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Faculty Publication: Schumann et al.

Wed, 04/22/2015 - 15:32 -- kcrotty

Blog Teaser

Schumann, J. H., & Wallace, E. A. (2015). Pitfalls of Direct-to-Consumer Vascular Screening Tests. American Family Physician, 91(8), 518-520.

 

Faculty Publication: DiGiacinto, Gildon, Stamile, & Aubrey

Wed, 04/08/2015 - 19:51 -- kcrotty

Blog Teaser

DiGiacinto, D., Gildon, B., Stamile, E., & Aubrey, J. (2015). Weight-Biased Health Professionals and the Effects on Overweight Patients. Journal of Diagnostic Medical Sonography, 31(2), 132-135. doi: 10.1177/8756479314557278^

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Faculty Publication: Bagley & Davis

Wed, 04/08/2015 - 19:33 -- kcrotty

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Bagley, J. E., & Davis, M. B. (2015). Cyst of Canal of Nuck. Journal of Diagnostic Medical Sonography, 31(2), 111-114. doi: 10.1177/8756479314557277^

 

Faculty Publication: Murray, O'Neal, & Weisz

Wed, 04/08/2015 - 18:17 -- kcrotty

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Murray, K. A., O’Neal, K. S., & Weisz, M. (2015). Dietary suggestions for migraine prevention. [Article]. American Journal of Health-System Pharmacy, 72(7), 519-521. doi: 10.2146/ajhp130671

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Faculty Publication: Escala, Hall, et al.

Wed, 04/01/2015 - 15:55 -- kcrotty

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Flores, G., Escala, M. K., & Hall, B. G. (2015). Dead wrong: the growing list of racial/ethnic disparities in childhood mortality. The Journal Of Pediatrics, 166(4), 790-793. doi: 10.1016/j.jpeds.2015.02.001^

 

Faculty Publication: Dadgar et al.

Wed, 04/01/2015 - 15:50 -- kcrotty

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Herren, C., Sobottke, R., Dadgar, A., Ringe, M. J., Graf, M., Keller, K., . . . Siewe, J. (2015). Peripartum pubic symphysis separation - Current strategies in diagnosis and therapy and presentation of two cases. Injury. doi: 10.1016/j.injury.2015.02.030

Background: During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation.; Methods: This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered.; Results: Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions.; Summary: Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.; Copyright © 2015 Elsevier Ltd. All rights reserved.

 

Faculty Publication: Ivins et al.

Thu, 03/26/2015 - 15:09 -- kcrotty

Blog Teaser

Ivins, D., Blackburn, B., Peterson, L. E., Newton, W. P., & Puffer, J. C. (2015). A Majority of Family Physicians Use a Hospitalist Service When Their Patients Require Inpatient Care. Journal Of Primary Care & Community Health, 6(2), 70-76. doi: 10.1177/2150131914555016^

Background:The hospitalist movement in the United States has risen in prominence over the past 2 decades with more physicians practicing as hospitalists. Our objective was to examine different strategies used by family physicians when their patients require inpatient care. Methods: Secondary analysis of a cross-sectional survey of physicians accessing the American Board of Family Medicine Web site in 2011 and the 2011 Area Resource File. Logistic regression assessed for associations between using hospitalists, managing inpatients personally, or with a group partner, and then comparing and contrasting these physicians with health care market characteristics. Results: A total of 3857 physicians had data on practice characteristics and could be geocoded to their county of residence. Compared with other physicians meeting inclusion criteria in the American Board of Family Medicine database, our sample was slightly older and more likely to be female. In all, 54% of respondents reported using hospitalist services while 18% reported managing hospitalized patients themselves. Respondents more likely to use hospitalist services were female and resided in urban areas. However, one third of these physicians living in isolated rural areas reported using hospitalist services. Respondents more likely to personally manage their patients in the hospital were more likely to be male and an international medical graduate. The likelihood of using hospitalist services increased with higher availability of hospitalist services. Conclusions: Overall, a majority of family physicians are using hospitalist services. Family physicians seem more likely to use hospitalist services when they are available which may lead to fragmentation of care.


