Heidi Splete

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

CHICAGO — An aqueous gel formula that combines 0.025% tretinoin and 1.2% clindamycin phosphate significantly reduces both inflammatory and noninflammatory acne lesions, Dr. James Leyden said in a poster presented at the annual meeting of the Society for Pediatric Dermatology.

The combination gel, marketed as Ziana, has been approved by the Food and Drug Administration for once-daily topical treatment of acne vulgaris in children aged 12 years and older.

In a phase III study, 1,710 patients aged 12–18 years were randomized into four groups to receive the combination gel, a tretinoin-only gel, a clindamycin phosphate-only gel, or a placebo gel. The baseline acne conditions ranged from mild to severe; patients were required to have 20–100 noninflammatory lesions, 20–50 inflammatory lesions, and two nodules to enroll in the study.

Overall, the patients in the combination gel group showed significantly greater reductions in the number of inflammatory lesions, noninflammatory lesions, and total lesion counts after 12 weeks of daily treatment, compared with the other groups, wrote Dr. Leyden of Broomall, Pa. He has received financial support from several drug manufacturers, including Medicis Pharmaceutical Corp., which manufactures Ziana and sponsored the study.

The average reductions for inflammatory and noninflammatory lesions, respectively, were 46% and 35% for the combination group; 35% and 26% for the tretinoin group; 36% and 23% for the clindamycin phosphate group; and 16% and 9% for the placebo group. The average reduction in total lesion count was 39% for the combination group, 30% for the tretinoin group, 29% for the clindamycin phosphate group, and 12% for the placebo group.

In addition, tolerability data from a subset of 45 patients were presented in a separate poster at the meeting. The findings showed that the clindamycin phosphate/tretinoin combination gel was as well tolerated as 0.1% adapalene gel and significantly better tolerated than 0.1% tretinoin microsphere gel based on clinical evaluation of redness and scaling and patient reports of burning, stinging, and itching, Dr. Leyden reported.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

WASHINGTON — High blood pressure remains a real and growing problem that, if left untreated, could increase in prevalence by 60% over the next 2 decades, Dr. Richard Roberts said at a press briefing.

“If action is not taken soon … there will be significant public health consequences,” said Dr. Roberts, a family physician and professor in the department of family medicine at the University of Wisconsin, Madison.

He spoke on behalf of a coalition of 14 medical groups and voluntary health organizations that commissioned a report to compile the latest information about high blood pressure and its impact on health care systems. The report, “High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next,” serves as a call to action for health policy makers and physicians.

Citing data from the National Health and Nutrition Examination Survey (NHANES), the report notes that the prevalence of high blood pressure in adults in the United States increased from 25% in 1988–1994 to 29% in 1999–2002. In addition, the growing problem of high blood pressure in children is expected to contribute to the overall increase in prevalence over the next 20 years.

The report, which was sponsored by an unrestricted educational grant from Novartis AG, calls for an international effort to address five public policy goals:

▸ Recognize that high blood pressure is a global health priority.

▸ Achieve global consensus on standards for managing high blood pressure.

▸ Empower primary care physicians to be the first lines of defense against high blood pressure on a global level.

▸ Educate patients about treatment options and acknowledge the difficulties of adhering to lifestyle and medication regimens.

▸ Conduct long-term clinical and epidemiologic studies on the costs and benefits of treating high blood pressure based on emerging trends and scientific research.

Losing weight and becoming more active are among the best ways to prevent hypertension, especially for young people. But for many, regular medication may be necessary to keep their blood pressure at a healthy level, said Dr. Michael A. Weber, chair of the American Society of Hypertension's Specialist Program and one of the coauthors of the report, at the briefing. Patients also need to understand that the only way to know if they have high blood pressure is to have it measured, he said. “It is a totally asymptomatic condition.”

Treating high blood pressure could reduce the probability of heart attacks by 40%–50%, the incidence of stroke, and the number of patients requiring kidney dialysis, added Dr. Weber, professor of medicine at the State University of New York, Brooklyn. He is a consultant for several pharmaceutical companies, including Novartis.

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS — Children with frequent, loud snoring are significantly more likely to develop recurrent otitis media and to require tympanostomy tubes than are children who don't snore, based on data from more than 16,000 children aged 5–7 years.

Recurrent otitis media and habitual snoring share many risk factors. To assess the relationship between these conditions, Dr. David Gozal of the University of Louisville (Ky.) and his colleagues compared the frequency of recurrent otitis media (ROM) and the need for tympanostomy tube placement in school-aged children who snored versus those who did not snore.

The researchers presented their findings in a poster at the annual meeting of the Associated Professional Sleep Societies.

Parents of 16,321 children who attended public school in Jefferson County, Ky., completed questionnaires about their children's sleeping habits.

Overall, 1,844 children (11%) had a history of habitual snoring (defined as snoring more than 3 nights per week). More than half (53%) of the habitual snorers were boys, and 26% of the habitual snorers were black.

A total of 5,074 children had a history of ROM, and 2,604 children had tympanostomy tubes.

