Overall inappropriate medication use in elderly patients remains a serious problem. Despite challenges in using explicit criteria for assessing inappropriate medications for elderly patients, such criteria can be applied to population-based surveys to identify opportunities to improve quality of care and patient safety. Enhancements of existing data sources to include dosage, duration, and indication may augment national improvement and monitoring efforts.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is still a major global healthcare problem. Of concern is S. aureus bacteremia, which exhibits high rates of morbidity and mortality and can cause metastatic or complicated infections such as infective endocarditis or sepsis. MRSA is responsible for most global S. aureus bacteremia cases, and compared with methicillin-sensitive S. aureus, MRSA infection is associated with poorer clinical outcomes. S. aureus virulence is affected by the unique combination of toxin and immune-modulatory gene products, which may differ by geographic location and healthcare- or community-associated acquisition. Management of S. aureus bacteremia involves timely identification of the infecting strain and source of infection, proper choice of antibiotic treatment, and robust prevention strategies. Resistance and nonsusceptibility to first-line antimicrobials combined with a lack of equally effective alternatives complicates MRSA bacteremia treatment. This review describes trends in epidemiology and factors that influence the incidence of MRSA bacteremia. Current and developing diagnostic tools, treatments, and prevention strategies are also discussed.

In general, this study provides evidence of impressive psychometric properties of the GDS-15 when administered to a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.

The PHQ-2 is a valid screening tool for major depression in older people but should be followed by a more-comprehensive diagnostic process. Although its specificity differs by age, sex, and racial and ethnic groups, these differences appear to be of little clinical significance.

Context Although stroke centers are widely accepted and supported, little is known about their impact on patient outcomes. Objective To examine the association between admission to stroke centers for an acute ischemic stroke and mortality. Design, Setting, and Participants Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n=30,947) between 2005 and 2006 at designated stroke centers and non-designated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential pre-hospital selection bias. Patients were followed for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n=39,409) or acute myocardial infarction (n=40,024) at designated stroke centers and non-designated hospitals. Main Outcome Measure Thirty-day all-cause mortality. Results Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with greater use of thrombolytic therapy (4.8% vs. 1.7%; adjusted difference 2.2%, 95% CI, 1.6% to 2.8%; P<0.001) and lower 30-day all-cause mortality (10.1% vs. 12.5%; adjusted mortality difference: −2.5%, 95% CI, −3.6% to −1.4%; P<0.001). Differences in mortality also were observed at all time points, including at 1-day, 7-day, and 1-year follow-up. Moreover, the outcome differences were specific to stroke, as stroke centers and non-stroke centers had similar 30-day all-cause mortality rates among those with acute myocardial infarction (adjusted mortality difference: +0.3%, 95% CI, −0.5% to 1.0%; P=0.50) and/or gastrointestinal hemorrhage (adjusted mortality difference: +0.1%, 95% CI, −0.9% to 1.1%; P=0.83). Conclusions Admission to a designated stroke center for acute ischemic stroke was associated with more frequent use of thrombolytic therapy and lower mortality.

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Objective There is an absence of nationally representative data describing pediatric patients who use emergency medical services (EMS) and the factors associated with EMS use by children. This study characterizes pediatric emergency department (ED) visits for which the patient arrived by EMS and identifies factors associated with those visits using a nationally representative database. Methods A secondary analysis of the ED component of the 1997–2000 National Hospital Ambulatory Medical Care Survey was performed. The dependent variable was the mode of arrival to the ED (EMS vs. not EMS), and independent variables were grouped into four domains: demographic, clinical, system, and service characteristics. Bivariate analyses and multivariate logistic regression analyses were conducted. Results There were 110.9 million ED visits by children aged <19 years between 1997 and 2000. Pediatric patients constituted 27.3% of all ED visits during this time, and 7.9 million (7.1%) of these patients arrived via EMS. Pediatric patients represented 13% of all EMS transports. The annual EMS utilization rate by children was 26 per 1,000, compared with 66 per 1,000 in the adult population (p < 0.001). Sixteen percent of children transported by EMS were admitted to the hospital. Sixty-two percent of pediatric patients arriving at the ED by EMS were transported as a result of injury or poisoning. Characteristics significantly associated with arrival by EMS in the final multivariate model included demographic (age, African American race, urban residence), clinical (need for greater immediacy of care, illnesses associated with certain diagnoses), and service (greater number of diagnostic services) variables. Conclusions Pediatric patients transported by EMS are more likely to have injuries and poisoning, and have higher-acuity illness than those arriving at the ED by other means. The epidemiology of pediatric EMS use may have important operational, training, and public health implications and requires further study.