The Association of Medication Knowledge and Adherence Scores With Hospital Readmission.

Introduction: Readmission scoring systems are used to predict 30-day hospital readmission. These prediction tools do not considerlack of patient medication knowledge or adherence which can worsen disease outcomes or increase risk of readmissions. Objective: To determine if medication knowledge and adherence, as assessed by validated questionnaires, are associated with an increased rate of 30-day readmission. Methods: Adult medical inpatients were randomly selected for a prospective, single center study that was conducted from January to August 2017. Patients were asked the 4-question Morisky Green Levine Scale (MGLS) and the 4-question Medication Knowledge Score (MKS). Validated readmission score; MKS; and MGLS, as well as baseline information and readmission status within 30 days after the index admission were recorded. Mean or median scores were compared for patients readmitted within 30 days with those not readmitted using descriptive and univariate inferential statistics. Results: Data from 119 patients showed a mean age of 63 years (SD = 16). There was no difference in baseline information: age, sex, or number of scheduled home medications between those readmitted within 30 days and those not readmitted. Patients readmitted within 30 days had a statistically higher readmission score compared to patients not readmitted (66.4 vs 57.1, P = .017). There was no difference in median MKS or mean MGLS between patients readmitted within 30 days and those not readmitted (MKS: 4.0 vs 3.0, P = .753; MGLS: 1 vs 1.3, P = .162). Conclusions: In this prospective study, neither the MKS nor the MGLS scores were associated with 30-day hospital readmission.

MAGraine: Magnesium compared to conventional therapy for treatment of migraines.

Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30 min after initiation of infusion of study drug. Secondary outcomes included NRS at 60 and 120 min, ED length of stay, necessity for rescue analgesia, and adverse effects. A total of 157 patients were analyzed in this study. Sixty-one patients received magnesium, 52 received prochlorperazine, and 44 received metoclopramide. Most patients were white females, and the median age was 36 years. Hypertension and migraines were the most common comorbidities, with a third of the patients reporting an aura. There was a median decrease in NRS at 30 min of three points across all three treatment arms. The median decrease in NRS (IQR) at 60 min was -4 (2-6) in the magnesium group, -3 (2-5) in the metoclopramide group, and -4.5 (2-7) in the prochlorperazine group (p = 0.27). There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects. Reported adverse effects were dizziness, anxiety, and akathisia. No significant difference was observed in NRS at 30 min between magnesium, metoclopramide and prochlorperazine.

Sustained viral suppression with co-administration of oxcarbazepine and dolutegravir.

Co-administration of dolutegravir and oxcarbazepine has been reported to reduce levels of dolutegravir and therefore is contraindicated due to insufficient data to make dosing recommendations. We present eight cases in which patients with human immunodeficiency virus (HIV) inadvertently received oxcarbazepine while concurrently receiving 50 mg of dolutegravir daily as part of their antiretroviral therapy. Upon further evaluation, lab results revealed that despite the risk of decreased levels of dolutegravir due to possible oxcarbazepine enzyme induction, patients maintained at or near virologic suppression (viral load <20 copies/ml). Suppression was maintained in patients virally suppressed prior to oxcarbazepine initiation as well as in patients receiving high doses of oxcarbazepine (>1200 mg). All patients self-reported complete adherence to oxcarbazepine and dolutegravir. Furthermore, careful review of additional patient medications suggested no other identifiable drug interactions that could have affected their antiretroviral therapy. This case series suggests that despite the well-documented drug interaction, concomitant administration of oxcarbazepine and dolutegravir in the clinical setting did not adversely affect viral suppression in patients with HIV.