Use of antiepileptic drugs and lipid-lowering agents in the United States.

INTRODUCTION: The extent to which enzyme-inducing antiepileptic drugs (EIAEDs) are used as first-line treatment in the United States remains unknown. Studies suggest that EIAEDs produce elevation of serum lipids, which could require additional treatment. We assessed the current use of EIAED in monotherapy for epilepsy in the U.S., as well as the correlation between the use of EIAEDs and subsequent new prescriptions for HMG-CoA reductase inhibitors ( statins ) for hyperlipidemia. METHODS: We queried the MarketScan® databases between July 2009 and January 2013, covering 66million patients with commercial or supplemental Medicare insurance. We identified individuals who had a diagnosis of seizures, continuous enrollment in the database from 6months prior to 24months after the epilepsy diagnosis, no utilization of an AED or a statin prior to that diagnosis, and at least 1 new AED prescription. We tabulated the fraction of subjects who were prescribed EIAEDs (phenytoin, carbamazepine, or barbiturates) and those prescribed all other AEDs. Rates of new statin prescription between 1 and 24months after AED prescription were assessed among the two groups, restricted to those with no prior history of vascular disease who had lipid serology obtained subsequent to the new AED prescription. RESULTS: Of the 11,893 patients with newly treated epilepsy, 2425 (20.4%) were started on an EIAED, and 9468 (79.6%) were started on a noninducing AED. There was a consistent and significant trend for EIAEDs to be increasingly prescribed with increasing age (p CONCLUSIONS: Enzyme-inducing antiepileptic drug prescription for epilepsy appears to increase with increasing age in the U.S. despite the absence of a cogent rationale for this practice, suggesting a failure to appreciate the complications of EIAED therapy among U.S. physicians. Statins were more often prescribed to those newly treated with EIAEDs compared with those given noninducing AEDs. These preliminary data provide further evidence suggesting that EIAEDs elevate lipids in a clinically meaningful manner

Tivantinib added to erlotinib in nonsmallcell lung cancer: The primary end point was not MET..

D ow nloaded from 2 The transmembrane tyrosine kinase receptor Mesenchymal-Epithelial Transition (MET) factor, activated by its ligand hepatocyte growth factor (HGF), is involved in cell proliferation, survival, motility, and metastasis [1]. The MET pathway is known to crosstalk with the epidermal growth factor receptor (EGFR) and KRAS signaling pathways, which are critical in the molecular pathogenesis of many solid tumors, including non-small lung cancer (NSCLC) with intrinsic or acquired resistance to EGFR inhibitors [2]. While MET amplification is a quite uncommon event in lung cancer, MET protein overexpression has been detected, by immunohistochemistry, in 27 % to 77 % of NSCLC samples with non-squamous histology and 1 % to 57 % of NSCLC samples with squamous cell histology [1]. Tivantinib is an oral drug that binds to the dephosphorylated MET kinase [3]. Although it has shown cytotoxic activity via molecular mechanisms that are independent from its ability to bin

A Review of Current Quality Metrics for Evaluating Patient-Centered Medical Homes

Objectives: This review sought to explore the quality metrics that are currently utilized to assess PCMHs Poster presented at 2016 ISPOR conference in Washington DC.https://jdc.jefferson.edu/jcphposters/1007/thumbnail.jp

Prevalence and Risk of Polypharmacy among the Elderly in an Outpatient Setting: A Retrospective Cohort Study in the Emilia-Romagna Region, Italy

