The association of PIRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting.

Because inappropriate prescribing is prevalent in individuals aged 65 and older, various criteria to assess it have been developed. This study's aim was to systematically review articles that describe criteria for assessing inappropriate prescribing in individuals aged 65 and older and to define the circumstances of their use (explicit/implicit), origins, development processes, and content. A systematic search was conducted on MEDLINE and PubMed (1990-2010) and augmented with a manual search. Original articles written in English were included if they described the development of the criteria and were aimed at people aged 65 and older. Articles that described criteria applicable only in hospital settings, specific drugs, or a particular disease or condition were excluded. Sixteen of 535 articles met the inclusion criteria. They described 14 criteria, half originating in the United States. The English-language restriction limited the search results. Most criteria were explicit, consensus validated, based totally or partly on Beers criteria, and focused on pharmacological appropriateness of prescribing and some were old. Drug- and disease-oriented explicit criteria require regular updating and are country specific. Implicit, person-specific criteria are universal and do not need updating, although their use requires up-to-date professional skills. Unlike explicit criteria, implicit criteria have been validated in people. Some of the 14 criteria were noncomprehensive, mainly because of the intended purpose. To conclude, different criteria exist for optimizing prescribing for individuals aged 65 and older. Possible deficiencies must be recognized and trade-offs made when selecting criteria for use. In the future, more-comprehensive and -timely criteria are needed.

The clinical triad of a firstborn delivered vaginally to a young (teenage) mother has been previously noted among juvenile onset recurrent respiratory papillomatosis (JO-RRP) patients. This study was based on a questionnaire survey of JO-RRP patients, adult onset recurrent respiratory papillomatosis (AO-RRP) patients, and juvenile and adult controls. The survey results revealed that the complete or partial triad was observed in 72% of JO-RRP patients, 36% of AO-RRP patients, 29% of juvenile controls, and 38% of adult controls. As compared with juvenile controls, JO-RRP patients were more often firstborn (P less than .05), delivered vaginally (P less than .05), and born to a teenage mother (P less than .01). Among adult participants, AO-RRP patients reported more lifetime sex partners (P less than .01) and a higher frequency of oral sex (P less than .05) than reported by adult controls. AO-RRP and JO-RRP appear to have distinguishable epidemiologic features indicating that the mode of human papillomavirus (HPV) transmission is different in these two disorders.

Objective. To estimate the scope of potentially inappropriate medication prescriptions (PIRx) among elderly residents in U.S. nursing homes (NHs), and to examine associated resident and facility characteristics. Data Sources. The 1996 Medical Expenditure Panel Survey Nursing Home Component (MEPS NHC), a survey of a nationally representative sample of NHs and residents. Study Design. The PIRx, defined by Beers's consensus criteria (1991, 1997), was identified using up to a year's worth of NH prescribed medicine data for each resident. The study sample represented 1.6 million NH residents (n 5 3,372). Results. At a minimum, 50 percent of all residents aged 65 or older, with an NH stay of three months or longer received at least one PIRx in 1996. The most common PIRx involved propoxyphene, diphenhydramine, hydroxyzine, oxybutynin, amitriptyline, cyproheptadine, iron supplements, and ranitidine. Resident factors associated with greater odds of PIRx were Medicaid coverage, no high school diploma, and nondementia mental disorders. Facility factors were more beds and lower RN-to-resident ratio. Factors associated with lower odds of PIRx were fewer medications, residents with communication problems, and being in an accredited NH. Onsite availability of pharmacists or mental health providers was not related. Implications. With quality of care and patient safety as major public health concerns, effective policies are needed to avoid PIRx occurrences and improve the quality of prescribing among elderly residents in NHs. Additional studies are needed to determine the impact of PIRx on this NH population.

A minority of families of persons with schizophrenia receive information about the illness from providers. Implementation of model family interventions is possible with considerable technical assistance. A gap exists between best practices and standard practices for families of persons with schizophrenia.

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Hypothesis: Patients with increasing comorbidities are at increased risk of admission to an inpatient facility after outpatient surgery. Design and Setting: Data from operations performed in hospital-based and freestanding ambulatory surgery centers in New York during 1997 were obtained under the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. Patients: Of the 783 558 patients eligible for inclusion in this study, 4351 were discharged directly for shortterm hospitalization (1:180), and 19 died (1:41 240). We performed a split-half analysis by randomly assigning the study sample to an analysis half for estimation or a holdout half for testing. Main Outcome Measures: We developed an outpatient surgery admission index from independent predictors of immediate hospital admission using the following point values: 65 years or older (1), operating time longer than 120 minutes (1), cardiac diagnoses (1), peripheral vascular disease (1), cerebrovascular disease (1), malignancy (1), seropositive findings for human immunodeficiency virus (1), and regional (1) or general anesthesia (2). Results: Increasing scores were associated with higher odds of admission relative to scores of 0 or 1. For scores of 4 or higher, the odds ratio was 31.96 (95% confidence interval, 26.29-38.86), and 2.8% of these patients were discharged to the hospital. For the holdout half of the data set, scores of 4 or higher had an odds ratio of 34.62 (95% confidence interval, 28.55-41.97). Conclusion: The proposed outpatient surgery admission index provides an evidence-based guide to assist clinicians and the health care systems in which they work in identifying patients at higher risk of immediate hospital admission.

The Delphi process resulted in a structured DRP Risk Assessment Tool that is focused on the highest priority DRPs that should be identified and resolved. The tool also assists the PNs to identify solutions to these problems, which is a unique feature compared to similarly purposed prior tools.