BACKGROUND & AIMS: :Currently, 25 million Americans are known to have diabetes, with an additional 7 million cases believed to be undiagnosed. It is estimated that direct and indirect costs of diabetes top $200 billion. Due to the significant health and financial burdens associated with diabetes, it is imperative that this disease be treated quickly and aggressively. In 2009, the American Diabetes Association and the European Association for the Study of Diabetes developed a consensus statement regarding the treatment of type 2 diabetes, citing lifestyle modification and metformin as the preferred first line therapies. In this study, the authors looked at prescription claims data for adults who were newly initiated on oral hypoglycemic monotherapy between January 1, 2006, and December 31, 2008, to determine if initiation patterns changed over time, to evaluate how well the treatment guidelines were being followed, and to assess the economic consequences of prescribing patterns by drug class for both patients and insurers. The results showed that over the course of the study period the proportion of patients initially treated with metformin increased, whereas those receiving sulfonylureas as first-line therapy decreased. Thiazolidinediones experienced the greatest decrease, falling from 20% to 8%, while prescriptions for dipeptidyl peptidase-4 inhibitors increase from 0-7%. Over a 6-month period, patients taking metformin or sulfonylureas paid approximately $38 to $40 in co-pays while insurance paid about $77. Patients taking other agents paid approximately $130 in co-pays and insurance paid over $500. The authors concluded that based its cost and safety profile, metformin should be the first line drug therapy for patients with newly diagnosed type 2 diabetes. This CME multimedia activity, which is part of a 2-part multimedia activity on the management and treatment of diabetes, contains a video presentation and is available through the website of The American Journal of Medicine at http://amjmed.com/content/multimedia. Click on "Patterns of Medication Initiation in Newly Diagnosed Diabetes Mellitus: Quality and Cost Implications" to access this part of the multimedia program.

背景与目标： : 目前，已知有2500万名美国人患有糖尿病，另外700万例病例被认为无法诊断。据估计，糖尿病的直接和间接成本高达2000亿美元。由于与糖尿病相关的重大健康和经济负担，必须迅速积极地治疗这种疾病。2009年，美国糖尿病协会和欧洲糖尿病研究协会提出了关于2型糖尿病治疗的共识声明，理由是生活方式改变和二甲双胍是首选的一线疗法。在这项研究中，作者查看了2006年1月1日和2008年12月31日之间新开始口服降糖单药治疗的成年人的处方索赔数据，以确定起始模式是否随时间变化，以评估治疗指南的遵循程度。并按药物类别评估处方模式对患者和保险公司的经济后果。结果显示，在研究期间，最初接受二甲双胍治疗的患者比例增加，而接受磺脲类药物作为一线治疗的患者比例下降。噻唑烷二酮类药物的下降幅度最大，从20% 降至8%，而二肽基peptidase-4抑制剂的处方从0-7% 增加。在6个月的时间里，服用二甲双胍或磺脲类药物的患者支付了大约38至40美元的共付额，而保险支付了大约77美元。接受其他代理的患者支付了大约130美元的自付费用，保险支付了超过500美元。作者得出结论，基于其成本和安全性，二甲双胍应该是新诊断的2型糖尿病患者的一线药物治疗。此CME多媒体活动是有关糖尿病管理和治疗的两部分多媒体活动的一部分，包含视频演示，可通过http://amjmed.com/content/multimedia. 的《美国医学杂志》网站获得点击 “新诊断糖尿病开始用药的模式: 质量和成本影响”，访问多媒体程序的这一部分。

