A randomized, pragmatic, pharmacist-led intervention reduced opioids following orthopedic surgery.

Objectives: To determine whether a pharmacist-led, patient-directed intervention can reduce opioid use following total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Study Design: Randomized trial.

Methods: Patients scheduled to undergo THA or TKA (during 2015 and 2016) were randomized to usual care or intervention.

A qualitative study to develop materials educating patients about opioid use before and after total hip or total knee arthroplasty.

Objective: The authors undertook a qualitative study with open-ended, structured interviews to understand patient)s educational needs for patients undergoing total hip and total knee arthroplasty (THA/TKA).

Design: Provider interviews explored their approach with THA/TKA patients on: pain management; barriers to opioid tapering; and recommendations/changes on educational materials to support pain management and opioid reduction. Patient interviews explored their experience, understanding, beliefs surrounding opioids, and recommendations on important content.

Expression of DNA-dependent protein kinase catalytic subunit in laryngeal squamous cell carcinoma and its importance.

The aim of the present study was to explore the expression and distribution of DNA-dependent protein kinase catalytic subunit (DNA-PKcs) in tumor tissues and adjacent normal mucosa tissues of patients with laryngeal squamous cell carcinoma (LSCC), and further analyze the association between the expression and the clinicopathological parameters of patients with LSCC. Clinical data of tumor tissues and corresponding adjacent normal mucosa tissues of pathologically diagnosed LSCC in 96 cases were collected in the present study. Of these specimens, the mRNA and protein expression levels of DNA-PKcs in LSCC tissues and the adjacent normal mucosa tissues were analyzed via reverse transcription-quantitative polymerase chain reaction and western blot analysis.

Langerhans' cell histiocytosis of the temporal bone: A case report.

Langerhansmporal histiocytosis (LCH) refers to a group of diseases that are characterized by the primary pathogenesis of an abnormal polyclonal proliferation of Langerhans cells that affect different structures of the human body, including the temporal bone. Thus far, the etiology of LCH remains unclear. Diagnosis of LCH is based on a synthetic analysis of the clinical presentations, as well as on features of imaging and histopathology.

Predicting 5-Year Risk of RRT in Stage 3 or 4 CKD: Development and External Validation.

Background And Objectives: Only a minority of patients with CKD progress to renal failure. Despite the potential benefits of risk stratification in the CKD population, risk prediction models are not routinely used. Our objective was to develop and externally validate a clinically useful and pragmatic prediction model for the 5-year risk of progression to RRT in stage 3 or 4 CKD.

Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts.

Introduction: Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI.

Objective: To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education.

Methods: We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission.

Systolic BP and Mortality in Older Adults with CKD.

Background And Objectives: Optimal BP targets for older adults with CKD are unclear. This study sought to determine whether a nonlinear relationship between BP and mortality-as described for the broader CKD population and for older adults in the general population-is present for older adults with CKD.

Design, Setting, Participants, & Measurements: A cohort of 21,015 adults age 65-105 years with a moderate or severe reduction in eGFR (<60 ml/min per 1.

Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study.

Background: Whether there is a kidney function threshold to statin effectiveness in patients with acute myocardial infarction is poorly understood. Our study sought to help fill this gap in clinical knowledge.

Methods: We undertook a new-user cohort study of the effectiveness of statin therapy by level of estimated glomerular filtration rate (eGFR) in adults who were hospitalized for myocardial infarction between 2000 and 2008.

Predicting mortality in older adults with kidney disease: a pragmatic prediction model.

Objectives: To develop mortality risk prediction models for older adults with chronic kidney disease (CKD) that include comorbidities and measures of health status and use not associated with particular comorbid conditions (nondisease-specific measures).

Design: Retrospective cohort study.

Setting: Kaiser Permanente Northwest (KPNW) Health Maintenance Organization.

[Expression and significance of DNA-dependent protein kinase in human laryngeal squamous cell carcinoma].

Objective: To study the expression of DNA-dependent protein kinase (DNA-PK) in human laryngeal squamous cell carcinoma (LSCC) and normal laryngeal mucosa (NLM), and to analysize the relationship between the expression and the clinicopathologic parameters of LSCC.

Method: Immunohistochemical technique (Envision) was used to detect the expression of DNA-PK in 64 cases of LSCC and 15 cases of NLM. To investigate an investigation was conducted on the relationship between the expression and clinico-pathological features of LSCC.

Prescription opioids for back pain and use of medications for erectile dysfunction.

Study Design: Cross-sectional analysis of electronic medical and pharmacy records.

Objective: To examine associations between use of medication for erectile dysfunction or testosterone replacement and use of opioid therapy, patient age, depression, and smoking status.

Summary Of Background Data: Males with chronic pain may experience erectile dysfunction related to depression, smoking, age, or opioid-related hypogonadism.

Predicting costs of care in heart failure patients.

Background: Identifying heart failure patients most likely to suffer poor outcomes is an essential part of delivering interventions to those most likely to benefit. We sought a comprehensive account of heart failure events and their cumulative economic burden by examining patient characteristics that predict increased cost or poor outcomes.

Methods: We collected electronic medical data from members of a large HMO who had a heart failure diagnosis and an echocardiogram from 1999-2004, and followed them for one year.

Correlates of higher-dose opioid medication use for low back pain in primary care.