Background: Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multi-factorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases. Objective: We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of exposure to polypharmacy, in the elderly population of the Emilia-Romagna region in Italy. Methods: We conducted a retrospective cohort study of the 2007 Emilia-Romagna outpatient pharmacy database linked with patient information available from a demographic file of approximately 1 million Emilia-Romagna residents aged ≥65 years. The cohort was comprised of 887 165 elderly subjects who had at least one prescription filled during the study year. Using the World Health Organization’s defined daily dose (DDD) to determine the duration of treatment for a given drug, we defined a polypharmacy episode as overlapping treatment with five or more medications occurring for at least one day. The prevalence of polypharmacy was measured together with subject characteristics found to be predictive of polypharmacy exposure. Results: A total of 349 689 elderly people in the population (39.4%) were exposed to at least one episode of polypharmacy during the study period. The prevalence of polypharmacy substantially increased with age and with a higher number of chronic conditions. Over 35% of those exposed to polypharmacy were exposed for 101 or more days of the year. The top three classes of medications involved in polypharmacy were antithrombotics, peptic ulcer disease and gastro-oesophageal reflux disease agents and ACE inhibitors. The odds of exposure to polypharmacy were higher for older subjects, males and subjects living in urban areas. Conclusions: This study provides evidence that the prevalence of polypharmacy in the elderly in Emilia-Romagna is substantial. Educational programmes should be developed to inform clinicians about the magnitude of the polypharmacy phenomenon and the patient characteristics associated with polypharmacy. Raising physicians’ awareness of polypharmacy may help to ensure safe, effective and appropriate use of medication in the elderly

Predicting risk of hospitalisation: a retrospective population-based analysis in a paediatric population in Emilia-Romagna, Italy.

OBJECTIVES: Develop predictive models for a paediatric population that provide information for paediatricians and health authorities to identify children at risk of hospitalisation for conditions that may be impacted through improved patient care. DESIGN: Retrospective healthcare utilisation analysis with multivariable logistic regression models. DATA: Demographic information linked with utilisation of health services in the years 2006-2014 was used to predict risk of hospitalisation or death in 2015 using a longitudinal administrative database of 527 458 children aged 1-13 years residing in the Regione Emilia-Romagna (RER), Italy, in 2014. OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in 2015 for problems that are potentially avoidable were developed and evaluated using the C-statistic, for calibration to assess performance across levels of predicted risk, and in terms of their sensitivity, specificity and positive predictive value. RESULTS: Of the 527 458 children residing in RER in 2014, 6391 children (1.21%) were hospitalised for selected conditions or died in 2015. 49 486 children (9.4%) of the population were classified in the \u27At Higher Risk\u27 group using a threshold of predicted risk \u3e2.5%. The observed risk of hospitalisation (5%) for the \u27At Higher Risk\u27 group was more than four times higher than the overall population. We observed a C-statistic of 0.78 indicating good model performance. The model was well calibrated across categories of predicted risk. CONCLUSIONS: It is feasible to develop a population-based model using a longitudinal administrative database that identifies the risk of hospitalisation for a paediatric population. The results of this model, along with profiles of children identified as high risk, are being provided to the paediatricians and other healthcare professionals providing care to this population to aid in planning for care management and interventions that may reduce their patients\u27 likelihood of a preventable, high-cost hospitalisation

Changes in the state of ice buildup on a composite plate: ultrasonic monitoring and assessment.

From airplane wings to overhead power lines, through large blades of wind turbines, a buildup of ice can cause problems ranging from low performance to catastrophic failure. Therefore, it is of the utmost importance to control or prevent ice formation, especially on the critical areas of the structures. However, de-icing and anti-icing countermeasures can result energetically expensive and harmful to the environment. In addition, excessive use thereof will reduce the life of an ice protection system (IPS) and introduce fatigue to the controlled structures. Therefore, in order to manage properly the available resources, it is desirable to have an IPS that can both detect ice formation and monitor the ice thickness on critical surfaces. This would allow the IPS to operate when it is necessary. Ultrasonic guided-wave-based techniques have proved to be reliable for ice detection but approaches to assess ice state over time have not been reported yet. The present work investigates the interaction of ultrasonic waves, propagating in a composite plate, with an ice mass changing state, as it melts. The use of a metric is discussed as indicator of ice condition variation

Lessons from Italy

Learning Objectives: Describe how public health and healthcare services are provided by the Italian National Healthcare System Define the epidemiology and pattern of the spread of COVID-19 in the Italian population Identify strategies that have been adopted in Italy to contain and mitigate the pandemi

Assessing Chronic Disease Rates Through Automated Pharmacy Data

No abstract available