Background Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of non-malignant pain. Objectives To characterize the diagnosis and management of non-malignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. Design, setting, and participants Serial cross-sectional and multivariate regression analyses of the National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of office-based physician visits. Measures (1) Annual visits volume among adults with primary pain symptom or diagnosis; (2) receipt of any pain treatment; and (3) receipt of prescription opioid or non-opioid pharmacologic therapy in visits for new musculoskeletal pain. Results Primary symptoms or diagnoses of pain consistently represented one-fifth of visits, varying little from 2000 through 2010. Among all pain visits, opioid prescribing nearly doubled from 11.3% to 19.6%, whereas non-opioid analgesic prescribing remained unchanged (26%–29% of visits). One-half of new musculoskeletal pain visits resulted in pharmacologic treatment, though the prescribing of non-opioid pharmacotherapies decreased from 38% of visits (2000) to 29% of visits (2010). After adjusting for potentially confounding covariates, few patient, physician or practice characteristics were associated with a prescription opioid rather than a non-opioid analgesic for new musculoskeletal pain, and increases in opioid prescribing generally occurred non-selectively over time. Conclusions Increased opioid prescribing has not been accompanied by similar increases in non-opioid analgesics or the proportion of ambulatory pain patients receiving pharmacologic treatment. Clinical alternatives to prescription opioids may be underutilized as a means of treating ambulatory non-malignant pain.

The need to achieve ≥95% adherence to HAART for treatment effectiveness may be a barrier for universal initiation at early stages of HIV. Using longitudinal data collected from 2006-2011 from cohort studies of MSM (MACS) and IDUs (ALIVE study), we estimated the minimum adherence needed to achieve HIV RNA suppression (<50 copies/mL), defined as the level at which at least 80% were virally suppressed, and the odds of suppression was not significantly different than that observed with ≥95% adherence. In the MACS, ≥80% suppression was observed with 80-84% adherence and the odds ratio for suppression (vs.≥95% adherence) was 1.43 (0.61, 3.33). In the ALIVE study where <35% were on newer drugs, only 71.4% were suppressed among those who reported ≥95% adherence. Although IDUs on older HAART regimens may need to be ≥95% adherent, concerns related to non-adherence may be less of a barrier to initiation of modern HAART regimens.

Background We examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression, and estimated the minimum cutoff of adherence to newer HAART formulations needed for HIV RNA suppression by regimen type. Methods We used VA pharmacy dispensing data from the Veterans Aging Cohort Study Virtual Cohort between October 2000 and September 2010, and defined adherence as the duration of time the patient had the medications available, relative to the total number of days between refills for all antiretrovirals in a year. Temporal trends in adherence and viral load suppression were examined by the patient's most frequently used HAART regimen in the year. The minimum needed adherence was defined as the level at which the odds of suppression was not significantly different than that observed with ≥95% adherence using repeated measures logistic regression. Results 21,865 HAART users contributed 82,217 person-years of follow-up. There was a significant increase (ptrend<0.001) in the proportion virally suppressed even among those with <95% adherence (2001: 38% to 2010: 84%) and the trend was similar when restricting to their first HAART regimen. For NNRTI multi-pill users, the odds of suppression did not differ for 85-89% adherence compared to those with ≥95% adherence, odds ratios: 0.82 (0.64,1.04), but for PI users, the odds of suppression significantly differed if adherence levels were <95% compared to ≥95% adherence. Conclusions Although all HIV-infected persons should be instructed to achieve perfect adherence, concerns of slightly lower adherence should not hinder prescribing new HAART regimens early in HIV infection.

A127conditions were more frequent in parents with NEs related to work or friends. CONCLUSIONS: PWH with one NE were more likely to report other NEs. PWH/parents with NEs reported greater social worker involvement and treatment for psychological conditions. Further studies are needed to assess temporal relationships between NEs and HTC visits/advice, and support the relevance of timely social work and psychological counselling in comprehensive care.

laucoma is a leading cause of blindness in the United States and worldwide. 1 The goal of glaucoma treatment has been to lower intraocular pressure (IOP) to a level where the threat to the optic nerve is minimized. Minimally invasive glaucoma surgical (MIGS) devices are increasingly being used to lower IOP, with a claimed higher safety profile than other glaucoma devices. 2 While there is no universal definition of a MIGS device, the US Food and Drug Administration (FDA) and the American Glaucoma Society refer to them as devices that are surgic ally implanted in the eye with minimal to no conjunctival manipulation or scleral dissection and designed to lower IOP by improving the aqueous humor outflow mechanism. 3 The FDA approved the first MIGS device in June 2012, and there are more devices presently in various stages of development. 4 The FDA cosponsored a meeting with the American Glaucoma Society in February 2014 to explore the design of MIGS clinical trials. 5,6 Patient preference information, defined as information obtained through "qualitative or quantitative assessments of the relative desirability or acceptability of attributes that differ among alternative diagnostic or therapeutic strategies," was not the focus of these discussions. 7 Our objective was to examine how often MIGS studies registered on ClinicalTrials.gov measure the outcomes that patients value directly. MethodsAfter consultations with glaucoma specialists, we defined a priori outcomes as patient-centric or not patient-centric. Patient-centric outcomes, also referred to as a patientcentered outcome by the Patient-Centered Outcomes Research Institute, 8 are outcomes that patients notice or report directly, such as how well one can see (including visual acuity measured by an eye chart), ability to drive, a reduction in topical medication use, or adverse events. We classified an outcome as not patient-centric if it is a surro-IMPORTANCE Minimally invasive glaucoma surgical (MIGS) devices are one option for lowering intraocular pressure in patients with glaucoma.OBJECTIVE To examine how often existing clinical studies of MIGS devices registered on ClinicalTrials.gov measure patient-centric outcomes that patients value directly. DESIGN, SETTING, AND PARTICIPANTSWe searched ClinicalTrials.gov, a registry of publicly and privately supported clinical studies, on February 20, 2015, for records of MIGS device studies involving patients with glaucoma. Two investigators independently abstracted study design and outcome details from eligible records. We classified outcomes as patient-centric or not patient-centric using a prespecified definition.MAIN OUTCOMES AND MEASURES Proportion of patient-centric and nonpatient-centric outcomes registered on ClinicalTrials.gov. RESULTSWe identified 51 eligible studies specifying 127 outcomes. Reduction in intraocular pressure was the most frequent outcome specified (78/127; 61%) and a primary outcome in 41 studies. Patient-centric outcomes-such as adverse events (n = 19; 15%), topical medication use (n = 1...