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BACKGROUND Our goal was to describe specific patterns associated with co-prescriptions of gabapentin, opioids, and benzodiazepines among disabled Medicare beneficiaries. METHODS Using 2013-2015 Medicare data, we conducted a retrospective cohort study among fee-for-service disabled beneficiaries continuously enrolled in Medicare Parts A, B, and D. The index date was defined as the earliest fill date for a gabapentin, opioid, or benzodiazepine prescription. Monotherapy, dual therapy, and tri-therapy were defined as utilization of one, two, and three medication classes, respectively. Augmentation was defined as a prescription for a different medication class in addition to prescription for initial medication; switching referred to a change in prescription for a different medication class with no subsequent fills of initial medication. We used descriptive statistics, Kaplan Meier analyses and Cox proportional hazards to examine the association between initial therapy and monotherapy, dual therapy, tri-therapy, switching and augmentation. RESULTS Among 151,552 disabled beneficiaries, gabapentin initiators were more likely to augment therapy (50.1%) when compared to opioid (28.7%) and benzodiazepine (38.7%) users. When compared to opioid initiators, the risk of augmentation (HR[95%CI]: 1.85[1.82-1.89]) and switching (1.62 [1.51-1.73]) was significantly higher among gabapentin initiators. Risk of augmentation was also significantly higher among beneficiaries with co-morbid pain and mental health conditions (p

Initial findings of the Human Microbiome Project (HMP), funded by the U.S. National Institutes of Health (NIH), raise important questions about the role and variation of microorganisms within individuals and across populations ( 1 ). One related area of growing research and commercial interest is the development and use of probiotics, substances containing live microorganisms that have a beneficial effect when taken in sufficient quantities ( 2 ) and “designed to intentionally manipulate microbiome and host properties” ( 3 ). We offer observations about the regulatory process for probiotics and potential areas for reform.

This article analyzes the controversial topic of whether or not to repair a lacerated extensor hallucis longus tendon. A literature review of extensor hallucis longus tendon injuries is presented. The authors then provide a treatment protocol for extensor hallucis longus tendon injuries.

ConclusionsThree organic mercurial preparations possessing diuretic activity were assayed by the oral route against the Standard, mercuhydrin solution given intramuscularly, in patients with congestive failure. Of the three materials, the 3-chloro-mercuri-2-methoxy propylurea proved to be the most effective, producing with oral doses a diuretic response equivalent to results obtained by the conventional doses of intramuscular mercuhydrin. The diuretic potency of this compound when given orally is somewhat more than one-fourth of its potency by intramuscular injection, and by the latter route 4.3 times (in milligrams) as potent as intramuscular mercuhydrin. We are not aware of any mercurial diuretic with such a favorable ratio of intramuscular to oral potency, namely 4:1. In the case of the thiol compound we tested in this study, the ratio was 11.1. In another study(7) in which mercuhydrin was tested by the intramuscular and oral routes, this ratio was 24:1. There still remains the problem of gastrointesti...

THE relative efficacy of the mercurial diuretics by various modes of administration is a matter of considerable practical importance. On intravenous injection, these compounds sometimes produce serious reactions,1 , 2 and because the occasional fatal reaction is confined almost exclusively to this route of administration, there has been a tendency to turn to the intramuscular injection for routine treatment.3 The desirability of instructing patients in the technic of self-injection to avoid the need of a physician for each dose in the more intensive systems of treatment has focused attention on the subcutaneous injection as a technic that patients or members of the . . .

The utility of digitalis therapy in children is a subject of much controversy. That this group of drugs is not as effective in children as it is in adults is generally accepted, but there is the belief, fairly widely held among those familiar with the problems of heart disease in children, that digitalis therapy may be injurious to children with heart disease and failure. Sutton and Wyckoff1studied the effect of digitalis in heart failure among a group of children and concluded that the drug is useful, and in dosages,approximately similar to those for adults. Jacobsen and Davison2found digitalis effective in children with active carditis and failure, but in larger doses than those required by adults on the basis of body weight. Jezer and Schwartz3gave very large doses of digitalis to a group of children in congestive failure; from this experience they concluded that the