Nearly twice as many of the habitually snoring children had a history of ROM, compared with children who did not snore (16% vs. 9%), even after controlling for known otitis media risk factors such as asthma, chronic rhinitis, allergies, and exposure to cigarette smoke, they reported.

Similarly, children with a history of habitual snoring were almost three times more likely than children without a history of snoring to have had tympanostomy tubes placed (24% vs. 9%, respectively), after controlling for the same risk factors, the investigators found.

The findings support an association between habitual snoring and an increased risk of ROM and need for tympanostomy tubes.

Additional studies are needed to assess the prevalence of obstructive sleep apnea in children with ROM, the investigators wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

Using medication to treat children with attention-deficit/hyperactivity disorder offers no long-term advantage over other treatment methods, according to a follow-up study.

Dr. Peter S. Jensen and his colleagues at Columbia University, New York, found that children with ADHD who were treated with medication (including stimulants, bupropion, and tricyclics) showed greater improvements in symptoms, compared with children who had been treated with behavior therapy after 14 months of treatment. But those on the medication algorithm lost that advantage after 3 years, based on data from the Multimodal Treatment Study of Children With ADHD (J. Am. Acad. Child Adolesc. Psychiatry 2007;46:989-1002).

The original study included 579 children aged 7–10 years who had been diagnosed with “ADHD combined type.” The children were randomized into one of four treatment groups—intensive multicomponent behavior therapy, intensive medication management, the combination, and routine community care—and they were followed for 14 months.

Of those, 485 children, now aged 10–13 years, took part in a long-term follow-up study. All of the children showed some ADHD and oppositional defiant disorder symptom (ODD) improvement, compared with baseline after 14 months, although the differences were significantly greater in the children in the medication and combination groups after 14 months and 24 months.

But none of the randomized treatment groups showed significant differences on any of five measures of clinical and functional outcomes by 36 months' follow-up. The clinical and functional outcomes were parent reports and teacher reports of ADHD and ODD symptoms, reading achievement scores, social skills, and functional impairment.

Intensive medication management of ADHD in children may have a long-term impact only if the intensity of the medication use is maintained over time, the researchers wrote.

The study was supported in part by the National Institute of Mental Health.

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

WASHINGTON – Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts about patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders. When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety. The results suggest a need for accurate and up-to-date information to make the CPOE allergy alerts more useful for clinicians

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS

MINNEAPOLIS – Treatment with both eszopiclone and escitalopram significantly improved the symptoms of insomnia and anxiety–compared with escitalopram alone, according to data from 595 adults presented at the annual meeting of the Associated Professional Sleep Societies.

Results from a pair of studies supported by Sepracor Inc. showed that the eszopiclone/escitalopram combination was well tolerated and significantly improved not only anxiety but also the length and quality of sleep. Because insomnia often coexists with generalized anxiety disorder, a double-duty treatment regimen would be helpful for patients who suffer from both conditions, the researchers noted.

All study participants met criteria for generalized anxiety disorder and insomnia. All of them received 10 mg escitalopram (Lexapro) daily for 10 weeks. At the same time, 294 were randomized to receive 3 mg eszopiclone (Lunesta), while 301 received placebo for 8 weeks, followed by a 2-week discontinuation period.

Overall, patients who took the combination therapy showed significant improvements in mood and anxiety symptoms based on their Clinical Global Impression scale and the Hamilton Anxiety scale scores after 1, 2, 4, 6, 8, and 10 weeks of treatment, Dr. Mark H. Pollack reported. Dr. Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital, Boston, conducted the study.

Similarly, scores on the 17-item Hamilton Rating Scale for Depression (HAM-D17) were significantly better in the combination therapy group at all evaluation points. Anxiety remission rates were higher in the combination therapy group, too, compared with the placebo group (42% vs. 36%), said Dr. Pollack, who serves on the advisory boards of and has received support for research from several pharmaceutical companies, including that of Sepracor.

In a second study of the same group of patients, presented by Dr. W. Vaughn McCall, professor and chairman of the department of psychiatry and behavioral medicine at Wake Forest University, Winston-Salem, N.C., significantly more patients who received combination therapy had no clinically meaningful insomnia at 8 weeks, compared with the escitalopram-only patients (47% vs. 33%).

In addition, combination therapy patients took significantly less time to fall asleep, slept longer, and scored significantly better on the insomnia severity index than did the escitalopram-only group, said Dr. McCall, who serves on Sepracor's speakers' bureau and its advisory board.

The adverse event rates were similar in both groups during the study period (78% for the combination group and 68% for the escitalopram-only group) and were identical (16%) during the 2-week discontinuation period. Overall the treatment was well tolerated, and no patients showed evidence of rebound insomnia as a result of the medications.

The most common adverse events reported in at least 10% of the combination therapy group were unpleasant taste (24%), headache (19%), dry mouth (16%), and sleepiness (11%); the most common adverse events reported in the escitalopram-only group were headache (15%) and nausea (15%).

ELSEVIER GLOBAL MEDICAL NEWS

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.