Association between depression and maintenance medication adherence among Medicare beneficiaries with chronic obstructive pulmonary disease

La exposición de Roberto Rollié realizada a fines del año 2000 en el Centro Cultural Islas Malvinas (La Plata), a cuyo registro se accedió mediante la licenciada María Branda, permite hacer un repaso por la vasta obra del autor platense. Este artículo, además de presentar un recorrido por esta exposición, invita a pensar el archivo personal de Branda y su papel como productora del fondo documental de Roberto Rollié.Roberto Rollié’s exhibition held at the end of the year 2000 at the Malvinas Islands Cultural Center (La Plata), whose registration was accessed by María Branda, allows a review of the vast work of the author. This article, in addition to presenting a tour of this exhibition, invites us to think about Branda’s personal archive and his role as producer of Roberto Rollié’s documentary collection.Facultad de Bellas Arte

Neuropsychiatric Symptoms in Patients with Dementia and the Longitudinal Costs of Informal Care in the Cache County Population

Introduction Severity of dementia and neuropsychiatric symptoms contribute to increasing informal care costs. We examined which neuropsychiatric symptoms subdomains (NPS-SD) were associated with informal costs in a population-based sample. Methods Dementia progression and informal costs (2015 dollars) were estimated from the Cache County Dementia Progression Study. Overall NPS and specific NPS-SD were assessed with the Neuropsychiatric Inventory. Generalized Estimating Equations (GEE with gamma-distribution/log-link) modeled the relationship between NPS-SDs and informal cost trajectories. Results Two hundred eighty participants (52.1% female; age M = 85.67, SD = 5.60) exhibited an adjusted cost increase of 5.6% (P = .005), 6.4% (P \u3c .001), 7.6% (P = .030), and 13% (P = .024) for every increasing Neuropsychiatric Inventory unit in psychosis-SD, affective-SD, agitation/aggression-SD, and apathy-SD, respectively. An increase in each unit of apathy was associated with a 2% annual decrease in costs (P = .040). Discussion We extend our prior work on informal costs and dementia severity by identifying NPS-SD associated with informal costs. Interventions targeting NPS-SD may lower informal costs

A sustainable strategy to prevent misuse of antibiotics for acute respiratory infections.

Over 50% of antibiotics prescriptions are for outpatients with acute respiratory infections (ARI). Many of them are not needed and thus contribute both avoidable adverse events and pressures toward the development of bacterial resistance. Could a clinical decision support system (CDSS), interposed at the time of electronic prescription, adjust antibiotics utilization toward consensus treatment guidelines for ARI?This is a retrospective comparison of pre- (2002) and post-intervention (2003-2006) periods at two comprehensive health care systems (intervention and control). The intervention was a CDSS that targeted fluoroquinolone and azithromycin; other antibiotics remained unrestricted. 7000 outpatients visits flagged by an ARI case-finding algorithm were reviewed for congruence with the guidelines (antibiotic prescribed-when-warranted or not-prescribed-when-unwarranted).3831 patients satisfied the case definitions for one or more ARI: pneumonia (537), bronchitis (2931), sinusitis (717) and non-specific ARI (145). All patients with pneumonia received antibiotics. The relative risk (RR) of congruent prescribing was 2.57 (95% CI = (1.865 to 3.540) in favor of the intervention site for the antibiotics targeted by the CDSS; congruence did not change for other antibiotics (adjusted RR = 1.18 (95% CI = (0.691 to 2.011)). The proportion of unwarranted prescriptions of the targeted antibiotics decreased from 22% to 3%, pre vs. post-intervention (p<0.0001).A CDSS interposed at the time of e-prescription nearly extinguished unwarranted use targeted antibiotics for ARI for four years. This intervention highlights a path toward sustainable antibiotics stewardship for outpatients with ARI

Effect of the CDSS on antibiotics use for ARI.

<p>Comparison of antibiotic utilization for ARI between the time periods before (dark bars) or after (light bars) introduction of the CDSS. Y-axis represents proportions of ARI visit where antibiotics were prescribed. For comparisons involving antibiotics targeted by the CDSS (dark and light bar pairs over the word “Targeted”), proportions are given by V_Targeted/(V_Targeted+V_NoAntibiotic), where V_Targeted is the number of visits where targeted antibiotics were prescribed and V_NoAntibiotic the number of visits not issued antibiotics. For comparisons involving other antibiotics (dark and light bar pairs over the word “Other”), proportions are given by V_Other/(V_Other+V_NoAntibiotic), where V_Other is the number of visits where Other antibiotics were prescribed. Upper panel only includes ARI visits where antibiotics were indicated; lower panel only includes those ARI visits where antibiotics were not indicated. Results for the intervention and the control sites are given on the left and right side of the figure, respectively. Note that proportions of visits where antibiotics were prescribed did not change pre vs. post-intervention, except for a decrease in Targeted antibiotics use at the intervention site.</p

Antibiotic Prescriptions by Visits.

<p>Number of ARI visits for which antibiotics were given (“Prescribed” rows) or withheld (“Not Prescribed” row) either in accordance with (“Warranted” columns) or against guideline recommendations (“Unwarranted” columns). Columns further separate the visits by 1) study site (Intervention vs. Control Site); 2) time periods (pre-intervention year (“2002”) vs. post-intervention years (“2003–6”)); and 3) by whether or not the antibiotics prescribed were those targeted by the intervention (“Targeted” vs. “Other”).</p

Diagnostic and treatment criteria for ARI.

<p>Diagnostic and treatment criteria for ARI.</p