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Kolla B.P.,Center for Sleep Medicine | Lovely J.K.,Mayo Medical School | Mansukhani M.P.,Community Medical Centers | Morgenthaler T.I.,Center for Sleep Medicine
Journal of Hospital Medicine | Year: 2013

Background: Inpatient falls are associated with significant morbidity and increased healthcare costs. Zolpidem has been reported to decrease balance and is associated with falls. Yet, it is a commonly used hypnotic agent in the inpatient setting. Zolpidem use in hospitalized patients may be a significant and potentially modifiable risk factor for falling. Objective: To determine whether inpatients administered zolpidem are at greater risk of falling. Design: Retrospective cohort study. Setting: Adult non-intensive care unit (non-ICU) inpatients at a tertiary care center. Methods: Adult inpatients who were prescribed zolpidem were identified. Electronic medical records were reviewed to capture demographics and other risk factors for falls. The fall rate was compared in those administered zolpidem versus those only prescribed zolpidem. Multivariate analyses were performed to determine whether zolpidem was independently associated with falls. Results: The fall rate among patients who were prescribed and received zolpidem (n = 4962) was significantly greater than among patients who were prescribed but did not receive zolpidem (n = 11,358) (3.04% vs 0.71%; P < 0.001). Zolpidem use continued to remain significantly associated with increased fall risk after accounting for age, gender, insomnia, delirium status, dose of zolpidem, Charlson comorbidity index, Hendrich's fall risk score, length of hospital stay, presence of visual impairment, gait abnormalities, and dementia/cognitive impairment (adjusted odds ratio [OR] 4.37, 95% confidence interval [CI] = 3.34-5.76; P < 0.001). Additionally, patients taking zolpidem who experienced a fall did not differ from other hospitalized adult patients who fell in terms of age, opioids, antidepressants, sedative-antidepressants, antipsychotics, benzodiazepine, or antihistamine use. CONCLUSION: Zolpidem use was a strong, independent, and potentially modifiable risk factor for inpatient falls. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine. Source

Kataoka S.,University of California at Los Angeles | Novins D.K.,Community Medical Centers | DeCarlo Santiago C.,University of California at Los Angeles
Child and Adolescent Psychiatric Clinics of North America | Year: 2010

Ethnic minority children continue to have substantial unmet mental health needs, and evidence-based treatments (EBTs) have proved challenging to disseminate widely among ethnic minority communities. Indeed, policy makers have made an important distinction between EBTs, interventions that have proven efficacy in clinical trials, and evidence-based practice, which involves " the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences." The present research evidence suggests that several interventions have been found to be effective in ethnic minority populations without a need for major adaptations of the original interventions. However, this article highlights the need to deliver evidence-based practice, which is defined as the implementation of EBTs delivered with fidelity and with the integration of important cultural systems and community factors. © 2010 Elsevier Inc. Source

Samus Q.M.,Johns Hopkins University | Amjad H.,Johns Hopkins University | Johnston D.,Johns Hopkins University | Black B.S.,Johns Hopkins University | And 2 more authors.
American Journal of Geriatric Psychiatry | Year: 2015

Objective: To provide a critical review of a multipronged recruitment approach used to identify, recruit, and enroll a diverse community-based sample of persons with memory disorders into an 18-month randomized, controlled dementia care coordination trial. Methods: Descriptive analysis of a recruitment approach comprised five strategies: community liaison ("gatekeepers") method, letters sent from trusted community organizations, display and distribution of study materials in the community, research registries, and general community outreach and engagement activities. Participants were 55 community organizations and 63 staff of community organizations in Baltimore, Maryland. Participant referral sources, eligibility, enrollment status, demographics, and loss to follow-up were tracked in a relational access database. Results: In total, 1,275 referrals were received and 303 socioeconomically, cognitively, and racially diverse community-dwelling persons with cognitive disorders were enrolled. Most referrals came from letters sent from community organizations directly to clients on the study's behalf (39%) and referrals from community liaison organizations (29%). African American/black enrollees were most likely to come from community liaison organizations. Conclusion: A multipronged, adaptive approach led to the successful recruitment of diverse community-residing elders with memory impairment for an intervention trial. Key factors for success included using a range of evidence-supported outreach strategies, forming key strategic community partnerships, seeking regular stakeholder input through all research phases, and obtaining "buy-in" from community stakeholders by aligning study objectives with perceived unmet community needs. © 2015 American Association for Geriatric Psychiatry. Source

De La Cruz O.,University of Pittsburgh | Minces L.R.,University of Pittsburgh | Minces L.R.,Community Medical Centers | Silveira F.P.,University of Pittsburgh
Journal of Infection | Year: 2015

Combination therapy with amikacin is recommended for treatment of nocardiosis in severely ill solid organ transplant recipients (SOT), but its use is complicated by nephrotoxicity. Linezolid has shown promise as an alternative in the empiric therapy of nocardiosis, but little is known about its effectiveness and safety in this setting. We describe the experience with linezolid for nocardiosis in SOT. Methods: Retrospective review of cases of nocardiosis in SOT at a large center from 2006 to 2012. Results: Nineteen cases were identified, 15/19 in lung transplant recipients. Median creatinine clearance at diagnosis was 56ml/min. Eighteen patients were treated: 17/18 (94%) received trimethoprim/sulfamethoxazole and 15/18 (83%) received linezolid. Median duration of linezolid treatment was 21 days and it was discontinued in 10/15 (67%) due to side effects. Thrombocytopenia and anemia occurred in 14/15 (93%) and 9/15 (60%) of patients on linezolid, respectively, and were not different from patients not on linezolid. Cure was observed in 16/19 (84%), 33% of deaths were related to nocardiosis. Conclusions: Linezolid was acceptable as initial empiric therapy for nocardiosis. Myelosuppression was a limiting factor, but not exclusive to patients on linezolid and could have been aggravated by concomitant use of other myelosuppressive drugs. © 2014 The British Infection Association. Source

Krasna M.J.,Community Medical Centers
Personalized Medicine | Year: 2010

Transforming healthcare through collaborative relationships is the key to making successful advances in personalized medicine. The strategies for building a framework to bring together expertise and resources in order to realize all the possibilities of personalized medicine are discussed in this article. The key to this endeavor is the ability to identify potential collaboration with academic medical centers, research laboratories, biotechnology companies and community cancer centers. Translation of research from bench to bedside is only paradigm changing if it can then be translated to community care. The value of clinical prospective biospecimen collection with high quality clinical annotation will be explored. Recognizing the opportunities for performing clinical trials, beta-testing of new technology especially in community clinical practice will be emphasized. The goal is to expand the realm of personalized cancer care to allow for integration of molecular marker and individualized therapy to the majority of cancer patients worldwide. © 2010 Future Medicine Ltd. Source

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