 

Faculty Publication: Malgor et al.

Sun, 03/22/2015 - 18:34 -- kcrotty

Blog Teaser

Malgor, R. D., Gloviczki, P., Fahrni, J., Kalra, M., Duncan, A. A., Oderich, G. S., . . . Driscoll, D. (2015). Surgical treatment of varicose veins and venous malformations in Klippel-Trenaunay syndrome. Phlebology / Venous Forum Of The Royal Society Of Medicine.

Background: Klippel-Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy.; Methods: The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan-Meier method and Log-rank statistics were used where appropriate.; Results: Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7-55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001).; Conclusions: In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome.

 

Faculty Publication: Fox, Gomez, & Munoz

Sun, 03/22/2015 - 18:25 -- kcrotty

Blog Teaser

Fox, M. D., Gomez, M. R., & Munoz, R. T. (2015). Just Deserts or Icing on the Cake? Addressing the Social Determinants of Health. [Article]. American Journal of Bioethics, 15(3), 42-44. doi: 10.1080/15265161.2014.998383^

 

Faculty Publication: Ghandhapudi, Tan, Marino, Taylor, Pack, Van De Wiele, Wren, Teague, et al.

Thu, 03/19/2015 - 15:32 -- kcrotty

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Gandhapudi, S. K., Tan, C., Marino, J. H., Taylor, A. A., Pack, C. C., Gaikwad, J., . . . Teague, T. K. (2015). IL-18 Acts in Synergy with IL-7 To Promote Ex Vivo Expansion of T Lymphoid Progenitor Cells. Journal Of Immunology (Baltimore, Md.: 1950).

Although IL-18 has not previously been shown to promote T lymphopoiesis, results obtained via a novel data mining algorithm (global microarray meta-analysis) led us to explore a predicted role for this cytokine in T cell development. IL-18 is a member of the IL-1 cytokine family that has been extensively characterized as a mediator of inflammatory immune responses. To assess a potential role for IL-18 in T cell development, we sort-purified mouse bone marrow-derived common lymphoid progenitor cells, early thymic progenitors (ETPs), and double-negative 2 thymocytes and cultured these populations on OP9-Delta-like 4 stromal layers in the presence or absence of IL-18 and/or IL-7. After 1 wk of culture, IL-18 promoted proliferation and accelerated differentiation of ETPs to the double-negative 3 stage, similar in efficiency to IL-7. IL-18 showed synergy with IL-7 and enhanced proliferation of both the thymus-derived progenitor cells and the bone marrow-derived common lymphoid progenitor cells. The synergistic effect on the ETP population was further characterized and found to correlate with increased surface expression of c-Kit and IL-7 receptors on the IL-18-treated cells. In summary, we successfully validated the global microarray meta-analysis prediction that IL-18 affects T lymphopoiesis and demonstrated that IL-18 can positively impact bone marrow lymphopoiesis and T cell development, presumably via interaction with the c-Kit and IL-7 signaling axis.


 

Faculty Publication: Bagley, Randall. & Anderson

Sun, 03/15/2015 - 22:39 -- kcrotty

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Bagley, J. E., Randall, K., & Anderson, M. (2015). A comparison of sonography and radiography student scores in a cadaver anatomy class before and after the implementation of synchronous distance education. Ultrasound, 23(1), 59-66. doi: 10.1177/1742271x14567173^

Distance education is a solution to expand medical imaging education to students who might not otherwise be able to obtain the education. It can be a mechanism to reduce the health care worker shortage in underserved areas. In some cases, distance education may be a disruptive technology, and might lower student performance. This study compares student scores in a cadaver anatomy course in the four cohorts preceding the implementation of distance education to the first three cohorts that took the course using a multiple campus design. The means and medians of the lecture exam average, the laboratory component score, and the final course score of the nondistance education cohorts were compared with those of the distance education cohorts using nonparametric statistical analysis. Scores in an anatomy course were compared by campus placement among the distance education cohorts, and the independent effect of distance education on the laboratory component, lecture examination average, and final course scores, while controlling for cumulative grade point average and site (originating/distant), was assessed. Students receiving the course in a nondistance education environment scored higher in the anatomy course than the students who took the course in a distance education environment. Students on the distant campus scored lower than students on the originating site. Distance education technology creates new opportunities for learning, but can be a disruptive technology. Programs seeking to implement distance education into their curriculum should do so with knowledge of the advantages and disadvantages.

