococcus/efectos de los fármacos , Reino Unido/epidemiología , Adulto Joven
17.
J Drugs Dermatol ; 18(8): 745-750, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31424706

RESUMEN

INTRODUCTION: Selecting a systemic therapy for patients with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. The objective of this study was to use data from electronic health records to understand prescribing patterns associated with biologic therapies for psoriasis and utilization of concomitant non-biologic psoriasis therapies in patients on biologics. METHODS: A retrospective cohort study was performed using OptumInSight's electronic health records database. Patients were classified as having psoriasis if they had 2 diagnosis codes for psoriasis or 1 diagnosis for psoriasis and a subsequent prescription for a systemic psoriasis therapy or phototherapy on a separate day. Only patients with at least 1 prescription for a biologic medication were included. The time between the first and last prescription in each prescription episode was calculated; at least 1 prescription every 180 days was required to be considered continuous therapy. We also identified a subgroup of patients with prescription episodes of at least 12 months duration in which to evaluate concomitant use of topical medications, phototherapy, and other systemic agents in patients receiving prescriptions for biologics. RESULTS: There were 34,714 eligible psoriasis patients. The median time between first and last prescriptions was 3.3 - 7.0 months, depending on the drug and up to 50% of patients that received a prescription for a biologic medication did not receive a second prescription for the same medication. In a subset of patients with prescription episodes of at least 12 months duration, more than 50% continued to receive prescriptions for topical therapies, most commonly topical steroids. DISCUSSION: Recognition of prescribing patterns associated with biologic medications for psoriasis is important to understand healthcare utilization and improve health systems practices for patients and providers.


Asunto(s)
Productos Biológicos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Psoriasis/tratamiento farmacológico , Adulto , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estados Unidos
18.
J Drugs Dermatol ; 18(8): 798-802, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31424710

RESUMEN

Cutaneous fungal infections account for millions of office visits per year, yet their varied presentations often lead to misdiagnosis. If dermatology clinics are Clinical Laboratory Improvement Amendment (CLIA) certified, direct microscopy with potassium hydroxide or other stains can be used to inexpensively and rapidly diagnose fungal infections. In this survey, we examined dermatologists' perceptions of fungal preparations and CLIA certification to identify barriers that prevent the use of these bedside diagnostics. The response rate was 13% (n=308, based on the number of emails opened). When a cutaneous fungal infection is suspected, 20.94% rarely/never and 19.86% sometimes perform fungal preparations, often because they think clinical diagnosis is adequate or that preparations take too long. 21.32% reported not having CLIA certification, most frequently because the process requires too much work, or they do not know how to apply. Of providers with CLIA certification, over 25% thought it was difficult to obtain. Our results demonstrate that numerous barriers prevent the common use of fungal preparations, including the perception that clinical diagnosis is sufficient and the lack of required CLIA certification. These barriers emphasize the need for additional education about cutaneous fungal infections and use of bedside diagnostics. Additionally, policy-based interventions are necessary to ease the process of CLIA certification.


Asunto(s)
Dermatomicosis/diagnóstico , Hongos/aislamiento & purificación , Indicadores y Reactivos/química , Adulto , Anciano , Dermatólogos/estadística & datos numéricos , Dermatología/métodos , Dermatología/estadística & datos numéricos , Dermatomicosis/microbiología , Dermatomicosis/patología , Diagnóstico Diferencial , Femenino , Humanos , Hidróxidos/química , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estadística & datos numéricos , Microscopía , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Compuestos de Potasio/química , Pautas de la Práctica en Medicina/estadística & datos numéricos , Piel/microbiología , Piel/patología , Encuestas y Cuestionarios/estadística & datos numéricos
19.
Schmerz ; 33(5): 408-414, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31444575

RESUMEN

BACKGROUND AND METHODS: An online questionnaire about cannabis medication (CAM) was sent to German pain therapists 1 year after the introduction of the new act "Amendment to drug and other regulations" of 06.03.2017. RESULTS: A total of 120 pain therapists participated. Information on 1560 treated patients was analyzed. Only in the case of Dronabinol and Sativex® did at least 50% of physicians feel well informed. Requests for the coverage of costs were sent to the statuary health insurance companies for 1521 patients. These requests had already been decided for 1265 patients (83%) at the time of the questionnaire. A total of 457 requests (36.1%) were denied, including 28 requests from palliative care patients. Most of the pain therapists (67.5%) were well informed about Dronabinol, but less so about the other CAM. CONCLUSION: The study shows an information deficit in knowledge and handling of selected CAM among physicians. Given the high rejection rate, there may also be a knowledge gap on the side of the health insurances. From a certain number of patients upwards, the non-interventional accompanying survey required by law was deemed to be barely practicable from both a time and an economical point of view.


Asunto(s)
Cannabis , Manejo del Dolor , Dolor , Medicina Paliativa , Pautas de la Práctica en Medicina , Encuestas y Cuestionarios , Alemania , Humanos , Internet , Dolor/tratamiento farmacológico , Manejo del Dolor/estadística & datos numéricos , Medicina Paliativa/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Sociedades
20.
Pan Afr Med J ; 33: 48, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31448011

RESUMEN

Introduction: diagnostic methods and management of iron deficiency and iron deficiency anemia in clinical practice in Algeria is poorly known. Methods: we conducted a cross-sectional survey among doctors in different specialties treating patients with iron deficiency anemia in 2016. Results: data analysis was based on 349 questionnaires which were validated (anesthesia/resuscitation: 39; obstetrics and gynaecology: 111; oncology/Hematology: 71; hepato-gastroenterology: 64; cardiology: 36; internal medicine: 28). All specialties combined, 73% (254/349) of physicians thought that at least 30% of their patients had iron deficiency anemia; 65% of physicians (226/349) thought that at least 30% of their patients had iron deficiency. Iron deficiency was investigated systematically by 57% (63/111) of physicians of the group obstetrics and gynaecology, but only by 11% (26/238) of the remaining doctors; indeed, 82% (195/238) of physicians investigated it only in patients with anemia. The assessment of iron deficiency showed that the hemoglobin (Hb) was almost always determined (89%; 310/349) while laboratory tests to explore iron metabolism were inadequate: 70% (244/349) of physicians performed serum ferritin test and only 37% (128/349) performed transferrin saturation. Patients with iron deficiency (with or without anemia) received oral iron therapy (prescribed by 92% (322/349) of physicians) and iron injections therapy depending on Hb level (prescribed by 36% (127/349) of physicians). Conclusion: this survey shows that iron deficiency is evaluated only in patients with anemia. In particular, laboratory tests to measure iron deficiency are insufficiently prescribed.


Asunto(s)
Anemia Ferropénica/diagnóstico , Hierro/deficiencia , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Argelia , Anemia/diagnóstico , Anemia/terapia , Anemia Ferropénica/terapia , Estudios Transversales , Femenino , Ferritinas/sangre , Encuestas de Atención de la Salud , Hemoglobinas/análisis , Humanos , Hierro/administración & dosificación , Masculino , Persona de Mediana Edad , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA