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Delirium is a serious and prevalent problem that occurs in many hospitalized older adults. Delirium superimposed on dementia (DSD) occurs when a delirium occurs concurrently with a pre-existing dementia. DSD is typically underrecognized by medical and nursing staff. The current study measured nursing identification of DSD using standardized case vignettes, and the Mary Starke Harper Aging Knowledge Exam (MSHAKE). Results revealed that the nurses in this study had a high level of general geropsychiatric nursing knowledge as measured by the MSHAKE, yet had difficulty recognizing DSD compared to dementia alone and delirium alone. Only 21% were able to correctly identify the hypoactive form of DSD, and 41% correctly identified hypoactive delirium alone in the case vignettes. Interventions and educational programs designed to increase nursing awareness of DSD symptoms could help to decrease this gap in nursing knowledge.

Objective: Inappropriate antibiotic use is a well-recognized public health problem because of its association with the emergence of resistant bacteria. It also is a source of unnecessary health care costs and of potentially severe adverse drug reactions. Although there are no evidence-based indications for the use of antibiotics in the treatment of asthma in the absence of comorbid bacterial conditions, physicians might feel more pressure to prescribe them to children with this common chronic disease. The objectives of this study were to (a) determine if antimicrobial prescription utilization rates are higher for pediatric patients with asthma than a matched comparison group and (b) identify common variables (gender and age) that might explain higher antibiotic utilization rates in children., Methods: Using administrative claims data, we conducted a retrospective cohort study of children with asthma (age range 5 to 18 years) who were members of a large health plan from January 1, 2000, to December 31, 2002, in the southeastern United States. A comparison group was created that was matched according to age, sex, regional codes, and insurance product line. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify asthmatic patients (493.xx), as well as to link antibiotic prescriptions to diagnosis codes from claims for medical office visits., Results: Asthmatics consistently received significantly more services, including a mean of 1.74 (SD 1.82) antibiotics per patient per year (PPPY) compared with a mean of 0.96 (SD 1.32) antibiotics PPPY for nonasthmatics (t=25.71, P <0.001). Asthmatics received antibiotics more often for all diagnoses. The more frequent receipt of antibiotics was true for conditions related to the respiratory tract (e.g., upper respiratory infection and bronchitis) as well as for conditions unrelated to the respiratory tract (e.g., urinary tract infection and acne). A diagnosis of asthma significantly increased the likelihood of a prescribed antibiotic by 26% to 86%., Conclusion: This study demonstrated that pediatric asthmatic patients received significantly more antibiotic prescriptions than nonasthmatics for conditions caused by bacteria as well as for conditions more likely to be viral in origin. In this era of concern about the widespread use of antibiotics and consequent antimicrobial resistance, further research needs to be conducted concerning the appropriateness of antibiotics in the treatment of asthma. Studies on the appropriate use of antibiotics in asthma could help reduce the overall use of antibiotics in children.

Background: Despite progress in describing the problem of potentially inappropriate medication (PIM) use, there have been few prospective studies demonstrating that interventions with specific medication criteria can make a difference in decreasing the use of problematic drugs in older adults., Objective: To design an intervention study to change physician behavior regarding PIM prescribing to older patients., Study Design and Methods: A prospective randomized block design was used during an 18-month period from January 2001 to June 2002. The study population was primary care physicians (n = 355) in the Medicare + Choice product line of a southeastern managed care organization and their patients 65 years and older. There were 170 physicians in the treatment group and 185 in the control group. Physicians were assigned to the treatment or usual-care, groups using a randomization table, and each group included physicians who had and had not prescribed a PIM., Results: Approximately 71% (84/118) of the physicians in the intervention group who prescribed a PIM completed and faxed back at least 1 potentially inappropriate medication form to the managed care organization. On 15.4% (260/1692) of the medication forms, physicians made some change regarding PIM use., Conclusions: Although many studies have addressed medication use among older adults, intervention studies aimed at influencing physician prescribing in this population are limited. This study describes a low-cost, replicable method to contact and educate physicians on drug therapy issues in older adults.