When Data Conflict With Practice: Rethinking the use of Prophylactic Antibiotics Before Dental Treatment

Concern is growing about the overuse of antibiotics and the subsequent rise in antibiotic-resistant bacteria. Antibiotics are commonly used to prevent heart valve infections in susceptible patients undergoing dental or other surgical procedures. Although this practice has been standard for nearly 50 years, little evidence exists that it works. This Issue Brief summarizes a population-based study that challenges the link between dental procedures and heart valve infections, and illustrates the difficulty in incorporating new evidence into existing guidelines and longstanding practices

The Ineffectiveness of Retrospective Drug Utilization Review

As policymakers debate adding a prescription drug benefit to Medicare, they must also seek ways to promote cost-effective use of drugs and minimize inappropriate prescribing. For more than a decade, all state Medicaid agencies and most private insurers have used computerized drug utilization review (DUR) programs to prevent or rectify potential prescribing errors. DUR can be retrospective, in which claims data are reviewed to identify patterns of drug use, or prospective, in which prescriptions are reviewed before a drug is dispensed. This Issue Brief summarizes a landmark study that suggests that retrospective DUR has had no measurable effects on outpatient drug use or clinical outcomes in the Medicaid program

Evaluating Health Information Technology’s Clinical Effects

In 2009 the federal government appropriated $34 billion in stimulus-related funding to promote the “meaningful use” of health information technology among Medicare and Medicaid providers and hospitals. One of the key elements of this technology is the adoption of computerized physician order entry (CPOE) systems for inpatient drug prescribing. The potential for CPOE to improve prescribing patterns and prevent adverse events is large, and as yet, unrealized. Amidst enthusiasm for the benefits of CPOE, providers and policymakers are becoming aware that CPOE could introduce new errors into the system and cannot simply be assumed to “work.” This Issue Brief reports on the experience of one hospital system that used its CPOE to reduce the incidence of a serious drug interaction. This rigorous test of a specific CPOE intervention shows that an electronic alert system can be effective in changing prescribing, but may also have unintended consequences for patient safety

Reacting to Antibiotic Allergies

About 10-15% of all adults report that they are allergic to penicillin or other antibiotics, although the accuracy and significance of these reports remain unclear. In the outpatient setting, clinicians often face a dilemma in prescribing for patients with a history of an allergic reaction to antibiotics. Which drugs should these patients avoid? Are these patients at increased risk for an allergic reaction to related drugs? This Issue Brief summarizes several large studies that can help guide and improve the management of patients with antibiotic allergies

Drug Safety and Surveillance: the Case of Avandia

A year ago, a meta-analysis published in The New England Journal of Medicine sounded alarms about the cardiovascular safety of the popular diabetes drug Avandia (rosiglitazone). The study caused both policymakers and the public to question the Food and Drug Administration’s ability to ensure the safety of drugs brought to the marketplace, and evoked memories of Vioxx, the painkiller withdrawn from the market in 2004 because of its link to heart attacks. A year after the Avandia story broke, this Clinical Brief revisits the controversy, summarizes a new study of the cardiovascular safety of diabetes drugs, and analyzes the policy implications for the drug approval process

A Simple Model to Predict Scalar Dispersion within a Successively Thinned Loblolly Pine Canopy

Bark beetles kill millions of acres of trees in the United States annually by using chemical signaling to attack host trees en masse. As an attempt to control infestations, forest managers use synthetic semiochemical sources to attract beetles to traps and/or repel beetles from high-value resources such as trees and stands. The purpose of this study was to develop a simple numerical technique that may be used by forest managers as a guide in the placement of synthetic semiochemicals. The authors used a one-dimensional, one-equation turbulence model (k–lm) to drive a three-dimensional transport and dispersion model. Predictions were compared with observations from a unique tracer gas experiment conducted in a successively thinned loblolly pine canopy. Predictions of wind speed and turbulent kinetic energy compared well with observations. Scalar concentration was predicted well and trends of maximum observed concentration versus leaf area index were captured within 30 m of the release location. A hypothetical application of the numerical technique was conducted for a 12-day period to demonstrate the model’s usefulness to forest managers

A Simple Model to Predict Scalar Dispersion within a Successively Thinned Loblolly Pine Canopy

Bark beetles kill millions of acres of trees in the United States annually by using chemical signaling to attack host trees en masse. As an attempt to control infestations, forest managers use synthetic semiochemical sources to attract beetles to traps and/or repel beetles from high-value resources such as trees and stands. The purpose of this study was to develop a simple numerical technique that may be used by forest managers as a guide in the placement of synthetic semiochemicals. The authors used a one-dimensional, one-equation turbulence model (k–lm) to drive a three-dimensional transport and dispersion model. Predictions were compared with observations from a unique tracer gas experiment conducted in a successively thinned loblolly pine canopy. Predictions of wind speed and turbulent kinetic energy compared well with observations. Scalar concentration was predicted well and trends of maximum observed concentration versus leaf area index were captured within 30 m of the release location. A hypothetical application of the numerical technique was conducted for a 12-day period to demonstrate the model’s usefulness to forest managers