Prevalence and predictors of anticholinergic medication use in elderly nursing home residents with dementia: analysis of data from the 2004 National Nursing Home Survey.

Background: Medications with anticholinergic properties are frequently used in the elderly population. However, evidence suggests that these medications are associated with significant adverse effects and may lead to worsening of cognitive impairment, particularly in elderly patients with dementia.

Objective: To examine the utilization of anticholinergic medications and factors associated with anticholinergic medication use in elderly nursing home patients with dementia.

Risk of falls and fractures in older adults using antipsychotic agents: a propensity-matched retrospective cohort study.

Background: Antipsychotics, especially atypical agents, are widely used in the elderly population to treat behavioural and psychiatric symptoms. Very few studies have compared the risk of falls and fractures among older adults using typical and atypical agents and none of the studies have evaluated differential risk across antipsychotic classes.

Objective: To examine the risk of falls and fractures associated with atypical antipsychotic use and typical antipsychotic use in community-dwelling older adults in the US.

Risk of cerebrovascular adverse events in older adults using antipsychotic agents: a propensity-matched retrospective cohort study.

Objective: To compare the risk of cerebrovascular adverse events with second-generation antipsychotic users versus those taking first-generation antipsychotics in community-dwelling older adults.

Method: A population-based retrospective cohort study matched on propensity score was used to examine the risk of cerebrovascular adverse events in second-generation antipsychotic users compared to first-generation antipsychotic users. IMS LifeLink Health Plan Claims Database was used to identify older adults (> or = 50 years) taking second-generation or first-generation antipsychotic agents from July 1, 2000, to December 31, 2007.

Crofelemer, a novel agent for treatment of secretory diarrhea.

Objective: To review the chemistry, pharmacology, pharmacokinetics, efficacy, and safety of crofelemer.

Data Sources: A literature search using the terms SP-303, Provir, and crofelemer was performed with PubMed (up to April 2010), Google Scholar, and selected Ovid bibliography searches. Additional references from the bibliographies of articles included in the search, as well as company and Food and Drug Administration Web sites, were also assessed.

Quantitative assessment of combination antimicrobial therapy against multidrug-resistant bacteria in a murine pneumonia model.

Background: Combination antimicrobial therapy is clinically used as a last-resort strategy to control multidrug-resistant bacterial infections. However, selection of antibiotics is often empirical, and conventional assessment of combined drug effect has not been correlated to clinical outcomes. Here, we report a quantitative method to assess combined killing of antimicrobial agents against 2 multidrug-resistant bacteria.

Off-label use of second-generation antipsychotic agents among elderly nursing home residents.

Objective: This study examined off-label and evidence-based use of second-generation antipsychotic agents among elderly nursing home residents and factors associated with off-label use.

Methods: This study involved a retrospective, cross-sectional analysis of data from the 2004 National Nursing Home Survey (NNHS). The sample included nursing home residents 65 years and older who received second-generation antipsychotic agents.

Symposium on roles of and cooperation between academic- and practice-based pharmacy clinicians.

Purpose: The findings of an academic symposium as they relate to the history and role of the academic pharmacy clinician, the strengths and limitations of the academic pharmacy clinician model, and the framework for future synergistic work relations among clinical pharmacy practitioners are summarized.

Summary: On April 23, 2008, a symposium was convened to bring key thought leaders together to discuss the relationship of the academic-based pharmacy clinician and the practice-based pharmacy clinician. Participants included clinical faculty and administrators from two colleges of pharmacy, practice-based clinical pharmacists and pharmacy managers from seven health care institutions, and representatives from the American Association of Colleges of Pharmacy, the American College of Clinical Pharmacy, and the American Society of Health-System Pharmacists.

A novel Transformation Model© for personalized medicine laboratory systems.

The role of health system laboratories is critical to the appropriate clinical integration of personalized medicine. We conducted semistructured interviews with experts and opinion leaders representing laboratory medicine, health policy and the diagnostics industry, to examine what is known about the real-world effectiveness of health laboratories as organizations. We describe and encourage the wider use of an evidence-based, novel Transformation Model© to prepare for the future and set goals for a better health system.

Application of the Extended Technology Acceptance Model in predicting pharmacists' intention to use personal digital assistants.

Objective: To evaluate pharmacists' behavioral intention to use personal digital assistants (PDAs) in their profession, by means of the Extended Technology Acceptance Model (ETAM).

Design: Prospective cross-sectional study.

Setting: Hospital and community pharmacies in Houston, TX, in 2004.

Unmet prescription medication need in U.S. children.

Objectives: To examine the nature and extent of unmet prescription medication need (UPMN) in children and its predictors using the 2003 National Survey of Children's Health (NSCH).

Design: Retrospective cross-sectional survey.

Setting: United States in 2003-2004.

Good research practices for comparative effectiveness research: analytic methods to improve causal inference from nonrandomized studies of treatment effects using secondary data sources: the ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report--Part III.

Objectives: Most contemporary epidemiologic studies require complex analytical methods to adjust for bias and confounding. New methods are constantly being developed, and older more established methods are yet appropriate. Careful application of statistical analysis techniques can improve causal inference of comparative treatment effects from nonrandomized studies using secondary databases.

Concomitant antipsychotic prescribing in US outpatient settings.

