Algorithms based on ICD-9-CM codes will undercount hospitalizations for AE-COPD, and as many as one in five patients identified by these algorithms may be misidentified as having a COPD exacerbation. These findings suggest that relying on ICD-9-CM codes alone to identify patients hospitalized for AE-COPD may be problematic.

Effective intervention strategies for increasing dispensing of intranasal naloxone by pharmacists should focus on pharmacists' concerns, include education to multiple audiences, and address provider-level, system-level, and society-level barriers.

ICD-9-CM diagnosis codes are increasingly used to estimate the burden of disease, as well as to evaluate the quality of care and outcomes of various conditions. Acute exacerbations of COPD (AE-COPD) are common and associated with substantial health and financial burden in the U.S. Whether published algorithms that employ different combinations of ICD-9-CM codes to identify patients hospitalized for AE-COPD yield similar or different estimates of disease burden is unclear. In this study, the Nationwide Inpatient Sample from years 2000-2006 was used to identify and compare the number of hospitalizations, healthcare utilization, and outcomes for patients hospitalized for AE-COPD in the U.S. AE-COPD was identified using five different published ICD-9-CM algorithms. Estimates of the annual number of hospitalizations for AE-COPD in the U.S. varied more than 2-fold (e.g., 421,000 to 870,000 in 2006). Outcomes and healthcare utilization of patients hospitalized for AE-COPD varied substantially, depending on the algorithm used (e.g., in-hospital mortality 2.0% to 5.1%, total hospital days 2.0 to 5.1 million in 2006). Observed trends in the number of hospitalizations over the 7-year period varied depending on which algorithm was used. In conclusion, the estimated health burden and trends in hospitalizations for AE-COPD in the United States differ, depending on which ICD-9-CM algorithm is used. To improve our understanding of the burden of AE-COPD and to ensure that quality of care initiatives are not misdirected, a validated approach to identifying patients hospitalized for AE-COPD is needed.

Background: While Fetal Alcohol Spectrum Disorders (FASD) represent a significant public health problem, Native Americans are underrepresented in population and targeted screening programs. Prior reports suggest that Native American tribal communities may have higher prevalence of alcohol use during pregnancy; however, systematic examination using ethanol biomarkers is lacking. Methods: This study utilized data collected through the Navajo Birth Cohort Study (NBCS)-a birth cohort study of a Southwestern tribal community. Prevalence of prenatal alcohol exposure (PAE) was assessed by a battery of meconium biomarkers among 333 NBCS participants. Meconium samples were analyzed for nine individual fatty acid ethyl ester (FAEE) species, ethyl glucuronide (EtG), and ethyl sulfate (EtS) by LC-MS/MS.

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THR and TKR surgical patients at one institution who were receiving postsurgical VTE prophylaxis with warfarin spent a substantial proportion of time with their INR below the target range and had a high rate of symptomatic VTE.