Unlabelled: Factors associated with high-dose opioid therapy for noncancer pain are poorly understood. We documented the prevalence of high-dose opioid use as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher doses of opioids (≥100 mg/day morphine equivalent at last dispensing; n = 453) and receiving opioids for 90+ consecutive days were compared to 2 groups: lower-dose opioid group (1-99 mg/day; n = 4,815) or no-opioid group (n = 10,184).

Epidemiology and healthcare costs of incident Clostridium difficile infections identified in the outpatient healthcare setting.

Objective: To describe the epidemiology and healthcare costs of Clostridium difficile infection (CDI) identified in the outpatient setting.

Design: Population-based, retrospective cohort study.

Patients: Kaiser Permanente Colorado and Kaiser Permanente Northwest members between June 1, 2005, and September 30, 2008.

Clostridium difficile infection, Colorado and the northwestern United States, 2007.

To determine the incidence of Clostridium difficile infection during 2007, we examined infection in adult inpatient and outpatient members of a managed-care organization. Incidence was 14.9 C.

[Research on misdiagnosis of space occupying lesions in unilateral nasal sinus].

Objective: By nearly 3-year retrospective analysis of cases with space-occupying lesions in unilateral nasal sinus in Guizhou Province People's Hospital, clinical diagnostic and misdiagnosis of such lesions were explored to provide references for clinicians in diagnosis and treatment of such diseases.

Method: Combining related literatures in recent years, 213 patients with space-occupying lesions in unilateral nasal sinus were selected. The patients misdiagnosed were reviewed for its clinical manifestations, of patients had been misdiagnosed, imaging features and and pathology.

Predicting poor outcomes in heart failure.

Background: Health plans must prioritize disease management efforts to reduce hospitalization and mortality rates in heart failure patients.

Methods And Results: We developed a risk model to predict the 5-year risk of mortality or hospitalization for heart failure among patients at a large health maintenance organization. We identified 4696 patients who had an echocardiogram and a heart failure diagnosis from 1999 to 2004.

Predicting chronic kidney disease outcomes: are two estimated glomerular filtration rates better than one?

The National Kidney Foundation's (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) definition of chronic kidney disease (CKD), stages 3-5, requires 2 estimated glomerular filtration rates (eGFRs) <60 ml/min/1.73 m(2) more than 3 months apart. By requiring 2 eGFRs, the NKF definition reduced identification of people without chronic disease, which may have decreased identification of individuals with early CKD, but increased identification of those who ultimately have progression of CKD or require renal replacement therapy (RRT).

Opioids for back pain patients: primary care prescribing patterns and use of services.

Background: Opioid prescribing for noncancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychologic distress, health care utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use.

Methods: We analyzed electronic data for 6 months before and after an index visit for back pain in a managed care plan.

Predicting the risk of end-stage renal disease in the population-based setting: a retrospective case-control study.

Background: Previous studies of predictors of end-stage renal disease (ESRD) have limitations: (1) some focused on patients with clinically recognized chronic kidney disease (CKD); (2) others identified population-based patients who developed ESRD, but lacked earlier baseline clinical measures to predict ESRD. Our study was designed to address these limitations and to identify the strength and precision of characteristics that might predict ESRD pragmatically for decision-makers--as measured by the onset of renal replacement therapy (RRT).

Methods: We conducted a population-based, retrospective case-control study of patients who developed ESRD and started RRT.

An economic evaluation of a laboratory monitoring program for renin-angiotensin system agents.

Background: The efficiency of patient safety interventions is not well studied, especially laboratory monitoring for drug therapy. More than one-third of preventable adverse drug events are associated with inadequate monitoring. Current knowledge of decreasing adverse drug events through expanded monitoring programs is lacking.

Systolic blood pressure and mortality among older community-dwelling adults with CKD.

Background: Chronic kidney disease (CKD) is an increasingly common condition, especially in older adults. CKD manifests differently in older versus younger patients, with a risk of death that far outweighs the risk of CKD progressing to the point that dialysis is required. Current CKD guidelines recommend a blood pressure target <130/80 mm Hg for all patients with CKD; however, it is unknown how lower versus higher baseline blood pressures may affect older adults with CKD.

Integrating clinical trial findings into practice through risk stratification: the case of heart failure management.

Heart failure case management programs have been shown in clinical trials to be highly effective at preventing future hospitalizations. But the absolute benefits of these programs depend on the baseline risk of outcome in the treated population. Because baseline risks of hospitalization in trials are often higher than community-based samples, translating trial results to the community setting may be misleading.

Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril.

Purpose: Angiotensin-converting enzyme (ACE) inhibitors are recommended for patients with chronic kidney disease (CKD) because they slow disease progression. But physicians' concerns about the risk of hyperkalemia (elevated serum potassium level), a potentially fatal adverse effect, may limit optimal management with ACE-inhibitors. We synthesized known predictors of hyperkalemia into a prognostic risk score to predict the risk of hyperkalemia.

Outcomes predicted by phosphorous in chronic kidney disease: a retrospective CKD-inception cohort study.

Background: The impact of secondary hyperparathyroidism on morbidity and mortality among patients with chronic kidney disease (CKD) is unclear.

Methods: We conducted a retrospective cohort study to investigate the relationship between CKD and serum phosphorous. Through clinical databases at a large health maintenance organization, we identified a dynamic CKD inception cohort between 1997 and 2004, with stage 3-5 kidney disease with subsequent phosphorous measurement; the patients were followed up for up to 5 years for outcomes of mortality, cardiovascular mortality, cardiovascular hospitalizations and renal replacement therapy (RRT; dialysis or transplant).