Background: Clinicians use concomitant antipsychotic therapy for management of psychotic disorders despite a paucity of evidence for this practice.

Objective: To examine national patterns and determinants of concomitant antipsychotic therapy.

Methods: Concomitant antipsychotic therapy was defined as simultaneous use of 2 or more antipsychotic agents.

The association of Medicare drug coverage with use of evidence-based medications in the Veterans Health Administration.

Background: Veterans with Medicare managed-care plans have access to pharmacy benefits outside the Veterans Health Administration (VA), but how this coverage affects use of medications for specific disease conditions within the VA is unclear.

Objective: To examine patterns of pharmacotherapy among patients with diabetes mellitus, ischemic heart disease, and chronic heart failure enrolled in fee-for-service (FFS) or managed-care (HMO) plans and to test whether pharmacy benefit coverage within Medicare is associated with the receipt of evidence-based medications in the VA.

Methods: A retrospective analysis of veterans dually enrolled in the VA and Medicare healthcare systems was conducted.

Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data.

Background: Atypical antipsychotic agents are increasingly being used for the treatment of behavioural and psychological symptoms of dementia. However, recent data suggest that the risk of adverse effects may offset the benefits of atypical agents in patients with dementia.

Objectives: To examine utilization of antipsychotic medications and the factors associated with use of atypical antipsychotics among elderly nursing home residents with dementia.

Overview of the changing epidemiology of candidemia.

Candida spp. are currently the fourth most common cause of bloodstream infections in US hospitals, and the third most common cause of bloodstream infections in the intensive care unit. Over the last 2 decades there has been a shift towards a greater involvement of non-Candida albicans spp.

Prevalence of type III secretion protein exoenzymes and antimicrobial susceptibility patterns from bloodstream isolates of patients with Pseudomonas aeruginosa bacteremia.

The purpose of this study was to determine the prevalence of two type III secretion effector proteins, exoU and exoS from bloodstream isolates of hospitalized patients with Pseudomonas aeruginosa (PSA) bacteremia, to characterize antimicrobial susceptibility patterns, and to compare mortality rates. PSA bloodstream isolates and antibiotic susceptibility profiles were collected from a university-affiliated hospital. ExoS and exoU genes were detected by polymerase chain reaction.

Hospitalization risk associated with typical and atypical antipsychotic use in community-dwelling elderly patients.

Background: Due to age-related changes in drug disposition and response, elderly patients are more susceptible to the adverse effects of antipsychotic medications than younger adults. However, few studies have examined the impact of typical and atypical antipsychotic use on all-cause hospitalization in the elderly population.

Objective: This study compared the short-term effects of incident use of typical and atypical antipsychotic agents on the risk for hospitalization in a community-dwelling elderly population.

Antipsychotic drug use among elderly nursing home residents in the United States.

Background: Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of atypical agents in the 1990s.

Objective: The goal of this study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States.

Significant publications on infectious diseases pharmacotherapy in 2007.

Purpose: Significant publications on infectious diseases (ID) pharmacotherapy in 2007 were compiled and summarized.

Summary: On January 2, 2008, the 21 members of the Houston Infectious Disease Network (HIDN) were asked to select an article that was published in a peer-reviewed journal between January 1 and December 31, 2007, and write a summary highlighting why the article was significant to the diagnosis or treatment of ID. Articles were selected based on prior "top 10" presentations at major ID and pharmacy meetings or were listed as major articles in prominent ID journals.

Increased bacterial adherence and biomass in Pseudomonas aeruginosa bacteria exposed to clarithromycin.

Long-term low-dose macrolides alter response in patients with chronic sessile Pseudomonas aeruginosa colonization. We examined the effect of clarithromycin on 1) adherence of P. aeruginosa cells and 2) biofilm formation.

Use/misuse of over-the-counter medications and associated adverse drug events among HIV-infected patients.

Background: Self-medication practices and polypharmacy are common among human immunodeficiency virus (HIV)-infected patients. Inappropriate use of over-the-counter (OTC) medications potentiates the risk for drug misuse and adverse drug events (ADEs).

Objectives: To investigate use and misuse of OTC medications in HIV-infected patients and determine related ADEs.

Hypertension management in outpatient visits by diabetic patients.

Background: Hypertension is a common comorbidity among patients with diabetes. Few national studies have examined hypertension management in diabetic patients and even fewer studies have examined prescribing of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), the recommended first line of treatment in hypertensive diabetic patients.

Objective: This study examined hypertension management, including behavioral therapy and pharmacotherapy, in a nationally representative sample of outpatient visits by diabetic patients.

Rifamycin antibiotics for treatment of Clostridium difficile-associated diarrhea.

Objective: To review the existing data on use of the rifamycin class of antibiotics as therapy for Clostridium difficile-associated diarrhea (CDAD).

Data Sources: A literature search was performed using PubMed (1996-January 2008), abstracts from the International Conference on Antimicrobial Agents and Chemotherapy (September 2007), the Infectious Diseases Society of America (October 2007), Salix Pharmaceuticals Web site (January 2008), ActivBiotics Web site (January 2008), Google Scholar, and searches of selected bibliographies using the terms rifamycin, ansamycins, rifampin, rifabutin, rifampicin, rifaximin, rifalazil, Clostridium difficile, C. difficile, and CDAD.