Systematic models of anticoagulation management result in better clinical outcomes than routine medical care. At the University of Illinois at Chicago Medical Center (UIMCC) systematic anticoagulation management is provided via 2 models of care: a pharmacist managed antithrombosis clinic (PMATC) and a nurse managed anticoagulation clinic (NMAC). The objective of this study was to evaluate the quality of oral anticoagulation management in these two models of care by assessing efficacy, safety, monitoring and resource utilization outcomes. A retrospective, observational cohort study was conducted between January 2005 and April 2007. A total of 200 patients, 100 in each group, were randomly selected and contributed 179.3 and 206.8 patient-years of therapy for the PMATC and NMAC respectively (p<0.0001). Venous thromboembolism and atrial fibrillation were the 2 most common indications for anticoagulation therapy, although the PMATC group managed a higher proportion of patients with shorter-term venous indications then the NMAC group (78% vs 4% respectively; p<0.0001). The PMATC group reached goal INR faster after initiating therapy then the NMAC group. (median of 9 days vs 22 days respectively; p=0.0003). The mean % of patients with INR controlled within the therapeutic range (TTR) was 65.8% in the PMATC group and 71.2% in the NMAC group (p=0.009). The PMATC group had a higher proportion of difficult to manage patients who were non-compliant with their clinic monitoring appointments and non-compliant with their warfarin therapy as compared to the NMAC group. (median number of missed appointments per year was 4.8 vs 1.0 respectively; p < 0.0001 and median number of deviations from prescribed warfarin dose was 16.6 vs 3.5 respectively; p < 0.0001). The percent of patients who developed thromboembolic events and major bleeding complications during therapy were similar in the PMATC and NMAC groups (1.2% vs 0.5% per patient-year of therapy, respectively; RR 2.40; 95% CI 0.096 to 4.26; and 4.7% vs. 4.9% per patient-year of therapy, respectively; RR 0.96; 95% CI, 0.28 to 3.30). Hospital admissions and emergency department visits due to non-therapeutic INRs were higher in the NMAC group compared to the PMATC group (9.2% vs 0.6% per patient-year of therapy, respectively; RR 0.06; 95% CI 0.004 to 0.79; and 1.5% vs 0 per patient-year of therapy, respectively.) Patients who spent > 60% of the time in therapeutic INR range had a lower median number of missed clinic monitoring appointments and a lower median number of deviations from the prescribed warfarin dose as compared to patients who spent < 60% of the time in the therapeutic INR range (1.8 vs 4.0, respectively; p=0.0002 and 9.1 vs. 12.8, respectively; p=0.02). In this study, the PMATC model showed better outcomes in attaining a faster therapeutic INR after initiating warfarin therapy and also demonstrated more judicious resource utilization by lower hospitalization rates and emergency room visits due to non-therapeutic INRs. Although the TTR was lower in the PMATC group, the 2 groups faired similarly with regards to clinical outcomes such as recurrent thromboembolism and major bleeding complications. The difference in TTR can be attributed to the higher proportion of more difficult to manage, non-compliant patients in the PMATC group. Both models of care were found to be well within acceptable limits of national benchmark quality data for systematic anticoagulation management, although the PMATC model had better resource utilization outcomes.

IntroductionLeptospirosis is a zoonotic disease with high prevalence in low-income and middle-income countries and tropical and subtropical regions. The clinical symptoms of the disease are similar to symptoms presented by other endemic infectious diseases that could be present simultaneously. Thus, leptospirosis could be masked by similar infections like dengue, malaria, hantavirus, melioidosis and borreliosis, among others. Therefore, leptospirosis could present itself as an under-reported infection or as a coinfection with another pathogen, as has been reported in the literature. However, there is a lack of documented evidence about the specific risk factors of leptospirosis infection, the symptoms, the coinfection’s mortality and the frequency of coinfection. Additionally, leptospirosis coinfections have not been considered a neglected public health concern. Therefore, this systematic review aims to evaluate published articles that show the risk factors associated with leptospirosis infection and coinfection with other pathogens.Methods and analysisThe search process to identify eligible studies will be conducted including the LILACS, ProQuest, PubMed and Scopus databases with no restriction in terms of publication date. Also, grey literature will be included in the research. Authors will independently screen the title and abstracts of the articles identified from the search using Rayyan free software. Eligibility criteria include peer-reviewed research articles written in English or Spanish, including observational studies, cohorts, case–control, cross-sectional, ecological studies and report cases. The systematic review will include studies that report descriptions of leptospirosis cases with coinfection or co-occurrence. The search will be accomplished by articles from 1950 to May 2022. The data will be extracted in a standard extraction form using an Excel format.Ethics and disseminationResults will be published in a peer-reviewed journal. Also, findings will be disseminated through scientific meetings. Ethical approval will not be required as this is a systematic review and primary data will be not collected or included.PROSPERO registration numberCRD42021234754.