BACKGROUND & AIMS: PURPOSE:To compare the predictability of intraocular lens (IOL) power calculation using several corneal power measurements in eyes that underwent phototherapeutic keratectomy (PTK). STUDY DESIGN:Retrospective case series. METHODS:We reviewed the clinical charts of 42 eyes of 25 consecutive patients who underwent cataract surgery after PTK for granular corneal dystrophy or band keratopathy. IOL power calculations were performed using the SRK/T formula with four corneal power measurements [automated keratometry (AK) measured with a partial coherence interferometer, simulated keratometry (Sim K), true net power (TNP), and total corneal refractive power (TCRP) measured with a rotating Scheimpflug camera]; we determined the prediction error, absolute error, and percentage within ± 1.0 D of the targeted refraction, 1 month postoperatively. RESULTS:The prediction error in the TCRP group was significantly better than those in the AK, Sim K, and TNP groups. The absolute error was also significantly better than those in the AK and Sim K groups, but not significantly different from that in the TNP group. The percentages of within ± 0.5 and 1.0 D in the TCRP group were significantly higher than those in the AK and Sim K groups, but not significantly different from that in the TNP group. CONCLUSIONS:The TCRP provides the highest predictability of IOL power calculation in post-PTK eyes. This result suggests that the use of the TCRP, rather than of conventional anterior keratometry, may be clinically helpful for improving the refractive accuracy of post-PTK eyes.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Children with attention deficit hyperactivity disorder (ADHD) exhibit deficits in executive function. Since there are no clear biomarkers for the disorder, this study aimed to investigate the neurophysiological biomarkers for deficits in executive function in children with ADHD using functional near-infrared spectroscopy (fNIRS) and electroencephalography. METHODS:Twenty patients diagnosed with ADHD and 19 typically developing children (TDC; 8-11 years old) were included. Event related potentials (ERPs) were recorded using an electroencephalogram (EEG) and oxygenated hemoglobin concentrations (Oxy-Hb) were recorded using fNIRS during a colored Go/NoGo task, simultaneously. Latencies and amplitudes of NoGo-N2 and NoGo/Go-P3 tasks were measured using EEG. RESULTS:Children with ADHD showed significantly decreased Oxy-Hb in the right frontal cortex as well as longer NoGo-P3 latencies and a decreased NoGo/Go-P3 amplitude. There was a significant positive correlation between the Oxy-Hb and NoGo/Go-P3 amplitude. CONCLUSIONS:These results suggest that children with ADHD experience executive dysfunction. Hemodynamic and electrophysiological findings during the Go/NoGo task might be useful as a biomarker of executive function. SIGNIFICANCE:These findings have key implications for understanding the pathophysiology of deficits in executive function in ADHD.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:We previously reported on an objective new tool that uses quantitative electroencephalography (QEEG) normative- and referenced-electroencephalography sampling databases (currently called Psychiatric EEG Evaluation Registry [PEER]), which may assist physicians in determining medication selection for optimal efficacy to overcome trial-and-error prescribing. The PEER test compares drug-free QEEG features for individual patients to a database of patients with similar EEG patterns and known outcomes after pharmacological interventions. Based on specific EEG data elements and historical outcomes, the PEER Report may also serve as a marker of future severe adverse events (eg, agitation, hostility, aggressiveness, suicidality, homicidality, mania, hypomania) with specific medications. We used a retrospective chart review to investigate the clinical utility of such a registry in a naturalistic environment. RESULTS:This chart review demonstrated significant improvement on the global assessment scales Clinical Global Impression - Improvement and Quality of Life Enjoyment and Satisfaction - Short Form as well as time to maximum medical improvement and decreased suicidality occurrences. The review also showed that 54.5% of previous medications causing a severe adverse event would have been raised as a caution had the PEER Report been available at the time the drug was prescribed. Finally, due to the significant amount of off-label prescribing of psychotropic medications, additional, objective, evidence-based data aided the prescriber toward better choices. CONCLUSION:The PEER Report may be useful, particularly in treatment-resistant patients, in helping to guide medication selection. Based on the preliminary data obtained from this chart review, additional studies are warranted to establish the safety and efficacy of adding PEER data when making medication decisions.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:This paper explores the issues that arise from the discussion of administering rescue medication to children who experience prolonged convulsive seizures in mainstream schools in the UK. SITUATION ANALYSIS:Current guidelines recommend immediate treatment of children with such seizures (defined as seizures lasting more than 5 min) to prevent progression to status epilepticus and neurological morbidity. As children are unconscious during prolonged convulsive seizures, whether or not they receive their treatment in time depends on the presence of a teacher or other member of staff trained and able to administer rescue medication. However, it is thought that the situation varies between schools and depends mainly on the goodwill and resources available locally. RECOMMENDATIONS:A more systematic response is needed to ensure that children receive rescue medication regardless of where their seizure occurs. Possible ways forward include: greater use of training resources for schools available from epilepsy voluntary sector organisations; consistent, practical information to schools; transparent guidance outlining a clear care pathway from the hospital to the school; and implementation and adherence to each child's individual healthcare plan. IMPLICATIONS:Children requiring emergency treatment for prolonged convulsive seizures during school hours test the goals of integrated, person-centred care as well as joined-up working to which the National Health Service (NHS) aspires. As changes to the NHS come into play and local services become reconfigured, every effort should be made to take account of the particular needs of this vulnerable group of children within broader efforts to improve the quality of paediatric epilepsy services overall.

