Asthma-chronic obstructive pulmonary disease overlap and cost-related medication non-adherence among older adults in the United States.

BACKGROUND: Cost-related medication non-adherence (CRN) can negatively impact health outcomes in older adults with asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) by reducing access and adherence to essential medications. The objective of this study is to examine the association of ACO to any CRN and specific forms of CRN among a nationally representative sample of older (age ≥ 65 years) adults. METHODS: We adopted a cross-sectional study design using data from pooled cross-sectional Medicare Current Beneficiary Surveys (MCBS) (2006-2013) and linked fee-for-service Medicare claims. Unadjusted and adjusted logistic regressions that accounted for the complex survey design examined the association of ACO to any CRN and specific forms of CRN. RESULTS: Among older adults with ACO, 16% reported any CRN. The most common form of CRN was "failing to get prescription". As compared to older adults with no asthma and no COPD, those with ACO were more likely to report any CRN (adjusted odds ratios [AOR] = 1.50, 95%CI = [1.14, 1.96]) and all forms of CRN. However, when the number of unique medications was added to the model, there were no statistically significant differences in CRN between the two groups. CONCLUSIONS: Older adults with ACO represent a vulnerable population with increased risk for CRN. Multiple factors can contribute to CRN including: a higher number of prescribed medications, multiple co-morbidities, and cost of therapies. Medication comprehensive review interventions have the potential of reducing the risk of CRN among the older Medicare beneficiaries with ACO.

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States.

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Association of the severity of diabetes-related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes.

PURPOSE: This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC. METHODS: Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004-2011 and pre-existing diabetes (N = 7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis. RESULTS: Overall, women with a DCSI = 2 and a DCSI ≥ 3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with a DCSI = 2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03-1.53). CONCLUSION: The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.

Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study.

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I-III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life.

Quality indicators in a community optometrist led cataract shared care scheme.

PURPOSE: Cataract shared care schemes involving community optometrists show wide variation in practice. We report on defined key performance indicators (KPIs) which improve accountability between stakeholders. METHODS: In this prospective study over nine months at a UK public hospital, we evaluated the outcomes of consecutive direct cataract referrals from community optometrists against two KPIs agreed under a service-level agreement between the Hospital Eye Service and community optometrists: (1) 85% of patients listed for cataract listing at first consultation; and (2) 90% postoperative feedback return rate on patients discharged to community optometrists. A detailed analysis on referral triage, surgical listing and postoperative form return rate is reported in this study. RESULTS: A total of 733 direct cataract referrals were received using a designated referral form of which 86% were listed for cataract surgery. The predominant reason for not listing was a failure to reach the visual threshold set by the local clinical commissioning guidelines. Out of 569 cataract surgical episodes, 402 (71%) patients were discharged on the same day of surgery to community optometrist follow up. Completed postoperative feedback was returned from 374 patients (93%). CONCLUSION: Direct cataract referrals from accredited community optometrists led to a majority of patients receiving a definitive clinical decision during first consultation. Postoperative community follow up reduced hospital visits and allowed for convenient consultation closer to home following uncomplicated cataract surgery. A service-level agreement with an accreditation scheme measured against KPIs enhances the accountability of stakeholders involved in the cataract shared care scheme.

Identification of Prdm genes in human corneal endothelium.

Corneal endothelial cells (CECs) are essential for maintaining corneal stromal hydration and ensuring its transparency, which is necessary for normal vision. Dysfunction of CECs leads to stromal decompensation, loss of transparency and corneal blindness. Corneal endothelium has low proliferative potential compared to surface epithelial cells leading to poor regeneration of CEC following injury. Additionally, the tissue exhibits age related decline in endothelial cell density with re-organisation of the cell layer, but no regeneration. The mechanisms which control proliferation and differentiation of neural crest derived CEC progenitors are yet to be clearly elucidated. Prdm (Positive regulatory domain) family of transcriptional regulators and chromatin modifiers are important for driving differentiation of a variety of cellular types. Many Prdm proteins are expressed in specific precursor cell populations and are necessary for their progression to a fully differentiated phenotype. In the present work, we sought to identify members of the Prdm gene family which are specifically expressed in human (h) CECs with a view to begin addressing their potential roles in CEC biology, focussing especially on Prdm 4 and 5 genes. By performing semi-quantitative reverse transcription coupled to PCR amplification we found that in addition to Prdm4 and Prdm5, Prdm2 and Prdm10 genes are expressed in hCECs. We further found that cultured primary hCECs or immortalised HCEC-12 cells express all of the Prdm genes found in CECs, but also express additional Prdm transcripts. This difference is most pronounced between Prdm gene expression patterns of CECs isolated from healthy human corneas and immortalised HCEC-12 cells. We further investigated Prdm 4 and Prdm 5 protein expression in cultured primary hCECs and HCEC-12 cells as well as in a human cadaveric whole cornea. Both Prdm 4 and Prdm 5 are expressed in human corneal endothelium, primary hCECs and in HCECs-12 cells, characterised by expression of the Na+/K+-ATPase. We observed that both proteins exhibit cytosolic (intracellular, but non-nuclear and distinct from extracellular fluid) as well as nuclear localisation within the endothelial layer, with Prdm 5 being more concentrated in the nuclei of the endothelial cells than Prdm 4. Thus, our work identifies novel Prdm genes specifically expressed in corneal endothelial cells which may be important in the control of CEC differentiation and proliferation.

