Objective. Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA).Disease-modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.
We undertook the first broad-scale quasi-experimental evaluation of youth outcomes in communities using the Communities That Care program (Hawkins, J. D., & Catalano, R. F., Jr. San Francisco, CA, USA: Jossey-Bass Inc, Publishers, 1992a), which targets adolescent problem behaviors. We evaluated 15 risk factors and 6 outcomes (substance use and delinquent behaviors) for 38,107 youth in 2001 and 98,436 youth in 2003 in Pennsylvania schools. Multilevel analyses compared student reports in communities with CTC programs to comparable communities without CTC, while controlling for level of poverty in the community. Results favored the CTC communities at greater than chance levels in terms of lower rates of some risk factors and outcomes. In a follow-up analysis, CTC community grade cohorts were included only if the grade cohort was expected to benefit from a CTC sponsored program (based on timing of program implementation and target age of the program). Evidence of CTC effects for grade cohorts that received evidence-based programs was even stronger. These findings suggest that community coalitions can affect adolescent public health problems at a population level, especially when evidence-based programs are utilized.
Objective. To examine whether an electronic health record (EHR) best practice alert (BPA), a clinical reminder to help guideline adherence, improved vaccination rates in rheumatology patients receiving immunosuppressants. Guidelines recommend yearly influenza and pneumococcal vaccination with revaccination for patients age >65 years who are taking immunosuppressive medications. Results. PostBPA influenza vaccination rates significantly increased (47% to 65%; P < 0.001), with significant improvement at both sites. PostBPA pneumococcal vaccination rates likewise significantly increased (19% to 41%; P < 0.001). PostBPA documentation rates for influenza and pneumococcal vaccinations also increased significantly. Site 2 (nursedriven) had significantly higher preBPA vaccination rates for influenza (69% versus 43%; P < 0.001) than pneumococcal (47% versus 15%; P < 0.001). Conclusion. The use of a BPA significantly increased influenza and pneumococcal vaccination and documentation rates in rheumatology patients taking immunosuppressants. A nurse-driven process offered higher efficacy. An EHR programmed to alert providers is an effective tool for improving quality of care for patients receiving immunosuppressants.
1 months (IQR 16.3-65.1 months), respectively (P < 0.001). Of the 91 patients developing diabetes mellitus, 16 were ever and 75 were never TNF␣ inhibitor users, yielding incidence rates of 8.6 and 17.2 per 1,000 person-years (P ؍ 0.048), respectively. Adjusting for covariates, the hazard ratio for incident diabetes mellitus in TNF␣ inhibitor users was 0.49 (95% confidence interval 0.24 -0.99, P ؍ 0.049) compared to the never users. Conclusion. In this inception RA cohort, anti-TNF␣ use was associated with a 51% reduction in risk of developing diabetes mellitus.
A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.
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