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Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time‐to‐first unplanned healthcare utilization, which included 90‐day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. Methods: A secondary data analysis of a clinical trial (Shed‐MEDS NCT02979353) was performed. Cox regression was used to compare the time‐to‐first 90‐day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time‐to‐first 90‐day ED visit/readmission/death. Results: The hazard of first 90‐day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61–1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04–1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01–1.07) were significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre‐hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the control group. Conclusions: The intervention and control groups had comparable time‐to‐first 90‐day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90‐day period following hospital discharge. [ABSTRACT FROM AUTHOR]

The article presents a study which aimed to understand from clinicians and older adults ways to optimize a proposed home-based deprescribing intervention that focuses on tailoring medications based on patient's daily and life goals. Topics include clinicians included in the study, daily activities/goals for older adults, and the need to identify older adults prototypes and design flexible deprescribing interventions that can target a broad range of older adults for maximum impact.

Background: Ongoing studies are currently investigating the extent of surgical resection required for subsolid cancers. This study aimed to investigate the predictive factors related to recurrence in patients with clinical stage IA subsolid cancer who underwent either lobectomy or sublobar resection. Methods: This was a prospective multicenter observational study conducted in eight qualifying university teaching hospitals between April 2014 and December 2016. A total of 173 patients with subsolid nodules pathologically confirmed to have primary lung adenocarcinoma and stage IA disease were included in the final analysis. All patients underwent lobectomy, segmentectomy, or wedge resection performed by experienced thoracoscopic surgeons at each site. The surgical procedure was chosen based on the decision of the surgeons involved. The primary endpoint was time to recurrence (TTR). Results: The study population was 43.9% (76 of 173) male with a mean age of 60.7 years. During the median follow‐up period of 5.01 years, nine patients (5%) experienced disease recurrence. In the multivariable analysis, tumor size (size ≥2 cm) (hazard ratio: 73.717, 95% confidence interval [CI]: 3.635–895.036; p < 0.001) and stage IA3 (hazard ratio: 62.010, 95% CI: 2.837–855.185; p < 0.001) were independent predictors of tumor recurrence. When analyzing the recurrence outcome in patients according to surgical procedure, no significant difference was found in TTR among the three groups (i.e., lobectomy, segmentectomy, and wedge resection; p = 0.99). Conclusions: Patients with radiologically subsolid lung adenocarcinoma measuring <3 cm could be candidates for sublobar resection instead of lobectomy. [ABSTRACT FROM AUTHOR]