Differences in Medicare Expenditures Between Appalachian and Nationally Representative Cohorts of Elderly Women With Breast Cancer: An Application of Decomposition Technique.

Background: Differences in Medicare expenditures during the initial phase of cancer care among rural and medically underserved elderly women with breast cancer (BC) and those from a nationally representative cohort have not been reported. The objective of this study was to determine Medicare expenditures during the initial phase of care among women in West Virginia (WV) who were Medicare beneficiaries with BC and compare them with national estimates. The magnitude of differences in these expenditures was also determined by using a linear decomposition technique. Methods: A retrospective observational study was conducted using the WV Cancer Registry-Medicare database and the SEER-Medicare database. Our study cohorts consisted of elderly women aged ≥66 years diagnosed with incident BC in 2003 to 2006. Medicare expenditures during the initial year after BC diagnosis were derived from all of the Medicare files. Generalized linear regressions were performed to model expenditures, after controlling for predisposing factors, enabling resources, need, healthcare use, and external healthcare environmental factors. Blinder-Oaxaca decomposition was conducted to examine the proportion of the differences in the average expenditures explained by independent variables included in the model. Results: Average Medicare expenditures for the WV Medicare cohort during the initial phase of BC care were $25,626 compared with $29,502 for the SEER-Medicare cohort; a difference of $3,876. In the multivariate regression, this difference decreased to $708 and remained significant. Only 16% of the differences in the average expenditures between the cohorts were explained by the independent variables included in the model. Enabling resources (6.86%), healthcare use (7.55%), and external healthcare environmental factors (3.33%) constituted most of the explained portion of the differences in the average expenditures. Conclusions: The difference in average Medicare expenditures between the elderly beneficiaries with BC from a rural state (WV) and their national counterparts narrowed but remained significantly lower after multivariate adjustment. The explained portion of this difference was mainly driven by enabling and healthcare use factors, whereas 84% of this difference remained unexplained.

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer.

Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

Types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer.

OBJECTIVE: To examine the association between types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer. METHODS: A population-based retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. The study cohort consisted of elderly men (≥ 66 years) with localised prostate cancer diagnosed between 2002 and 2009 (N = 98,264). The initial cancer treatment received during the 6 months after cancer diagnosis consisted of (i) radical prostatectomy (RP); (ii) radiation therapy (RT); (iii) hormone therapy; and (iv) no treatment. Pre-existing chronic conditions were classified into the following eight groups: (i) only cardiometabolic conditions (CM); (ii) only mental health conditions (MH); (iii) only respiratory conditions (RESP); (iv) CM and MH; (v) CM and RESP; (vi) MH and RESP; (vii) all three conditions, CM, MH and RESP; and (viii) none of the three types of conditions. RESULTS: Only 20% did not receive any cancer treatment; 47.4%, 22.1% and 10.5% received RT, RP, and hormone therapy, respectively. In multinomial logistic regression, elderly men with only RESP were more likely to receive RP as compared with those with all the three types of chronic conditions; those with only CM, only RESP, CM and MH or CM and RESP were more likely to receive RT. No significant associations were observed between the receipt of hormone therapy and types of chronic conditions. CONCLUSIONS: A significant proportion of elderly men with chronic conditions have received aggressive initial cancer treatment. Our study findings suggest a conservative approach for the initial prostate cancer treatment among elderly men with significant chronic conditions and localised prostate cancer.

Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder, Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009-2010.

Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs-children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009-2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers' financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N = 16,323). Results Overall, 16.3 % of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0 % of caregivers who reported financial burden, 20.3 % who reported employment burden, and 10.8 % who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7 % respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6 %, 11.0 % respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95 % CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95 % CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.

Tobacco-use Cessation Counseling Service Usage.

