The American journal of medicine
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Adults with chronic disease are often unable to meet medication and food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. ⋯ Approximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both. WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse.
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Growing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome. ⋯ PICC-associated bloodstream infection is most associated with hospital length of stay, ICU status, and number of device lumens. Policy and procedural oversights targeting these factors may be necessary to reduce the risk of this adverse outcome.
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For physicians who see and treat patients who present with AFib in routine clinical practice there are 4 important factors to understand and bear in mind when diagnosing and planning treatment strategies: age, gender, prior or incident heart failure, and underlying coronary artery disease (CAD) and acute coronary syndrome (ACS). (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This review addresses the clinical characteristics of each of these presentations in order. For all patients with AFib, of either gender or any age, the greatest risk is failure to prescribe anticoagulation therapy, with currently only about half of these patients are being prescribed anticoagulation therapy, a percentage that is often much lower in the elderly, where only about 1 in 3 eligible patients receive anticoagulation. ⋯ As discussed, the real progress that has been seen in the prognosis of CHF has not been seen for patients with CHF and concomitant AFib, meaning that even with optimal therapy, the patient with AFib who develops CHF is at higher risk of mortality. The challenge for patients with ACS and AFib is that their ACS will probably require antiplatelet therapy, and addition of anticoagulation therapy as prophylaxis against stroke and systemic embolism because of the AFib creates the problem of so-called "triple therapy." This review includes a clinical decision algorithm for balancing the lowest risk of thromboembolic events against the highest risk of bleeding in patients who must receive triple therapy. Finally, this review concludes with a brief overview of the possible benefits of the NOACs in these populations, while also emphasizing that all clinicians-especially primary care physicians, who may become the principal caregivers for these patients with AFib in the era of NOACs-should be familiar with one of current bleeding scores, perhaps the best of which is the HAS-BLED score, which includes patients who have hypertension, abnormal renal or liver function, bleeding history, predisposition or labile INR, elderly patients who are frail or >65 years, or with a history of drugs/alcohol concomitantly.