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A Pragmatic Randomized Controlled Trial of a Bundled, Pharmacist-Led Hyperpolypharmacy Deprescribing Intervention

This randomized controlled trial study is testing an intervention to reduce unsafe medication use in patients aged 75 years and older. The intervention uses collaborative drug therapy management between physicians and pharmacists, standard-of-care treatment protocols, shared decision-making, and the CEASE deprescribing protocol.…

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Reducing Variation in Hospitalization and Processes of Care in Emergency Department Patients with Atrial Fibrillation: A Stepped Wedge Cluster Randomized Trial

This stepped-wedge cluster randomized trial will stagger implementation of a clinical decision support system (CDSS) across 13 KPNC emergency departments to assist emergency physicians and hospitalists in the comprehensive management of patients with atrial fibrillation/flutter. We will compare hospitalization rates,…

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Influence of Multimorbidity on Burden and Appropriateness of Implantable Cardioverter-Defibrillator Therapies

To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. Retrospective cohort study. Seven US healthcare delivery systems. Adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary…

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Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes

In clinical trials of patients with type 2 diabetes, long-acting insulin analogs modestly reduced the risk of nocturnal hypoglycemia compared with human neutral protamine Hagedorn (NPH) insulin, but cost 2 to 10 times more. Outcomes in clinical practice may differ…

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Physicians’ Perceptions of Factors Influencing the Treatment Decision-Making Process for Men with Low-Risk Prostate Cancer

To assess physicians' attitudes regarding multiple factors that may influence recommendations for active surveillance (AS) vs active treatment (AT) given the central role physicians play in the treatment decision-making process. We conducted semistructured interviews to assess factors that physicians consider…

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The Accuracy of an Electronic Pulmonary Embolism Severity Index Auto-Populated from the Electronic Health Record: Setting the stage for computerized clinical decision support

The Pulmonary Embolism (PE) Severity Index identifies emergency department (ED) patients with acute PE that can be safely managed without hospitalization. However, the Index comprises 11 weighted variables, complexity that can impede its integration into contextual workflow. We designed a…

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