Objectives: Tobacco-use is common among elderly lung cancer patients and continued tobacco-use can impact prognosis. This study evaluates patterns of receipt of Tobacco-use Cessation Counseling (TCC) services among these patients. Methods: Using West Virginia Cancer Registry-Medicare linked database (2004-2007), we identified elderly patients with lung cancer (n = 922) and categorized them by receipt of TCC services. Hierarchical generalized logistic model was constructed and survival outcomes were analyzed by Kaplan-Meier analysis, Log-Rank test, and Cox proportional hazards modeling. Results: Majority of patients (76.7%) received TCC services. Unadjusted analysis showed favorable survival outcomes in patients who received TCC services. However, adjusted lung cancer mortality risk was no different between the groups (HR (95% CI) = 1.78 (0.87-3.64)). Conclusion: This study highlights the critical need to address disparities in receipt of TCC services among elderly. Although lung cancer preventive services are covered under the Medicare program, underutilization of these services is a concern.

A Discrete Choice Experiment to Elicit Patient Willingness to Pay for Attributes of Treatment-Induced Symptom Relief in Comorbid. Insomnia.

PURPOSE: Insomnia is a burdensome, commonly comorbid condition. How patients value various aspects of the safety and efficacy of available drugs has not been studied. The aim of the present study was to quantify patient-rated utility by studying willingness to pay (WTP) for attributes of symptom relief via a discrete choice experiment (DCE). METHODOLOGY: Adult primary care patients (West Virginia University Hospital) with comorbid insomnia were enrolled. The attributes and levels examined were sleep onset latency (SOL; 10, 20,30 minutes), awakenings (1, 2, 3), wake time after sleep onset (WASO; 15,45, 60 minutes), total sleep time (TST; 6, 7, 8 hours), hangover (none, mild, moderate), FDA-approved duration of use (short term, not restricted to short term, no restrictions), and out-of-pocket cost per month ($20, $35, $50). Willingness to pay (WTP) data were analyzed using a random effects binary logistic regression model. RESULTS: A total of 82 patients completed the DCE (74 analyzed). SOL, WASO, TST, and cost were all found to predict treatment choice. Higher values of SOL, WASO, and cost resulted in decreased preference for a particular treatment, while higher TST predicted increased preference. Modeling revealed an estimated marginal WTP of $66.69 for an example product that improved SOL by 10 minutes, reduced WASO by 15 minutes, and improved TST by 1 hour. CONCLUSION: Patient WTP for symptomatic relief in insomnia can help clinicians fine-tune interventions based on patient preferences, provide evidence for drug formulary and reimbursement decisions, and potentially guide the development of novel drugs.

Spectrum of intracranial and spinal epidermoids including unusual locations and imaging findings: A pictorial review.

Intracranial and spinal epidermoids are benign slow-growing congenital lesions. They are predominantly intradural, extra-axial in location, with intra-axial locations (intra-parenchymal and spinal intramedullary) being rare. The most common locations of intradural epidermoids are cerebellopontine angle cistern followed by supra- and para-sellar regions, and fourth ventricle. Less common locations include inter-hemispheric fissure, sylvian fissure, lateral ventricle, intracerebral, velum interpositum cistern, superior cerebellar cistern and pineal gland. They can also be extradural, usually arising in the diploic space of the calvaria, though they are less common. Magnetic resonance imaging is the primary modality for diagnosis and knowing the extent of the lesion. In this pictorial review, we intend to illustrate their classical and unusual locations, atypical imaging findings including calcifications, rare complications like haemorrhage or spontaneous rupture.

Analysis of microbial keratitis incidence, isolates and in-vitro antimicrobial susceptibility in the East of England: a 6-year study.

BACKGROUND/OBJECTIVES: To report the incidence, microbiological profile and in-vitro antimicrobial susceptibilities of microbial keratitis (MK) in the East of England (EoE) over a 6-year period. SUBJECTS/METHODS: A retrospective study of patients diagnosed with MK who underwent corneal scraping at participating trusts, within the EoE, between 01/01/2015-01/07/2020. Analysis was performed on MK isolate profiles, in-vitro anti-microbial sensitivities and trends over time. RESULTS: The mean incidence of IK, in the EoE, was estimated at 6.96 per 100 000 population/year. 1071 corneal scrapes were analysed, 460 were culture positive (42.95%) of which 87.2% were bacteria (50.3% gram-positive and 49.7% gram-negative), 2.4% polymicrobial, 9.3% fungi and 1.1% acanthamoeba. The most common organisms were pseudomonas spp (29.57%). There was a non-statistically significant trend (NST) in increasing incidence of pseudomonas spp, staph aureus and serratia (p = 0.719, p = 0.615, and p = 0.099 respectively) and a declining NST in Fungi (p = 0.058). Susceptibilities in-vitro to, penicillin classes, fluoroquinolone and aminoglycosides were 76.7% and 89.4%, 79.2% and 97.2% and 95.4 and 96.1% to gram-positive and gram-negative bacteria respectively. Gram-negative organisms were increasingly resistant to cephalosporins with a 19.2% reduction in sensitivity over time. (p = 0.011). Ceftriaxone showed the greatest decrease in sensitivity of 41.67% (p = 0.006). CONCLUSION: In the EoE, MK is relatively prevalent though likely underestimated. Profiles are similar to other UK regions with the exception of a higher fungal and lower acanthamoeba incidence. Common first and second-line antimicrobial selection provides, on the whole, good coverage. Nevertheless, anti-microbial resistance, to cephalosporins, was observed so selection should be carefully considered when treating MK empirically.