背景与目标：

BACKGROUND & AIMS: :Although 70% of people with epilepsy (PWE) achieve seizure freedom following an appropriate antiepileptic drug (AED) regime, evidence suggests that adherence to AEDs by PWE is suboptimal. Nonadherence to AEDs is associated with increased morbidity, mortality, emergency department visits, and hospitalizations, with reduced adherence also correlating to a lower quality of life, decreased productivity, and loss of employment. Furthermore, research indicates that medication errors which are widespread in chronic disease are less well studied in epilepsy but are likely also to contribute to avoidable disease morbidity and mortality. The goals of this project were to determine rates of medication adherence by self-reported questionnaire and its links to perceived medication error in a cohort of PWE attending a general epilepsy outpatient clinic. Following a plan-do-study-act cycle, it was found that the most appropriate methodology for conducting was in the form of a bespoke 9-item self-administered questionnaire. One hundred eighty-six PWE completed a nine-question questionnaire asking patients about their own medication adherence habits and their perception that they were previously exposed to medication error. This study found that 41% of respondents reported suboptimal adherence to AED therapy, while 28.5% of respondents self-reported that they unintentionally do not take their AED medication on an occasional, regular, or frequent basis. A 5.9% of respondents self-reported that they intentionally do not take their medication as prescribed. A 6% of respondents self-reported that they are both unintentionally and intentionally nonadherent to their AED therapy. No significant associations were demonstrated between age, sex, perceived effectiveness of medication, feelings of stigma/embarrassment, adverse effects or additional neurological comorbidities, and unintentional or intentional nonadherence. A 28.5% of respondents to the questionnaire reported that they perceived themselves to have been subjected to medication error. Prescribing errors were the most common form of perceived medication error, followed by dispensing errors, then administration errors. Significant associations were found between ineffective medication and feelings of stigma or embarrassment about epilepsy with perceived prescribing errors. Intentional nonadherence to medication was significantly associated with perceived dispensing errors.

背景与目标： : 尽管有70% 的癫痫患者在适当的抗癫痫药物 (AED) 治疗后获得了癫痫发作的自由，但有证据表明，对PWE对AED的依从性是次优的。不遵守aed与发病率，死亡率，急诊就诊和住院有关，依从性降低还与生活质量降低，生产力下降和失业有关。此外，研究表明，在慢性病中普遍存在的药物错误在癫痫中的研究较少，但也可能导致可避免的疾病发病率和死亡率。该项目的目标是通过自我报告的问卷来确定药物依从性的比率，并确定其与参加普通癫痫门诊的PWE队列中感知到的药物错误的联系。在计划-做-研究-行动周期之后，发现最合适的方法是定制的9项自我管理问卷的形式。一百八十六个pww完成了一个九个问题的问卷调查，询问患者自己的药物依从性习惯以及他们以前曾暴露于药物错误的感觉。这项研究发现，41% 的受访者报告对AED治疗的依从性不佳，而28.5% 的受访者自我报告说，他们无意地不定期，定期或频繁地服用AED药物。5.9% 受访者自我报告说，他们故意不按规定服用药物。6% 受访者自我报告说，他们无意地和有意地不遵守AED疗法。年龄，性别，药物治疗的有效性，耻辱感/尴尬感，不良反应或其他神经系统合并症以及无意或有意的不依从性之间没有显着关联。问卷调查的28.5% 受访者报告说，他们认为自己遭受了用药错误。处方错误是感知到的药物错误的最常见形式，其次是配药错误，然后是给药错误。发现无效药物与对癫痫的污名或尴尬感与处方错误之间存在显着关联。故意不坚持用药与感知到的配药错误显着相关。

BACKGROUND & AIMS: :Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/nonmodifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, we aimed to provide a novel mobile health solution steeped in precision and personalized population health and a pantheoretical approach that increases the likelihood of adherence. We have described the stages of a pantheoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution.

背景与目标： : 患者不坚持健康的生活方式行为和药物治疗 (如药物治疗依从性) 占慢性病负担的很大一部分。尽管有大量的行为干预措施来克服关键的可修改/不可修改的障碍，并使促进者能够坚持，但短期和长期坚持健康的生活方式行为和医疗仍然很差。为了优化依从性，我们旨在提供一种新颖的移动健康解决方案，该解决方案适用于精确和个性化的人群健康，以及一种提高依从性可能性的泛理论方法。我们已经描述了利用定制，聚类/分析，个性化和优化干预/策略的泛理论方法的阶段，以获得遵守并强调构建此类解决方案所需的最小工程。

BACKGROUND & AIMS: PURPOSE:To investigate the effectiveness of corticosteroid treatments for patients showing decreases in hearing levels after stereotactic radiotherapy for vestibular schwannoma. METHODS AND MATERIALS:Twenty-one patients experienced a hearing loss in pure-tone average at greater than 20 dB or less than 10 dB within 1 year after irradiation administration of 44 Gy/22 fractions followed by a 4 Gy boost. Eight received oral prednisone at a daily dose of 30 mg, which was gradually decreased (medicated group), and 13 received none (nonmedicated group). The average observation period was 26.7 +/- 16.6 (range: 6--69) months. RESULTS:Hearing recovery was seen after initial onset of the hearing loss in all 8 patients in the medicated group and in 2 of 13 patients in the nonmedicated group (p = 0.001). The hearing recovery, that is, the change in pure-tone average (dB) at the last follow-up from the onset of hearing loss, was 9.8 +/- 6.9 dB (recovery) in the medicated group and -9.4 +/- 12.8 dB (further loss) in the nonmedicated group (p = 0.0013). The hearing recovery rate, normalizing to the degree of the hearing loss before medication, was also significantly higher in the medicated group than in the nonmedicated group (p = 0.0014). CONCLUSIONS:Corticosteroidal intake is suggested to be effective in improving hearing loss after stereotactic radiotherapy, at least in young patients having a useful pretreatment hearing level, if the treatment for hearing loss is administered immediately after the hearing loss is first detected.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Long-term medication therapy for patients with post-myocardial infarction (MI) can prolong life. However, recent data on long-term adherence are limited, particularly among some subpopulations. We compared medication adherence among Medicare MI survivors by disability status, race/ethnicity, and income. METHODS:We examined 100% of Medicare fee-for-service beneficiaries discharged post-MI in 2008. The outcomes were adherence to β-blockers, statins, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, for 1-year and 6-month postdischarge. Adherence was defined as having prescriptions in possession for ≥75% of days. RESULTS:Among aged beneficiaries who survived 1-year adherence to β-blockers were 68%, 66%, 61%, 58%, and 57% for whites, Asians, Hispanics, Native Americans, and blacks, respectively; among persons with disability, 1-year adherence was worse for each group: 59%, 54%, 52%, 47%, and 43%, respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location, and health status. Patterns of adherence to statins and angiotensin-converting enzymes/angiotensin II receptor blockers were similar. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to whites: odds ratio 0.70 (95% CI 0.65-0.75) for blacks and odds ratio 0.70 (95% CI 0.55-0.90) for Native Americans. CONCLUSIONS:Although β-blockers at discharge has improved since the National Committee for Quality Assurance implemented quality measures, long-term adherence remains problematic, especially among persons with disability and minority beneficiaries. Quality measures for long-term adherence should be created to improve outcomes in patients with post-MI. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.

