Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Piercefield EW[original query] |
---|
Antihypertensive medication adherence and blood pressure control among central Alabama veterans
Piercefield EW , Howard ME , Robinson MH , Kirk CE , Ragan AP , Reese SD . J Clin Hypertens (Greenwich) 2016 19 (5) 543-549 Medication nonadherence is associated with adverse outcomes. To evaluate antihypertensive medication adherence and its association with blood pressure (BP) control, the authors described population adherence to prescribed antihypertensive medication (proportion of days covered ≥80%) and BP control (mean BP <140/90 mm Hg) among central Alabama veterans during the fiscal year 2015. Overall, 75.1% of patients receiving antihypertensive medication were considered adherent, and 66.1% had adequate BP control. Patients adherent to antihypertensive medication were more likely to have adequate BP control compared with patients classified as nonadherent (67.4% vs 62.0%; adjusted odds ratio 1.33; 95% confidence interval, 1.22-1.44 [P<.0001]). Among patients who had uncontrolled BP, 73.6% were considered adherent to medication. Adherence to antihypertensive medication was associated with adequate BP control; however, a substantial proportion of patients with inadequate BP control were also considered adherent. Interventions to increase BP control could address more aggressive medication management to achieve BP goals. |
Antimicrobial and analgesic prescribing patterns for acute otitis externa, 2004-2010
Collier SA , Hlavsa MC , Piercefield EW , Beach MJ . Otolaryngol Head Neck Surg 2012 148 (1) 128-34 OBJECTIVE: Acute otitis externa (AOE) is a common but preventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly prescribed. The objective of this analysis was to describe pre- and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time. STUDY DESIGN: Retrospective longitudinal analysis of a large insurance database. SETTING: Outpatient departments in the United States. METHODS: Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims were linked and categorized by clinician specialty and antimicrobial type. RESULTS: The analysis included 907,261 initial outpatient visits. Use of systemic antimicrobials declined by 4.9% (95% confidence interval [CI], 4.1%, 5.7%) from 36.5% of initial visits in 2004 to 32.1% in 2010. Use of systemic antimicrobials varied by specialty. Systemic antimicrobials were prescribed in 47.1% of 2010 emergency department (ED) visits (-6.9% from 2004, 95% CI -12.3, -1.5), 25.9% of otolaryngologist visits (-1.6%, 95% CI -5.6, 2.4), and 20.4% of pediatrician visits (-6.6%, 95% CI -8.8, -4.4). Penicillins were prescribed most frequently (42.3% of systemic prescriptions in 2010), followed by cephalosporins (19.8%), erythromycin/macrolides (17.4%), and quinolones (11.1%). Opioids were prescribed in 26.4% of ED visits and 9% of outpatient visits. CONCLUSIONS: Use of systemic antimicrobials declined over time, but one-third of 2010 visits resulted in systemic antimicrobials, despite exclusion of visits with complicating factors. Use of systemic antimicrobials varied by specialty. Further educational efforts and outreach to other specialties might be warranted. |
Epidemiology of a large restaurant-associated outbreak of Shiga toxin-producing Escherichia coli O111:NM
Bradley KK , Williams JM , Burnsed LJ , Lytle MB , McDermott MD , Mody RK , Bhattarai A , Mallonee S , Piercefield EW , McDonald-Hamm CK , Smithee LK . Epidemiol Infect 2012 140 (9) 1644-54 SUMMARY: In August 2008, a large outbreak of Shiga toxin-producing Escherichia coli (STEC) O111:NM infections associated with a buffet-style restaurant in rural Oklahoma was identified. A case-control study of restaurant patrons and a retrospective cohort study of catered event attendees were conducted coupled with an environmental investigation to determine the outbreak's source and mode of transmission. Of 1823 persons interviewed, 341 (18.7%) met the outbreak case definition; 70 (20.5%) were hospitalized, 25 (7.3%) developed haemolytic uraemic syndrome, and one died. Multiple food items were significantly associated with illness by both bivariate and multivariate analyses, but none stood out as a predominant transmission vehicle. All water, food, and restaurant surface swabs, and stool cultures from nine ill employees were negative for the presence of Shiga toxin and E. coli O111:NM although epidemiological evidence suggested the outbreak resulted from cross-contamination of restaurant food from food preparation equipment or surfaces, or from an unidentified infected food handler. |
Hemolytic uremic syndrome after an Escherichia coli O111 outbreak
Piercefield EW , Bradley KK , Coffman RL , Mallonee SM . Arch Intern Med 2010 170 (18) 1656-63 BACKGROUND: In August 2008, the largest known US serotype 1 Escherichia coli O111 outbreak occurred in Oklahoma, causing 341 illnesses, including hemolytic uremic syndrome (HUS). HUS is not well described in non-O157 E coli outbreaks but occurs in 2% to 15% of O157 infections, predominantly among children. We examined outbreak-related hospitalizations to characterize E coli O111 illness, the HUS attack rate, and factors associated with subsequent HUS diagnosis among hospitalized patients. METHODS: Medical records were reviewed for clinical presentation and evidence of HUS among hospitalized patients identified during the outbreak investigation. Characteristics of hospitalized patients with vs without HUS were compared. RESULTS: HUS was identified in 26 of 156 (16.7%) confirmed or probable E coli O111 infections; 65.4% of patients with HUS required dialysis, and 1 patient died. The median age of patients with HUS was 43.5 years (age range, 1-88 years); adults composed 57.7% of HUS cases. Characteristics at hospital admission associated with subsequent HUS diagnosis included white blood cell count of at least 20 000/muL (adjusted odds ratio [aOR], 11.3; 95% confidence interval [CI], 1.7-75.3), elevated serum creatinine level for age (9.7; 1.4-69.2), and vomiting before hospital admission (6.8; 1.5-31.3). Administration of antimicrobial agents (risk ratio [RR], 1.0; 95% CI, 0.5-1.8) or medication with antimotility effects (1.4; 0.6-2.9) was not associated with subsequent HUS. CONCLUSIONS: The HUS attack rate in this E coli O111 outbreak was comparable to that for E coli O157-related illnesses, but most cases occurred among adults. On admission, factors associated with subsequent HUS can identify patients who require close monitoring and early aggressive supportive care to improve outcomes. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure