Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study

by Kueiyu Joshua Lin, Evan Dvorin, Aaron S. Kesselheim BackgroundEvidence and guidelines do not support use of systemic steroids for acute respiratory tract infections (ARTIs), but such practice appears common. We aim to quantify such use and determine its predictors. Methods and findingsWe conducted a cohort study based on a large United States national commercial claims database, the IBM MarketScan, to identify patients aged 18 –64 years with an ARTI diagnosis (acute bronchitis, sinusitis, pharyngitis, otitis media, allergic rhinitis, influenza, pneumonia, and unspecified upper respiratory infections) recorded in ambulatory visits from 2007 to 2016. We excluded those with systemic steroid use in the prior year and an ext ensive list of steroid-indicated conditions, including asthma, chronic obstructive pulmonary disease, and various autoimmune diseases. We calculated the proportion receiving systemic steroids within 7 days of the ARTI diagnosis and determined its significant predictors. We identified 9,763,710 patie nts with an eligible ARTI encounter (mean age 39.6, female 56.0%) and found 11.8% were prescribed systemic steroids (46.1% parenteral, 47.3% oral, 6.6% both). All ARTI diagnoses but influenza predicted receiving systemic steroids. There was high geographical variability: the adjusted odds ratio (aOR ) of receiving parenteral steroids was 14.48 (95% confidence interval [CI] 14.23–14.72,p
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research

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Authors: Stefani KM, Richards JR, Newman J, Poole KG, Scott SC, Scheckel CJ Abstract Context: Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty. Objective: To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role ...
Source: Journal of the American Osteopathic Association - Category: Complementary Medicine Tags: J Am Osteopath Assoc Source Type: research
Authors: Ozuna L, Champion C, Yorkgitis BK Abstract In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal. PMID: 32451541 [PubMed - in process]
Source: Journal of the American Osteopathic Association - Category: Complementary Medicine Tags: J Am Osteopath Assoc Source Type: research
Summary: Health care reform continues to be a topic of debate among lawmakers, politicians, physicians, and citizens of the United States. In recent years, proposed changes to the health care industry have grown in both granularity and popularity, with the possibility of adapting a single-payer health insurance system reaching an all-time high. The implications of such a policy are far-reaching and can be challenging to conceptualize, especially in isolation. The purpose of this article is to review some of the anticipated changes under this new system, specifically as they pertain to the field of plastic surgery.
Source: Plastic and Reconstructive Surgery - Category: Cosmetic Surgery Tags: Plastic Surgery Focus: Special Topics Source Type: research
Publication date: Available online 28 May 2020Source: Journal of Integrative MedicineAuthor(s): Jian-sheng Li, Xue-fang Liu, Hao-ran Dong, Wan-chun Zheng, Su-xiang Feng, Yan-ge Tian, Peng Zhao, Jin-di Ma, Zhou-xin Ren, Yang Xie
Source: Journal of Integrative Medicine - Category: Complementary Medicine Source Type: research
ConclusionWe found that 1-in-11 cancer survivors developed a SPC. Given the increasing number of cancer survivors and the importance of SPC as a cause of cancer death, there is a need for increased screening for and prevention of SPC.
Source: Journal of Cancer Research and Clinical Oncology - Category: Cancer & Oncology Source Type: research
AbstractPurposeCompared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE.MethodsThis single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications includ...
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
ovia J, Alfonso F PMID: 32459205 [PubMed - as supplied by publisher]
Source: Archivos de Cardiologia de Mexico - Category: Cardiology Authors: Tags: Arch Cardiol Mex Source Type: research
Christopher A. PrebleOn any given day, my inbox is filled with opinion pieces on U.S.-China relations. A number warn “the U.S. doesn ’t need a cold war” or that “a cold war with China would be a mistake. ” Others seem to have concluded thatwe ’re already in one, so we ’d better get serious about fighting it.After reading the Trump administration ’s “United States Strategic Approach to the People ’s Republic of China” – a 16 ‐​page document issued before the currentcrackdown on Hong Kong, and apparently drafted even before the CO...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
Having chronic conditions is associated with increased tooth loss. Primary care providers can educate their patients about the importance of good oral health and screen and refer them for needed dental care.
Source: CDC Morbidity and Mortality Weekly Report - Category: American Health Tags: Diabetes MMWR Morbidity & Mortality Weekly Report Oral Health Source Type: news
Will DuffieldPresident Trump has escalated his war of words with America ’s leading technology firms. Afterthreatening to “close down” social media platforms, he announced that he would issue an executive order concerning Section 230 of the Communications Decency Act, a bedrock intermediary liability protection for internet platforms. However, a draft of the forthcoming executive order seems to slyly misunderstand Section 230, reading contingency into its protections. Let ’s take a look at thestatute and the relevant sections of the proposedexecutive order to see how its interpretatio...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
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