ß-hydroxybutyrate is a metabolic regulator of proteostasis in the aged and Alzheimer disease brain.

Loss of proteostasis is a hallmark of aging and Alzheimer disease (AD). Here, we identify ß-hydroxybutyrate (ßHB), a ketone body, as a regulator of protein solubility in the aging brain. ßHB is a small molecule metabolite which primarily provides an oxidative substrate for ATP during hypoglycemic conditions, and also regulates other cellular processes through covalent and noncovalent protein interactions. We demonstrate ßHB-induced protein insolubility across in vitro, ex vivo, and in vivo mouse systems. This activity is shared by select structurally similar metabolites, is not dependent on covalent protein modification, pH, or solute load, and is observable in mouse brain in vivo after delivery of a ketone ester. Furthermore, this phenotype is selective for pathological proteins such as amyloid-ß, and exogenous ßHB ameliorates pathology in nematode models of amyloid-ß aggregation toxicity. We have generated a comprehensive atlas of the ßHB-induced protein insolublome ex vivo and in vivo using mass spectrometry proteomics, and have identified common protein domains within ßHB target sequences. Finally, we show enrichment of neurodegeneration-related proteins among ßHB targets and the clearance of these targets from mouse brain, likely via ßHB-induced autophagy. Overall, these data indicate a new metabolically regulated mechanism of proteostasis relevant to aging and AD.

Occurrence of Banana bract mosaic virus on Musa ornata Roxb based hybrids in India.

Musa ornata, wild species of banana is being used as a cut flower, potted plants and for landscape gardening etc., They are also being utilized in banana hybridization programmes for introgressing pest and disease tolerant traits into banana cultivars in addition to the development of inter specific ornamental banana hybrids. Symptoms of banana bract mosaic virus (BBrMV) was observed in the bracts of interspecific M. ornata based hybrid developed using another wild species i.e., Musa rubra Kurz at ICAR-National Research Centre for Banana (NRCB), Tiruchirapalli. Presence of the virus in the bracts, leaves and roots of symptomatic plants was confirmed through triple antibody sandwich enzyme linked immunosorbent assay with BBrMV monoclonal and polyclonal antibodies. BBrMV HC-Pro (1370 bp), CP (900 bp) and VPg (570 bp) genes were amplified from the infected bracts using reverse transcriptase polymerase chain reaction with BBrMV respective gene primers. The amplicons of these three genes were cloned and sequenced. Blastn analysis revealed that HC-Pro, VPg and CP gene sequences has 97.67%, 97.72% and 99.67% similarity with the respective gene sequences of BBrMV infecting banana. Phylogenetic analysis clustered the test isolate with other BBrMV isolates of banana and other hosts based on CP and HC-Pro and VPg gene sequences. The virus is transmitted through Pentalonia nigronervosa and the transmitted plants expressed symptoms under glass house conditions. To the best of our knowledge, this is the first report of BBrMV on ornamental M. ornata hybrid in India and its transmission occurs through Pentalonia nigronervosa. Supplementary Information: The online version contains supplementary material available at 10.1007/s13337-022-00788-6.

A Randomized Controlled Trial Comparing Microthin Descemet Stripping Automated Endothelial Keratoplasty With Descemet Membrane Endothelial Keratoplasty: Two-Year Report.