 

Faculty Publication: Wetherill & Gray

Sun, 03/08/2015 - 17:57 -- kcrotty

Blog Teaser

Wetherill, M. S., & Gray, K. A. (2015). Farmers' Markets and the Local Food Environment: Identifying Perceived Accessibility Barriers for SNAP Consumers Receiving Temporary Assistance for Needy Families (TANF) in an Urban Oklahoma Community. Journal of Nutrition Education and Behavior, 47(2), 127-133.e121. doi: http://dx.doi.org/10.1016/j.jneb.2014.12.008^
 
AbstractObjective To examine barriers to farmers' market (FM) use by Supplemental Nutrition Assistance Program (SNAP) consumers receiving Temporary Assistance for Needy Families. Design Focus groups. Setting An urban community in Oklahoma. Participants Supplemental Nutrition Assistance Program beneficiaries receiving Temporary Assistance for Needy Families (n = 64 across 8 focus groups). Phenomenon of Interest Perceptions about FM foods and barriers to FM use. Analysis Transcript-based content analysis using the 5 dimensions of access framework. Results Few participants ate fresh produce regularly and most appreciated the convenience of shopping at a supermarket. Farmers' markets were not perceived as available or accommodating to shopping needs and affordability and acceptability concerns were expressed. Few were aware of FMs that accepted SNAP. Emerging themes suggested residential segregation and cultural barriers to FM use. Conclusions and Implications Farmers' market managers, community nutritionists, and researchers should develop interventions that correct common misperceptions about FM products, minimize access barriers, and increase awareness of SNAP payment options. Residential segregation and cultural barriers may have a role in FM use and should be explored further.
 

 

Faculty Publication: Vargas et al.

Thu, 03/05/2015 - 15:11 -- kcrotty

Blog Teaser

Roach, R., Gamez Vargas, J., & David, K. M. (2015). Eliminating Barriers to Dual Enrollment in Oklahoma. [Article]. New Directions for Community Colleges, 2015(169), 31-38. doi: 10.1002/cc.20130^

Policy, financial, and transportation barriers have limited participation in dual enrollment for marginalized (low-socioeconomic, first-generation, and ethnic minority) students in Oklahoma. This chapter presents a collaborative effort by education and community leaders that has successfully eliminated these barriers and increased the number of marginalized students participating in dual enrollment. [ABSTRACT FROM AUTHOR]
Copyright of New Directions for Community Colleges is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.

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Faculty Publication: Malgor et al.

Thu, 03/05/2015 - 15:06 -- kcrotty

Blog Teaser

Malgor, R. D., Alalahdab, F., Elraiyah, T. A., Rizvi, A. Z., Lane, M. A., Prokop, L. J., . . . Murad, M. H. (2015). A systematic review of treatment of intermittent claudication in the lower extremities. Journal Of Vascular Surgery, 61(3S), 54S-73S. doi: 10.1016/j.jvs.2014.12.007^

Background: Peripheral arterial disease is common and is associated with significant morbidity and mortality.; Methods: We conducted a systematic review to identify randomized trials and systematic reviews of patients with intermittent claudication to evaluate surgery, endovascular therapy, and exercise therapy. Outcomes of interest were death, amputation, walking distance, quality of life, measures of blood flow, and cost.; Results: We included eight systematic reviews and 12 trials enrolling 1548 patients. Data on mortality and amputation and on cost-effectiveness were sparse. Compared with medical management, each of the three treatments (surgery, endovascular therapy, and exercise therapy) was associated with improved walking distance, claudication symptoms, and quality of life (high-quality evidence). Evidence supporting superiority of one of the three approaches was limited. However, blood flow parameters improved faster and better with both forms of revascularization compared with exercise or medical management (low- to moderate-quality evidence). Compared with endovascular therapy, open surgery may be associated with longer length of hospital stay and higher complication rate but resulted in more durable patency (moderate-quality evidence).; Conclusions: In patients with claudication, open surgery, endovascular therapy, and exercise therapy were superior to medical management in terms of walking distance and claudication. Choice of therapy should rely on patients' values and preferences, clinical context, and availability of operative expertise.; Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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Faculty Publication: Malgor et al.