背景与目标：

BACKGROUND & AIMS: :Worldwide, approximately 1 to 2% of the adult population suffers from chronic headache due to overuse of pain medication. Guidelines recommend acute withdrawal of medication, but the optimal treatment remains unknown. We aimed to evaluate the benefit of treatments for patients with medication overuse headache (MOH). We performed an extensive literature search until November 2015, selecting randomized controlled trials that evaluated interventions for adults with MOH. Two authors assessed the eligible trials and extracted data. We calculated effect estimates and used the random effects model for the pooled analysis. Our primary outcome measures were 'headache days' and 'days with medication.' Outcome data were categorized as short-term (up to 12 weeks) or long-term (≥12 weeks) outcomes. This review consists of 16 trials including 1,105 patients. Four trials evaluated the use of prednisone with placebo or celecoxib after medication withdrawal; 7 trials evaluated various methods of withdrawal versus other methods of withdrawal, and 5 trials evaluated prophylactic medication compared with placebo or ibuprofen. We found no significant differences in headache days between prednisone versus placebo or between outpatient versus inpatient treatment, but we found a significant difference in days with medication. Overall, we found no benefit of prophylactic medication versus placebo. We found low to very low quality of evidence of no benefit of prednisone, prophylaxis, and various withdrawal interventions. Because the burden of MOH for patients is enormous, larger and high-quality intervention trials are needed. PERSPECTIVE:This article presents a critical look at studies of patients with MOHs. It appears that the withdrawal strategy remains the best treatment option, although there is scant evidence on the efficacy of any treatment options.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Clinical, health, and economic outcomes in patients with type 2 diabetes may be influenced by self-management behaviors and type of pharmacotherapy. OBJECTIVE:This study examined differences in medication adherence and total health care costs among patients with type 2 diabetes who initiated or converted to insulin administration with a pen device in comparison with a vial/syringe as add-on therapy to oral antidiabetic drugs. METHODS:This study evaluated patients with type 2 diabetes who were enrolled in the North Carolina Medicaid program from September 24, 2001, to July 18, 2006. Patients receiving insulin with a vial/syringe who converted to pen therapy were compared with those who remained on vial/syringe in both unmatched comparisons (n = 560 and n = 9988, respectively) and after pair-matching (both cohorts, n = 560) with the use of propensity scores. In a second analysis, patients who initiated insulin with vial/syringe (n = 1162) were compared with a cohort that initiated insulin pen therapy (n = 168) after controlling for covariates in a multivariate regression model. All included patients had complete enrollment for at least 24 months of follow-up. Multiple linear regression models were used to predict the comparative impact on total health care costs and medication adherence for each cohort. Adjusted means were calculated to determine the group differences for each outcome. RESULTS:Diabetes-related and overall medication adherence was comparable for patients initiating insulin with a pen versus a syringe (53% vs 50% and 94% vs 94%, respectively). However, total annualized health care costs were significantly lower for patients using pen therapy than for those using a syringe ($14,857.42 vs $31,764.78, respectively; P < 0.05). Cost reductions with pen therapy were reflected in hospital costs ($1195.93 vs $4965.31, respectively; P < 0.05), diabetes-related costs ($7324.37 vs $13,762.21, respectively; P < 0.05), and outpatient costs ($7795.98 vs $13,103.51, respectively; P < 0.05). However, prescription costs of syringe were significantly lower ($535.70 vs $670.52; P < 0.05) and costs of pen were higher ($840.33 vs $0; P < 0.05) in patients who were switched from syringe to pen versus those who remained on syringe therapy. CONCLUSIONS:In a state Medicaid setting among patients with type 2 diabetes, initiating insulin therapy with a pen device was associated with comparable medication adherence and significant reductions in health care resource utilization and associated costs compared with vial/syringe insulin. Health care professionals and policy makers should consider the potential economic benefits of pen therapy when initiating insulin among Medicaid beneficiaries who fail to respond to oral antidiabetic drugs.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To identify all published studies evaluating computerized physician order entry (CPOE) in the inpatient setting and uniformly classify these studies on outcome measure and study design. DATA SOURCES:All studies that evaluated the effect of CPOE on outcomes pertaining to the medication process in inpatients were electronically searched in MEDLINE (1966 to August 2006), EMBASE (1980 to August 2006) and the Cochrane library. In addition, the bibliographies of retrieved articles were manually searched. Articles were selected if one of their main objectives was CPOE evaluation in an inpatient setting. REVIEW METHOD:Identified titles and abstracts were independently screened by three reviewers to determine eligibility for further review. RESULTS:We found 67 articles, which included articles on CPOE evaluation on some outcome at the time of ordering. Most papers evaluated multiple outcome measures. The outcome measures were clustered in the following categories: adherence (n=22); alerts and appropriateness of alerts (n=7); safety (n=21); time (n=7); costs and (organizational) efficiency (n=23); and satisfaction, usage and usability (n=10). Most studies used a before-after design (n=35) followed by observational studies (n=24) and randomized controlled trials (n=8). CONCLUSION:The impact of CPOE systems was especially positive in the category adherence to guidelines, but also to some extent in alerts and appropriateness of alerts; costs and organizational efficiency; and satisfaction and usability. Although on average, there seems to be a positive effect of CPOE on safety, studies tended to be non-randomized and were focused on medication error rates, not powered to detect a difference in adverse drug event rates. Some recent studies suggested that errors, adverse drug events (ADEs) and even mortality increased after CPOE implementation. Only in the category time the impact has been shown to be negative, but this only refers to the physician's time, not the net time. Except for safety, on the whole spectrum of outcomes, results of RCT studies were in line with non-RCT study results.

