Medication Use Quality and Safety in Older Adults: 2019 Update

Improving the quality of medication use and medication safety are important priorities for prescribers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2019. We selected high-quality studies that moved the field of research forward and were not merely replication studies. The chosen articles cover domains related to aspects of suboptimal prescribing and medication safety. The first study used a nationally representative sample of Medicare beneficiaries to examine the continuation of medications with limited benefit in patients admitted for cancer and non-cancer diagnoses in hospice (domain: potentially inappropriate medications). The second study, a retrospective cohort study of older adults in Ontario, Canada, assessed the association between prescribing oral anticoagulants in an emergency department relative to not prescribing anticoagulants in the emergency department and their persistence at 6 months (domain: underuse of medications). The third study, a cluster randomized trial in Quebec, Canada, evaluated the effect of conducting electronic medication reconciliation on several outcomes including adverse drug events and medication discrepancies (domain: medication safety). Lastly, the fourth study, a retrospective study using national inpatient and outpatient Veteran Health Administration combined with clinical and Medicare Claims data, examined the effects of intensification of antihypertensive medications on older adults' likelihood for hospital re-admission and other important clinical outcomes (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.     

Blastocyst culture and transfer: a step toward improved in vitro fertilization outcome.

OBJECTIVE: To evaluate the efficacy of blastocyst culture and transfer in human in vitro fertilization (IVF) as compared to day 3 embryo transfer. DESIGN: Prospective randomized trial. SETTING: Private assisted reproduction unit. PATIENT(S): A total of 162 IVF patients were included in the day 3 embryo transfer (n = 82) and blastocyst transfer (n = 80) groups. INTERVENTION(S): Embryo transfer on day 3 after culture in the standard culture media and blastocyst transfer on day 5 or 6 after culture in the sequential culture media. MAIN OUTCOME MEASURE(S):Implantation and pregnancy rates, multiple gestation rate. RESULT(S): The implantation rate for embryos transferred at the blastocyst stage was significantly higher than that for embryos transferred on day 3 (26% vs. 13%). The viable pregnancy rate was similar in both groups (29% vs. 26%). Significantly fewer embryos were required for transfer at the blastocyst stage compared with day 3 embryo transfer (2.0 +/- 0.1 vs. 3.5 +/- 0.63). The high-order multiple gestation rate was significantly less with the blastocyst transfer than with the day 3 embryo transfer (4% vs. 19%). CONCLUSION(S): With the use of blastocyst culture, a few embryos can be transferred without decreasing the overall pregnancy rate. This may reduce multiple gestations and improve human IVF outcome.     

Transverse and Sigmoid Sinus Dural Arteriovenous Fistula Mimicking Idiopathic Intracranial Hypertension and Carotid Cavernous Fistula

Intracranial dural arteriovenous fistulas (dAVFs) can produce a variety of symptoms depending on fistula location, size, and venous drainage. Although cavernous sinus fistulas (CCFs) classically present with symptoms of orbital venous congestion due to retrograde venous drainage into the superior ophthalmic vein (i.e. an arterialised “red eye”) (Miller NR. Neurosurg Focus 2007;23:1--15), dAVFs not localised to the cavernous sinus rarely present with a “red eye” and instead produce increased intracranial pressure, which can mimic idiopathic intracranial hypertension (IIH). The authors present a unique case of an intracranial dAVF with clinical features suggestive of both CCF and IIH. Clinicians should be aware of this possibility to avoid delayed diagnosis of the intracranial dAVF.     

Talimogene Laherparepvec in Non-Melanoma Cancers

BackgroundTalimogene laherparepvec (T-VEC) is the first oncolytic virus therapy approved by the United States Food and Drug Administration (in 2015) for the treatment of advanced-stage melanoma. Despite a paucity of Phase III trials for T-VEC as a therapy for non-melanoma cancers, successful off-label use of T-VEC for this purpose has been reported in the literature.ObjectiveWe sought to review the literature describing T-VEC as a treatment for non-melanoma cancer.MethodsSystematic searches of the PubMed literature database and ClinicalTrials.gov website were performed in July 2020, focusing on T-VEC in combination with non-melanoma cancer, including squamous cell carcinoma, Merkel cell carcinoma, sarcoma, cutaneous B-cell lymphoma, and cutaneous T-cell lymphoma. Articles were screened based on their title and abstract.ResultsNine articles with 87 patients were included. Relevant articles included case reports, case series, and Phase I and Phase II trials. The majority of patients in the studies had refractory cancers or had been heavily pretreated. Overall, T-VEC demonstrated efficacy for non-melanoma cancer, both independently and in combination with biologics.ConclusionT-VEC has demonstrated efficacy for non-melanoma cancers. Phase III trials of T-VEC for this indication are warranted to expand its clinical utility.     

Evaluation of PIRs Post-Fire Pull-Out Strength in Concrete Exposed to ISO 834-1 Fire

Post-installed rebars (PIRs) using mortar can offer bond strength at ambient temperature equal or higher to that of cast-in place rebars. However, high temperatures have the effect of weakening the bond, typically governed by the chemical and physical properties of the mortar which is often sensitive to temperature increase. Therefore, the behavior of PIRs in a fire situation becomes vulnerable. Moreover, after exposure of PIRs to high temperature, the heat transfer continues during the post-fire phase, which might endanger the construction after a fire event. In order to evaluate the evolution of the pull-out capacity during fire, Pinoteau et al. have developed the bond resistance integration method (Pinoteau’s RIM) to predict the bond resistance value of a rebar subjected to various temperatures in accordance with the fire exposure curves. Therefore, accurate temperature profiles during the post-fire phase are needed to ensure a correct calculation of the post-fire behavior of the PIR connection. This paper presents 3D finite element thermal simulations of PIRs in concrete exposed to ISO 834-1 fire conditions then cooled with ambient air. Numerical thermal profiles are then compared to the experimental results (i.e., post-fire pull-out tests). The proposed model provides guidelines for conducting numerical simulations to determine the thermal entry data necessary for predicting thermal profiles in PIRs during heating and cooling phases. Then, the post-fire pull-out capacity of PIRs in concrete is calculated using Pinoteau’s RIM, and compared to experimental post-fire pull-out results.