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Background: Recent clinical trials and guideline updates have highlighted the efficacy and safety of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in patients with type 2 diabetes (T2D) and comorbidities including atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or heart failure (HF). Objective: This study assesses the rates of guideline-based prescribing of SGLT2i in patients with T2D and one or more of the following comorbidities: ASCVD, CKD, or HF, prior to and after the 2022 American Diabetes Association (ADA) guideline publication within the Atrius Health clinical pharmacy, internal medicine, and specialty medicine departments. Methods: This is a retrospective chart review of data from the electronic medical record. Patients with the aforementioned criteria were included if they were managed by either the clinical pharmacy department, internal medicine, or specialty medicine departments. Patients were excluded if they did not have any of the comorbidities listed or a form of diabetes other than T2D. Results: Of the 10,631 patients enrolled, 354 (3.3%) were initiated on an SGLT2i during the study. The average number of SGLT2i initiations prior to the 2022 ADA guideline publication was five prescription starts per week. After the guideline publication initiation increased to seven prescription starts per week. Secondary outcomes showed the majority of SGLT2i prescriptions were started in the internal medicine department, followed by cardiology and nephrology. Conclusion: Overall utilization rates of SGLT2i are low but increased after the 2022 ADA guidelines were published. These results suggest opportunities to optimize the use of SGLT2i in this patient population. [ABSTRACT FROM AUTHOR]

Objectives: To study the determinants of emergency department (ED) utilization for non-traumatic dental conditions (NTDCs) by adults in Massachusetts.Methods: We analyzed patient-level factors associated with ED utilization for NTDCs in Massachusetts during 2013, using the Massachusetts All Payer Claims Dataset. The primary independent variables of interest were use of preventive dental service in the year preceding the ED visit and dental insurance coverage. Key covariates included age, gender, income, day of the ED visit, payer type, and residing in a geographically designated dental health professional shortage area (DHPSA). A multilevel logistic regression model was used to estimate the odds of NTDC ED visits as compared to two other categories of ED visits.Results: 1.1 percent of all ED visits in Massachusetts were for NTDCs in 2013. Preventive dental service use in the preceding year decreased the odds (OR = 0.72) of a NTDC ED visit, whereas having dental insurance coverage increased the odds (OR = 1.1) of a NTDC ED visit. Other patient-level characteristics that significantly increased odds of a NTDC ED visit included being between 26 and 35 years of age (OR = 1.2), male (OR = 1.3), uninsured (OR = 1.7) or enrolled in Medicaid (OR = 1.2), and visiting on a weekend (OR = 1.3).Conclusions: Increased access to preventive dental services may lower likelihood of ED use for NTDCs. Interventions that target younger adults, Medicaid enrollees, and the uninsured, may be the most efficient way to lower NTDC ED use. [ABSTRACT FROM AUTHOR]

Frequency, intensity, areal extent (AE) and duration of rain spells during summer monsoon exhibit large intra-seasonal and inter-annual variations. Important features of the monsoon period large-scale wet spells over India have been documented. A main monsoon wet spell (MMWS) occurs over the country from 18 June to 16 September, during which, 26.5 % of the area receives rainfall 26.3 mm/day. Detailed characteristics of the MMWS period large-scale extreme rain events (EREs) and spatio-temporal EREs (ST-EREs), each concerning rainfall intensity (RI), AE and rainwater (RW), for 1 to 25 days have been studied using 1° gridded daily rainfall (1951-2007). In EREs, 'same area' (grids) is continuously wet, whereas in ST-EREs, 'any area' on the mean under wet condition for specified durations is considered. For the different extremes, second-degree polynomial gave excellent fit to increase in values from distribution of annual maximum RI and RW series with increase in duration. Fluctuations of RI, AE, RW and date of occurrence (or start) of the EREs and the ST-EREs did not show any significant trend. However, fluctuations of 1° latitude-longitude grid annual and spatial maximum rainfall showed highly significant increasing trend for 1 to 5 days, and unprecedented rains on 26-27 July 2005 over Mumbai could be a realization of this trend. The Asia-India monsoon intensity significantly influences the MMWS RW. [ABSTRACT FROM AUTHOR]

Background: Warfarin is an effective anticoagulant but requires close International Normalized Ratio (INR) monitoring and may occasionally require correction of excessive anticoagulation. Current guidelines provide limited practical guidance on the administration of vitamin K for the management of supratherapeutic INR levels ≥ 5.0 in non-bleeding outpatients., Objective: Based on expert consensus and guidelines, the Atrius Health Anticoagulation Management Services (AMS) has developed internal guidance for oral vitamin K use in highly selected populations. This study will describe the internal guidance for oral vitamin K use and present associated results and clinical outcomes., Methods: Episodes with INR > 5.0 were included, with vitamin K considered for episodes with INR ≥ 6. Moreover, compelling indications and exclusions to select ideal patients for vitamin K intervention were also defined., Results: Overall, episodes were managed conservatively; of the 246 collected episodes of excessive anticoagulation, in 18 episodes (7%), patients received vitamin K, and in 228 (93%) episodes, patients did not receive vitamin K. The mean index INR was 6.0 (range 5.0 - 10.5, SD 1.07), with nearly 57% of episodes achieving INR correction and 15% of episodes developing INR overcorrection. High thrombotic risk patients, regardless of hemorrhagic risk, were less likely to receive vitamin K. Three episodes (1.2%) resulted in bleeding complications. No thrombotic complications occurred during the 30-day follow-up of the index INR value ≥ 5.0., Conclusion: Our internal guidance is a novel, standardized approach that serves as a decision support tool for the management of warfarin-associated coagulopathy and vitamin K intervention using patient-specific characteristics and index INR values. This guidance may assist other anticoagulation management services with practical applications and require validation in a prospective clinical trial., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: To study the determinants of emergency department (ED) utilization for non-traumatic dental conditions (NTDCs) by adults in Massachusetts., Methods: We analyzed patient-level factors associated with ED utilization for NTDCs in Massachusetts during 2013, using the Massachusetts All Payer Claims Dataset. The primary independent variables of interest were use of preventive dental service in the year preceding the ED visit and dental insurance coverage. Key covariates included age, gender, income, day of the ED visit, payer type, and residing in a geographically designated dental health professional shortage area (DHPSA). A multilevel logistic regression model was used to estimate the odds of NTDC ED visits as compared to two other categories of ED visits., Results: 1.1 percent of all ED visits in Massachusetts were for NTDCs in 2013. Preventive dental service use in the preceding year decreased the odds (OR = 0.72) of a NTDC ED visit, whereas having dental insurance coverage increased the odds (OR = 1.1) of a NTDC ED visit. Other patient-level characteristics that significantly increased odds of a NTDC ED visit included being between 26 and 35 years of age (OR = 1.2), male (OR = 1.3), uninsured (OR = 1.7) or enrolled in Medicaid (OR = 1.2), and visiting on a weekend (OR = 1.3)., Conclusions: Increased access to preventive dental services may lower likelihood of ED use for NTDCs. Interventions that target younger adults, Medicaid enrollees, and the uninsured, may be the most efficient way to lower NTDC ED use., (© 2018 American Association of Public Health Dentistry.)