Tagged: The American Journal of Medicine

Bleeding risk following systemic fluconazole or topical azoles in patients with atrial fibrillation on apixaban, rivaroxaban or dabigatran

Background Bleeding safety in relation to use of systemic fluconazole and topical azoles among patients with atrial fibrillation treated with apixaban, rivaroxaban or dabigatran is insufficiently explored, despite clinical relevance and several reports suggesting associations.Methods Using nationwide, Danish registers we identified patients with atrial fibrillation initiated on apixaban, rivaroxaban or dabigatran from 2012–2018. We investigated associations between bleeding incidents, and systemic fluconazole or topical azole treatment using a case-crossover design with 30-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI).

Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease

Lyme disease is the most common vector-borne infection in North America and Europe, commonly caused by one of three pathogenic genospecies of the spirochete Borrelia 1 2. Borrelia burgdorferi sensu stricto is transmitted solely in North America, mostlyby the tick Ixodes scapularis. The infection typically causes dermatologic, musculoskeletal, neurologic, and cardiac illnesses. Both under- and over-diagnosis of Lyme disease have been well described3 4 5. While antibiotic therapy resolves symptoms for most infected patients, some are left with persistent subjective problems such as pain, fatigue or brain fog that may fall within the proposed entity post-treatment Lyme disease syndrome 6.

Factors associated with inferior vena cava filter placement and retrieval for patients with cancer-associated thrombosis

Background Venous thromboembolism is a leading cause of death in patients with cancer. Inferior vena cava filters are utilized to mitigate the risk of pulmonary embolism for patients who have contraindication to or failure of anticoagulation.Methods We reviewed an insurance claims database to identify adults receiving cancer directed therapy and had a new diagnosis of venous thromboembolism. We then evaluated clinical and sociodemographic characteristics in patients with and without filter placement and retrieval.

The Impact of Provider Gender and Experience on the Quality Of Care Provided For Women With Urinary Incontinence

Background: Although specialists are skilled in the management of urinary incontinence, primary care clinicians are integral in early diagnosis and initiation of management in order to decrease overuse of specialty care and improve the quality of specialist visits. We measured the quality of incontinence care provided by primary care clinicians before referral to a specialist and evaluated the impact of provider variables on quality of care.Methods: We performed a retrospective review of 200 women referred for urinary incontinence to a Female Pelvic Medicine and Reconstructive Surgery specialist between March 2017-July 2018.

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