Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation.

Objectives: To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation.

Methods: We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes.

In-home Compared With In-Clinic Warfarin Therapy Monitoring in Mechanical Heart Valves: A Population-Based Study.

Objective: To evaluate differences in time in therapeutic range (TTR), major bleeding, thromboembolism, and survival comparing in-home and in-clinic international normalized ratio monitoring for patients with mechanical heart valves receiving warfarin anticoagulation.

Patients And Methods: An observational population-based study of 383 patients (mean ± SD age, 61.5±14.

Time-driven activity-based cost analysis for outpatient anticoagulation therapy: direct costs in a primary care setting with optimal performance.

Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.

Methods: A population-based cross-sectional study was conducted in conjunction with observations of patient care processes between August 2014 and January 2015.

Resident physician perspectives on outpatient continuity of care.

Background: The outpatient continuity clinic is an essential component of internal medicine residency programs, yet continuity of patient care in these clinics is suboptimal. Reasons for this discontinuity have been inadequately explored.

Objective: We sought to assess perceived factors contributing to discontinuity in trainee ambulatory clinics.

Improved resident physician confidence with advance care planning after an ambulatory clinic intervention.

Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients.

Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial.

Objective: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed.

Methods: Eligible postmenopausal women with bone mineral density T-scores less than -1.

Extended evaluation of a longitudinal medical school evidence-based medicine curriculum.

Background: Evidence-based medicine (EBM) is an important element of medical education. However, limited information is available on effective curricula.

Objective: To evaluate a longitudinal medical school EBM curriculum using validated instruments.

Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice.

Background: Bisphosphonates can reduce fracture risk in patients with osteoporosis, but many at-risk patients do not start or adhere to these medications. The aims of this study are to: (1) preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid (OSTEOPOROSIS CHOICE) for postmenopausal women at risk for osteoporotic fractures; and (2) assess the feasibility and validity (i.e.

Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital.

Objective: To determine if hospitalized medical and surgical patients were placed inappropriately on symptom-triggered therapy (STT) for alcohol withdrawal syndrome (AWS) and if certain conditions were more likely to be associated with inappropriate STT use or adverse events.

Patients And Methods: We randomly selected 124 (25%) of the 495 Mayo Clinic inpatients who received STT according to the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) protocol in 2003 and assessed them for STT appropriateness, defined as having both intact verbal communication and recent alcohol use. Adverse events, including delirium tremens, seizures, or death, were correlated with CIWA-Ar appropriateness.

Nurse-based telephone protocol versus usual care for management of URI and acute sinusitis: a controlled trial.

Two hundred and twelve patients with upper-respiratory-tract infection (URI) or sinusitis were treated using a nurse-based telephone protocol. This study evaluated the clinical outcomes and satisfaction of the patients compared with patients receiving usual care. For patients with URI, the rate of antibiotic administration was lower in the nurse-based telephone-treatment group (28% vs.