背景与目标：

BACKGROUND & AIMS: :The current quality improvement initiative evaluated the medication reconciliation process within select nursing homes in Washington, DC. The identification of common types of medication discrepancies through monthly retrospective chart reviews of newly admitted patients in two different nursing homes were described. The use of high-risk medications, namely antidiabetic, anticoagulant, and opioid agents, was also recorded. A standardized spreadsheet tool based on multiple medication reconciliation implementation tool kits was created to record the information. The five most common medication discrepancies were incorrect indication (21%), no monitoring parameters (17%), medication name omitted (11%), incorrect dose (10%), and incorrect frequency (8%). Antidiabetic agents in both sites were the most used high-risk medication. This initiative highlights that medication discrepancies on admission are common in nursing homes and may be clinically impactful. More attention needs to be given to work flow processes to improve medication reconciliation considering the increased risk for adverse drug events and hospitalizations. [Journal of Gerontological Nursing and Mental Health Services, 43(4), 9-14.].

背景与目标： : 当前的质量改进计划评估了华盛顿特区部分疗养院内的药物协调过程。描述了通过两个不同疗养院中新入院患者的每月回顾性图表审查来识别常见的药物差异类型。还记录了高风险药物的使用，即抗糖尿病，抗凝药和阿片类药物。创建了基于多个药物对账实施工具包的标准化电子表格工具来记录信息。五种最常见的药物差异是不正确的适应症 (21%)，无监测参数 (17%)，省略的药物名称 (11%)，不正确的剂量 (10%) 和不正确的频率 (8%)。这两个部位的抗糖尿病药物是使用最多的高危药物。该计划强调，入院时的药物差异在疗养院中很常见，并且可能对临床产生影响。考虑到不良药物事件和住院风险的增加，需要更多地关注工作流程，以改善药物协调。[老年护理与精神卫生服务杂志，43(4)，9-14。]。

BACKGROUND & AIMS: BACKGROUND:Asthma is one of the most common chronic conditions in children and has a major impact on health care use and quality of life. The Best Pharmaceuticals for Children Act mandates the federal government to sponsor pediatric studies of drugs approved for use in the United States but lacking evaluation in the pediatric population and lacking interest of commercial sponsors. As input into the drug selection and prioritization process, information is needed on the percentage of children who receive asthma-related medications. OBJECTIVE:To estimate the percentage of children who receive asthma-related medications. METHODS:Retrospective analysis of outpatient medical and drug claims from members of commercial health care insurance plans enrolled any time from January 1, 2004, through December 31, 2005. The study population included 4,259,103 children throughout the United States aged birth through 17 years. RESULTS:Fifteen percent of all children were dispensed an asthma-related medication. Among 218,943 children with an asthma diagnosis, 188,286 (86%) had a dispensed asthma-related medication at any time during the 2-year study period. Among children without any asthma diagnoses, 398,880 (10%) had a dispensed medication. Fifty-nine percent of children with an asthma diagnosis were dispensed an anti-inflammatory medication within 90 days after a claim with a diagnosis of asthma. CONCLUSIONS:Asthma-related medications are dispensed to a large percentage of the pediatric population, including many who do not have claims with asthma diagnoses listed. Data on the pharmacokinetics and safety of these drugs in children are largely unknown and difficult to obtain. Clinical studies that use new tools and approaches are needed to resolve this information gap.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:There is circumstantial evidence for the involvement of serotonergic and dopaminergic systems in the pathophysiology of social anxiety disorder. In the present study, using SPECT imaging we examined the (123)I-beta-(4-iodophenyl)-tropane binding potential for the serotonin and dopamine transporters in patients with a generalized social anxiety disorder and in age- and sex-matched healthy controls. METHODS:Twelve psychotropic medication-naïve patients with social anxiety disorder, generalized type (5 women and 7 men) and 12 sex- and age-matched healthy controls were studied. Volumes of interest were constructed on MRI-coregistered SPECT scans. Binding ratios were compared using the Mann-Whitney U test. Possible correlations between binding patterns and symptomatology were assessed using the Spearman rank correlation coefficient. RESULTS:Significantly higher binding potentials were found for the serotonin in the left and right thalamus of patients. Patients had also a significantly higher binding potential for the dopamine transporter in the striatum. CONCLUSION:The present study provided direct evidence for abnormalities in both the dopaminergic and the serotonergic systems in patients with generalized social anxiety disorder.

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