We examined the quality of adult epilepsy care using the Quality Indicators in Epilepsy Treatment (QUIET) measure, and variations in quality based on the source of epilepsy care.

Pneumonia and influenza together are the eighth leading cause of death and the leading causes of infectious death in the United States.¹ Professional societies including the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) have published clinical practice guidelines for community-acquired pneumonia,² which recommend the use of macrolides as part of combination antimicrobial therapy for patients hospitalized with community-acquired pneumonia. Although there is observational evidence that the empirical use of macrolides is associated with improved survival after pneumonia,^3-6 there is little randomized clinical trial evidence.⁷ However, there is some evidence that azithromycin is associated with QT prolongation and cardiac arrhythmias.^8,9

The purpose of our study was to examine the association of prior outpatient use of statins and angiotensin converting enzyme (ACE) inhibitors on mortality for subjects ≥ 65 years of age hospitalized with acute COPD exacerbations. We conducted a retrospective national cohort study using Veterans Affairs administrative data including subjects ≥65 years of age hospitalized with a COPD exacerbation. Our primary analysis was a multilevel model with the dependent variable of 90-day mortality and hospital as a random effect, controlling for preexisting comorbid conditions, demographics, and other medications prescribed. We identified 11,212 subjects with a mean age of 74.0 years, 98% were male, and 12.4% of subjects died within 90-days of hospital presentation. In this cohort, 20.3% of subjects were using statins, 32.0% were using ACE inhibitors or angiotensin II receptor blockers (ARB). After adjusting for potential confounders, current statin use (odds ratio 0.51, 95% confidence interval 0.40–0.64) and ACE inhibitor/ARB use (0.55, 0.46–0.66) were significantly associated with decreased 90-day mortality. Use of statins and ACE inhibitors prior to admission is associated with decreased mortality in subjects hospitalized with a COPD exacerbation. Randomized controlled trials are needed to examine whether the use of these medications are protective for those patients with COPD exacerbations.

Background. Studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors might be beneficial for the treatment of infections. Our purpose was to examine the association of statin, ACE inhibitor, and angiotensin II receptor blocker (ARB) use with pneumonia-related outcomes. Methods. We conducted a retrospective cohort study using Department of Veterans Affairs data of patients aged ≥65 years hospitalized with pneumonia. We performed propensity-score matching for 3 medication classes simultaneously. Results. Of 50 119 potentially eligible patients, we matched 11 498 cases with 11 498 controls. Mortality at 30 days was 13%; 34% used statins, 30% ACE inhibitors, and 4% ARBs. In adjusted models, prior statin use was associated with decreased mortality (odds ratio [OR], 0.74; 95% confidence interval [CI], .68–.82) and mechanical ventilation (OR, 0.81; 95% CI, .70–.94), and inpatient use with decreased mortality (OR, 0.68; 95% CI, .59–.78) and mechanical ventilation (OR, 0.68; 95% CI, .60–.90). Prior (OR, 0.88; 95% CI, .80–.97) and inpatient (OR, 0.58; 95% CI, .48–.69) ACE inhibitor use was associated with decreased mortality. Prior (OR, 0.73; 95% CI, .58–.92) and inpatient ARB use (OR, 0.47; 95% CI, .30–.72) was only associated with decreased mortality. Use of all 3 medications was associated with reduced length of stay. Conclusions. Statins, and to a lesser extent ACE inhibitors and ARBs, are associated with improved pneumonia-related outcomes. Prospective cohort and randomized controlled trials are needed to examine potential mechanisms of action and whether acute initiation at the time of presentation with these infections is beneficial.

Prescription drug monitoring programs (PDMPs) have been implemented in 49 out of 50 states in an effort to reduce opioid-related misuse, abuse, and mortality, yet the literature evaluating the impact of PDMP implementation remains limited. We conducted a scoping review to: (1) describe available evidence regarding impact of PDMPs in the U.S.; and (2) propose a conceptual model to inform future PDMP implementation and evaluation efforts. Scoping systematic review following Arksey and O’Malley’s (2005) methodology. We identified 11 relevant studies based on inclusion criteria using a PubMed database search of English-language studies published 1/1/2000–5/31/16. Data were extracted and thematic analysis conducted to synthesize results. Extant evidence for the impact of PDMPs as an opioid risk mitigation tool remains mixed. Thematic analysis revealed four domains of opioid-related outcomes frequently examined in original studies evaluating PDMP implementation: (1) opioid prescribing; (2) opioid diversion and supply; (3) opioid misuse; and (4) opioid-related morbidity and mortality. An evaluation framework incorporating these domains is presented that highlights significant gaps in empirical research across each of these domains. Evidence for the impact of state-level PDMPs remains mixed. We propose a conceptual model for evaluating PDMP implementation toward the goals of clarifying PDMP mechanisms of impact, identifying characteristics of PDMPs associated with best outcomes, and maximizing the utility of PDMP policy and implementation to reduce opioid-related public health burden.