Thu, 03/05/2015 - 15:02 -- kcrotty

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Alahdab, F., Wang, A. T., Elraiyah, T. A., Malgor, R. D., Rizvi, A. Z., Lane, M. A., . . . Murad, M. H. (2015). A systematic review for the screening for peripheral arterial disease in asymptomatic patients. Journal Of Vascular Surgery, 61(3S), 42S-53S. doi: 10.1016/j.jvs.2014.12.008^

Background: Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI).; Methods: We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate.; Results: We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low.; Conclusions: The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

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Faculty Publication: Bellgowan et al.

Thu, 03/05/2015 - 14:56 -- kcrotty

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Meier, T. B., Bellgowan, P. S. F., Singh, R., Kuplicki, R., Polanski, D. W., & Mayer, A. R. (2015). Recovery of Cerebral Blood Flow Following Sports-Related Concussion. JAMA Neurology. doi: 10.1001/jamaneurol.2014.4778^

Importance: Animal models suggest that reduced cerebral blood flow (CBF) is one of the most enduring physiological deficits following concussion. Despite this, longitudinal studies documenting serial changes in regional CBF following human concussion have yet to be performed.; Objective: To longitudinally assess the recovery of CBF in a carefully selected sample of collegiate athletes and compare time course of CBF recovery with that of cognitive and behavioral symptoms.; Design, Setting, and Participants: A cohort of collegiate football athletes (N = 44) participated in this mixed longitudinal and cross-sectional study at a private research institute specializing in neuroimaging between March 2012 and December 2013. Serial imaging occurred approximately 1 day, 1 week, and 1 month postconcussion for a subset of participants (n = 17). All athletes reported no premorbid mood disorders, anxiety disorders, substance abuse, or alcohol abuse.; Main Outcomes and Measures: Arterial spin labeling magnetic resonance imaging was used to collect voxelwise relative CBF at each visit. Neuropsychiatric evaluations and a brief cognitive screen were also performed at all 3 points. Clinicians trained in sports medicine provided an independent measure of real-world concussion outcome (ie, number of days withheld from competition).; Results: The results indicated both cognitive (simple reaction time) and neuropsychiatric symptoms at 1 day postinjury that resolved at either 1 week (cognitive; P < .005) or 1 month (neuropsychiatric; P < .005) postinjury. Imaging data suggested both cross-sectional (ie, healthy vs concussed athletes; P < .05) and longitudinal (1 day and 1 week vs 1 month postinjury; P < .001) evidence of CBF recovery in the right insular and superior temporal cortex. Importantly, CBF in the dorsal midinsular cortex was both decreased at 1 month postconcussion in slower-to-recover athletes (t11 = 3.45; P = .005) and was inversely related to the magnitude of initial psychiatric symptoms (Hamilton Depression Scale: r = -0.64, P = .02; Hamilton Anxiety Scale: r = -0.56, P = .046), suggesting a potential prognostic indication for CBF as a biomarker.; Conclusions and Relevance: To our knowledge, these results provide the first prospective evidence of reduced CBF in human concussion and subsequent recovery. The resolution of CBF abnormalities closely mirrors previous reports from the animal literature and show real-world validity for predicting outcome following concussion.

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Faculty Publication: Savitz, Wurfel, Bellgowan, Bodurka, Teague, et al.