PURPOSE: The purpose of this study was to report the 2-year outcomes of a double-blinded randomized controlled trial comparing Descemet membrane endothelial keratoplasty (DMEK) and microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK). METHODS: Fifty-six eyes of 56 patients were randomized to DMEK or microthin DSAEK (MT-DSAEK). The main outcome measure was best spectacle-corrected visual acuity (BSCVA) at 24 months. Other secondary outcomes included complications, endothelial cell density, and vision-related quality-of-life (vQoL) scores. RESULTS: There was no statistically significant difference in BSCVA between the DMEK and MT-DSAEK groups at the 2-year time point (mean ± SD; 0.04 ± 0.14 vs. 0.12± 0.19, P = 0.061) in contrast to the 1-year results (mean ± SD; 0.04 ± 0.13 vs. 0.11 ± 0.09, P = 0.002) previously reported. Endothelial cell density did not show a statistically significant difference at 24 months between the DMEK and MT-DSAEK groups (1522 ± 293 cell/mm2 vs. 1432 ± 327 cells/mm2, P = 0.27). There were 2 additional graft rejection episodes in the MT-DSAEK group between the 1- and 2-year follow-up periods, but this did not result in graft failure. The mean vQoL scores between DMEK and MT-DSAEK indicated similar patient satisfaction between the groups (97.1 ± 4.0 vs. 92.6 ± 10.2, P = 0.13). CONCLUSIONS: In summary, the trial showed no significant difference in BSCVA at 24 months between the DMEK and MT-DSAEK groups. Both techniques continued to demonstrate comparable outcomes for complication rates, endothelial cell loss, and patient-reported vQoL scores. TRIAL REGISTRATION: ISRCTN10578843.

Association of Entrepreneurial Traits With Interest in Becoming a Pharmacist Provider Among Student Pharmacists.

BACKGROUND: With the emerging opportunities for pharmacists to gain provider status, the need for understanding interest to become a pharmacist provider has never been greater. OBJECTIVE: To determine which entrepreneurial traits (locus of control, innovativeness, autonomy, risk-taking propensity, proactiveness, achievement motivation, people liking, problem-solving, and leadership) are associated with interest in becoming a pharmacist provider. METHODS: A cross-sectional survey was conducted among second- and third-year student pharmacists. Exploratory factor analysis (principal components with varimax rotation) was used to determine any underlying dimensions. Significant differences in interest in becoming a pharmacist provider by demographic and other characteristics were determined using t tests and analysis of variance (ANOVA; P ≤ .05). Multiple linear regression was used to determine the factors associated with interest in becoming a pharmacist provider. RESULTS: A total of 137 completed questionnaires were received. Gender (P = .003) and preference of workplace (P < .001) were significantly associated with interest in becoming a pharmacist provider. All factor loadings were more than 0.50 and Cronbach alpha values were more than .68. In the multiple linear regression analysis model, proactiveness (P = .036) and achievement motivation (P = .018) were positive predictors of interest in becoming a pharmacist provider. Females (P = .006) and individuals who preferred to work in a hospital (P < .001) or in specialty care (P = .007) had a significantly greater interest in becoming a pharmacist provider. CONCLUSIONS: Proactiveness and achievement motivation can be predictors of interest in becoming a pharmacist provider.

Initial maintenance therapy adherence among older adults with asthma-COPD overlap.

OBJECTIVES: To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting ß agonist [ICS/LABA]) on trajectories of adherence among older adults (≥ 65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO). STUDY DESIGN: We used a longitudinal, retrospective cohort design. METHODS: This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum's Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting. RESULTS: Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when "persistent high adherence" was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59). CONCLUSIONS: Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.

Determining the Entrepreneurial and Intrapreneurial Intentions of Student Pharmacists in Iran.

Objective. To identify factors and entrepreneurial characteristics associated with entrepreneurial and intrapreneurial intentions among Doctor of Pharmacy (PharmD) students in Iran.Methods. First, the Entrepreneurial-Intrapreneurial Pharmacist Questionnaire (EIPQ), which was developed in the United States, was translated from English to Persian. The paper-based Persian-EIPQ questionnaire was then tested in a convenience sample of student pharmacists enrolled in pharmacy schools in Iran. The entrepreneurial characteristics questionnaire was evaluated using exploratory factor analysis with varimax rotation. Internal consistency was examined using Cronbach alpha. The association of demographics and educational variables and entrepreneurial characteristics with entrepreneurial and intrapreneurial intentions was determined using a multiple linear regression model.Results. A total of 504 surveys, 98.6% of the completed questionnaires received, were analyzed. A majority of the participants were female (75.8%) and from 18 to 25 years old (92.2%). Entrepreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, autonomy, achievement motivation, and having an entrepreneur in the family. Intrapreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, achievement motivation, people liking, attending a private school, and having an entrepreneur in the family.Conclusion. Based on the findings, student pharmacists with higher levels of risk-taking propensity, achievement motivation, leadership self-efficacy, autonomy, and people liking may be more likely to have greater levels of entrepreneurial and/or intrapreneurial intention.