Medication prescribing practices for older prisoners in the Texas prison system.

Objectives: We sought to assess appropriateness of medication prescribing for older Texas prisoners.

Methods: In this 12-month cross-sectional study of 13 117 prisoners (aged > or = 55 years), we assessed medication use with Zhan criteria and compared our results to prior studies of community prescribing. We assessed use of indicated medications with 6 Assessing Care of Vulnerable Elders indicators.

Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing.

Background: Drugs-to-avoid criteria are commonly used to evaluate prescribing quality in elderly persons. However, few studies have evaluated the concordance between these criteria and individualized patient assessments as measures of problem prescribing.

Methods: We used data on 256 outpatients from the Iowa City VA Medical Center who were 65 years or older and taking 5 or more medications.

Physician use of brand versus generic drug names in 1993-1994 and 2003-2004.

Background: Physicians often refer to drugs by their brand names, which can result in brand name drugs being dispensed even when bioequivalent generic alternatives are available. As a result, use of brand-name terminology may result in increased drug costs.

Objective: To evaluate how often physicians use brand and generic names of drugs, how the use of terminology changes over time, and factors associated with this change.

Photostimulated expression of type 2 iodothyronine deiodinase mRNA is greatly attenuated in the rostral tuberal hypothalamus of the photorefractory turkey hen.

For many temperate-zone avian species, termination of breeding occurs when individuals no longer respond to previously stimulatory day lengths, a condition called photorefractoriness. Long day lengths induce significantly greater expression of c-fos and fos-related antigens (FRAs) in the tuberal hypothalamus of the photosensitive hen than that of the photorefractory hen. The tuber is also a site of photoinducible glial expression of type 2 iodothyronine deiodinase (Dio2), which converts thyroxine into its active form, triiodothyronine (T3).

Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis.

Background: Overuse of antibiotics in ambulatory care persists despite many efforts to address this problem. We performed a systematic review and quantitative analysis to assess the effectiveness of quality improvement (QI) strategies to reduce antibiotic prescribing for acute outpatient illnesses for which antibiotics are often inappropriately prescribed.

Research Design And Methods: We searched the Cochrane Collaboration's Effective Practice and Organisation of Care database, supplemented by MEDLINE and manual review of article bibliographies.

Age affects outcomes in chronic kidney disease.

Chronic kidney disease (CKD) is common among the elderly. However, little is known about how the clinical implications of CKD vary with age. We examined the age-specific incidence of death, treated end-stage renal disease (ESRD), and change in estimated glomerular filtration rate (eGFR) among 209,622 US veterans with CKD stages 3 to 5 followed for a mean of 3.

Characteristics and impact of drug detailing for gabapentin.

Background: Sales visits by pharmaceutical representatives ("drug detailing") are common, but little is known about the content of these visits or about the impact of visit characteristics on prescribing behavior. In this study, we evaluated the content and impact of detail visits for gabapentin by analyzing market research forms completed by physicians after receiving a detail visit for this drug.

Methods And Findings: Market research forms that describe detail visits for gabapentin became available through litigation that alleged that gabapentin was promoted for "off-label" uses.

What's in a name? Use of brand versus generic drug names in United States outpatient practice.

Background: The use of brand rather than generic names for medications can increase health care costs. However, little is known at a national level about how often physicians refer to drugs using their brand or generic names.

Objective: To evaluate how often physicians refer to drugs using brand or generic terminology.

Evolution of medication use in Jerusalem elders: Results from the Jerusalem Longitudinal Study.

Background: While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age.

Objective: The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years.

Methods: The study was a community-based, longitudinal, cohort study.

Conflicts and concordance between measures of medication prescribing quality.

Background: Several instruments commonly are used to assess the quality of medication prescribing. However, little is known about the relationship between these instruments or the concordance of their quality assessments when applied to the same group of patients.

Methods: We assessed 3 indicators of prescribing quality in a cohort of 196 veterans age 65 and older who were taking 5 or more medications.

Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry.

Purpose: Medical school is a critical time for physicians in training to learn the professional norms of interacting with the pharmaceutical industry, yet little is known about how students' attitudes vary during the course of training. This study sought to determine students' opinions about pharmaceutical industry interactions with medical students and whether these opinions differ between preclinical and clinical students.

Method: The authors surveyed medical students at Harvard Medical School (HMS) from November 2003 through January 2004 using a six-question survey.

Polypharmacy and prescribing quality in older people.

Objectives: To evaluate the relationship between inappropriate prescribing, medication underuse, and the total number of medications used by patients.

Design: Cross-sectional study.

Setting: Veterans Affairs Medical Center.

Narrative review: the promotion of gabapentin: an analysis of internal industry documents.

Background: Internal documents from the pharmaceutical industry provide a unique window for understanding the structure and methods of pharmaceutical promotion. Such documents have become available through litigation concerning the promotion of gabapentin (Neurontin, Pfizer, Inc., New York, New York) for off-label uses.

Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies.

Objective: We sought to assess which interventions are most effective at improving the prescribing of recommended antibiotics for acute outpatient infections.

Design And Methods: We undertook a systematic review with quantitative analysis of the Cochrane Registry Effective Practice and Organization of Care (EPOC) database, supplemented by MEDLINE and hand-searches. Inclusion criteria included clinical trials with contemporaneous or strict historical controls that reported data on antibiotic selection in acute outpatient infections.

Age and rising rates of cyclooxygenase-2 inhibitor use. Results from a national survey.

Background: Cyclooxygenase-2 (COX-2) inhibitors were widely prescribed in the years following their introduction, but little is known about the frequency and context of their use across different age groups.

Objective: To determine patterns and context of COX-2 inhibitor use in younger and older adults.

Design: Cross-sectional surveys conducted each year from 1998 to 2002.

Mortality risk stratification in chronic kidney disease: one size for all ages?

Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n=2583,911).

Interactions between pharmaceutical representatives and doctors in training. A thematic review.

Objective: Medical school and residency are formative years in establishing patterns of prescribing. We aimed to review the literature regarding the extent of pharmaceutical industry contact with trainees, attitudes about these interactions, and effects on trainee prescribing behavior, with an emphasis on points of potential intervention and policy formation.

Design: We searched MEDLINE from 1966 until May 2004 for English language articles.

Quality of ambulatory care for women and men in the Veterans Affairs Health Care System.

Background: Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory care is less well understood.

Objective: To study gender differences in quality of care for patients receiving primary care in the Veterans Affairs (VA) Health Care System.

Fluoroquinolone prescribing in the United States: 1995 to 2002.

Purpose: To measure changes in the rate and type of fluoroquinolones prescribed in the United States from 1995 to 2002.

Methods: We performed a longitudinal analysis of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey of adult visits to physicians in ambulatory clinics and emergency departments throughout the United States from 1995 to 2002. The main outcomes were fluoroquinolone prescribing rates and prescribing in accordance with Food and Drug Administration approval as of December 2002.