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Background: Usage of medication brand names in electronic health records may introduce conflicts of interest, perpetuate false perceptions of brand superiority, alter prescribing practices, and cause confusion leading to errors. We sought to identify the frequency of brand name medication usage in clinical documentation, as well as factors associated with increased usage. Methods: We conducted a descriptive analysis to identify generic and brand names for 518 medications in all clinical notes written at our healthcare system between 2015 and 2020. We used string-matching and regular expressions to identify medication mentions. We conducted bivariate analyses to identify associations between brand name usage and author-, note-, and medication-level factors, and a multivariate logistic regression to clarify independent associations between individual factors and brand usage. Results: A total of 104,456,653 notes from 37,285 unique authors were included in our analysis. 162,906,009 medication mentions were identified, of which 36.0% were brand name mentions with a steady year-over-year decrease. Factors associated with usage of brand name included: author role, years since release, length and syllabic complexity of the generic name, service type, and encounter context. Over-the-counter availability did not affect usage. There was sizable individual variation between note writers. Conclusions: Usage of brand names in documentation is a multifaceted phenomenon involving ease-of-writing and pronunciation, author role and training, and time since medication approval. Our findings indicate potential avenues to reduce usage frequency, including individual clinician education and system-level changes to reduce the difference in complexity between brand names and generic names.

It is characterised by gaze palsy in ipsilateral side and internuclear ophthalmoplegia on gaze to contralateral side. This case is reported for its rarity. A 65-year-old male reported to our hospital with complaints of double vision for 5 days. He is a known case of diabetes and hypertension for 10 years. On clinical examination, anterior segment was normal. Fundus was normal in both eyes. Vertical eye movements were normal. He had exotropia in right eye. Left eye horizontal movements were absent. Only abduction with nystagmus was present in right eye. MRI showed an exophytic haemorrhagic lesion measuring 2.4 x 1.7 cm size involving pons. In this case, left horizontal gaze palsy is due to parapontine reticular formation lesion and restriction of adduction in left eye was due to internuclear ophthalmoplegia from lesion in medial longitudinal fasciculus. Apart from vertical movements, only abduction was possible in right eye. Hence, this case was diagnosed as one-and-a-half syndrome (OAHS).

Niacin has multiple lipoprotein effects that may provide cardiovascular benefit when added to statin monotherapy.In this randomized, placebo-controlled trial (n = 75) of magnetic resonance imaging of carotid atherosclerosis, we performed a secondary comparison of combination niacin-statin (simvastatin 20 mg/Niacin-ER 2G [S20/N]) to monotherapy with moderate (20 mg [S20]) and high-dose (80 mg [S80]) simvastatin on lipids, apolipoproteins (apo), low density lipoprotein (LDL) and high density lipoprotein (HDL) particle subclasses, and inflammatory markers.At baseline, average age was 71, 72% were male, 62.5% used statins, and average LDL-cholesterol was 111 mg/dL. At 12 months, S20/N, compared to S80, significantly reduced apoB (-36.6% vs -11.9%; P = .05) and lipoprotein(a) (-18% vs +3.5%; P = .001) and had at least an equivalent effect on LDL-cholesterol (-39.3% vs -24.3%; P = .24). The combination reduced the proportion of subjects with atherogenic LDL pattern-B (50% to 11.5%) compared to S80 (56% to 56%) (P = .01). Despite increases in plasma free fatty acids (+62.4%; F = 5.65, P = .005 vs S20 and S80), plasma triglycerides (-29.4%; F = 6.88, P = .002 vs S20 and S80), and very-low-density lipoprotein (-44.2%; F = 7.94, P.001 vs S20 and S80), levels were reduced by S20/N. S20/N increased HDL-cholesterol levels (+18.1%) as compared to S20 (0%) and S80 (+5.9%) (P.001 vs both statin arms), largely due to an increase in HDL particle size (+4.6%; P = .01 vs both statin arms).We demonstrate that full-dose niacin/moderate-dose simvastatin combination has sustained benefits on atherogenic apoB lipoproteins, at least comparable to high-dose simvastatin, while also raising HDL-cholesterol. Results of large clinical trials will inform whether niacin-statin combinations reduce cardiovascular disease events.

Sudden cardiac arrest (SCA) is the leading cause of death in the United States and industrialized nations. In North America, the annual incidence of out-of-hospital SCA is over 0.55 per 1,000 population1 such that 164,000 to 300,000 out-of-hospital arrests occur annually.2 However, despite advances in recent decades, clinical outcomes from out-of-hospital SCA remain dismal, and survival to hospital discharge ranges from 4% to 13%.3–5 Clearly, improving the management of out-of-hospital SCA is a major public health issue. In 2005, the American Heart Association (AHA) substantially revised the previous guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care for SCA, which were published in 2000. In particular, new CPR codified the primary importance of uninterrupted mechanical chest compression, given provocative preclinical6 and clinical7 studies showing the benefits of this approach even without mouth-to-mouth respiration or assisted ventilation. Accordingly, the revised guidelines reduced the recommended number of breaths per CPR cycle but did not advocate elimination of assisted ventilation because of concerns including the generalizability of these results.8 New CPR also codified recent evidence that chest compressions are more effective when performed together with an impedance threshold device (ITD), which improves chest recoil, reduces intrathoracic pressure, and augments venous return.9 The rationale behind the numerous other changes to new CPR are described in the parent document.5 In this issue of Heart Rhythm, Aufderheide et al10 studied whether implementation of these new CPR guidelines improved outcomes in 1,605 victims of out-of-hospital SCA in five emergency medical service systems (EMS) in the United States, compared with 1,641 historical controls at these centers treated per the 2000 guidelines in the immediately preceding years. The primary endpoint was survival to hospital discharge, and secondary endpoints were the return of spontaneous circulation (ROSC), survival to hospital discharge based on initial cardiac arrest rhythm, and neurological status at time of discharge assessed by the cerebral performance score (CPS). The authors found a significant 30% relative increase (from 10.1% to 13.1%) in survival to hospital discharge and increased rate of ROSC (from 30.3% to 33.8%) in patients treated by new CPR compared with the 2000 guidelines. As expected, results varied markedly by presenting rhythm: survival to hospital discharge was 32% versus 20% in patients with ventricular tachycardia/ventricular fibrillation (VT/VF; new CPR versus prior guidelines; P