Journal of general internal medicine
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After non-fatal opioid overdoses, opioid prescribing patterns are often unchanged and the use of medications for opioid use disorder (MOUDs) remains low. Whether such prescribing differs by race/ethnicity remains unknown. ⋯ In a national cohort of patients with non-fatal opioid overdose in VA, there were no racial/ethnic differences in changes in opioid prescribing after overdose. Although blacks and Hispanics were more likely than white patients to receive MOUDs in the 30 days after overdose, less than 4% of all groups received such therapy.
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Predictive models based on electronic health records (EHRs) are used to identify patients at high risk for 30-day hospital readmission. However, these models' ability to accurately detect who could benefit from inclusion in prevention interventions, also termed "perceived impactibility", has yet to be realized. ⋯ Our study provides empirical evidence for the partial congruence between classifications of a high PREADM score and perceived impactibility. Findings emphasize the need for additional research to understand the extent to which combining EHR data with provider insights leads to better selection of patients for RPP inclusion.
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Mortality prediction models are useful to guide clinical decision-making based on prognosis. The frailty index, which allows prognostication and personalized care planning, has not been directly compared with validated prognostic models. ⋯ A deficit-accumulation frailty index performs as well as prognostic indices for mortality prediction, and better predicts ADL disability and falls in community-dwelling older adults. Frailty assessment offers a unifying approach to risk stratification for key health outcomes relevant to older adults.
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Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA. ⋯ A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify "at-risk" patients.
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Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to rank ARV combinations based upon a composite objective of achieving viral suppression and maximizing tolerability. ⋯ HIV-ASSIST is an educational decision support tool that provides ARV recommendations concordant with experienced HIV providers from two major academic centers for a diverse set of patient scenarios.