Mon, 03/02/2015 - 16:25 -- kcrotty

Blog Teaser

Savitz, J., Drevets, W. C., Wurfel, B. E., Ford, B. N., Bellgowan, P. S. F., Victor, T. A., . . . Dantzer, R. (2015). Reduction of kynurenic acid to quinolinic acid ratio in both the depressed and remitted phases of major depressive disorder. Brain, Behavior, and Immunity. doi: 10.1016/j.bbi.2015.02.007^

Low-grade inflammation is characteristic of a subgroup of currently depressed patients with major depressive disorder (dMDD). It may lead to the activation of the kynurenine-metabolic pathway and the increased synthesis of potentially neurotoxic metabolites such as 3-hydroxykynurenine (3HK) and quinolinic acid (QA), relative to kynurenic acid (KynA). Nevertheless, few studies have examined whether abnormalities in this pathway are present in remitted patients with MDD (rMDD). Here we compared the serum concentrations of kynurenine metabolites, measured using high performance liquid chromatography with tandem mass spectrometry, across 49 unmedicated subjects meeting DSM-IV-TR criteria for MDD, 21 unmedicated subjects meeting DSM-IV-TR criteria for rMDD, and 58 healthy controls (HCs). There was no significant group difference in the concentrations of the individual kynurenine metabolites, however both the dMDD group and the rMDD group showed a reduction in KynA/QA, compared with the HCs. Further, there was an inverse correlation between KynA/QA and anhedonia in the dMDD group, while in the rMDD group, there was a negative correlation between lifetime number of depressive episodes and KynA/QA as well as a positive correlation between the number of months in remission and KynA/QA. Our results raise the possibility that a persistent abnormality exists within the kynurenine metabolic pathway in MDD that conceivably may worsen with additional depressive episodes. The question of whether persistent abnormalities in kynurenine metabolism predispose to depression and/or relapse in remitted individuals remains unresolved.

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Faculty Publication: Bodurka, Simmons, et al.

Thu, 02/26/2015 - 22:23 -- kcrotty

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Kerr, K. L., Avery, J. A., Barcalow, J. C., Moseman, S. E., Bodurka, J., Bellgowan, P. S. F., & Simmons, W. K. (2015). Trait impulsivity is related to ventral ACC and amygdala activity during primary reward anticipation. [Article]. Social Cognitive & Affective Neuroscience, 10(1), 36-42.

Trait impulsivity is characterized by behavioral disinhibition and rash decision-making that contribute to many maladaptive behaviors. Previous research demonstrates that trait impulsivity is related to the activity of brain regions underlying reward sensitivity and emotion regulation, but little is known about this relationship in the context of immediately available primary reward. This is unfortunate, as impulsivity in these contexts can lead to unhealthy behaviors, including poor food choices, dangerous drug use and risky sexual practices. In addition, little is known about the relationship between integration of reward and affective neurocircuitry, as measured by resting-state functional connectivity, and trait impulsivity in everyday life, as measured with a commonly used personality inventory. We therefore asked healthy adults to undergo a functional magnetic resonance imaging task in which they saw cues indicating the imminent oral administration of rewarding taste, as well as a resting-state scan. Trait impulsivity was associated with increased activation during anticipation of primary reward in the anterior cingulate cortex (ACC) and amygdala. Additionally, resting-state functional connectivity between the ACC and the right amygdala was negatively correlated with trait impulsivity. These findings demonstrate that trait impulsivity is related not only to ACC-amygdala activation but also to how tightly coupled these regions are to one another.

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Faculty Publication: Kim, Lloyd, Condren, & Miller

Thu, 02/26/2015 - 22:19 -- kcrotty

Blog Teaser

Kim, M., Lloyd, A., Condren, M., & Miller, M. (2015). Beyond antibiotic selection: concordance with the IDSA guidelines for uncomplicated urinary tract infections. Infection, 43(1), 89-94. doi: 10.1007/s15010-014-0659-4^

The purpose of this report was to evaluate concordance with the most recent guidelines for the treatment of uncomplicated UTI based on antibiotic selection, dosage, frequency, and duration. A historical review of patients' medical records at a university-based internal medicine clinic was conducted. When aggregated across antibiotic type, frequency, and duration, overall concordance was 33.96 %. Prescribing concordance for uncomplicated UTI in the local region is suboptimal.

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