ObjectivesTo examine the frequency and predictors of antitumour necrosis factor (TNF) use, and to describe steroid utilisation among US patients with inflammatory bowel disease (IBD) aged 65 years and older prior to the publication of a new Medicare quality measure calling for the use of anti-TNFs and other steroid-sparing agents.DesignRetrospective cohort study.SettingThis study utilised 2006–2009 claims data for a national sample of Medicare beneficiaries.ParticipantsPatients with IBD (>1 claim for ICD codes 555.xx, 556.xx) without anti-TNF contraindications, enrolled in Medicare parts A and B ≥12 months and part D ≥6 months were included (n=8502).Outcome measuresWe estimated incidence rate ratios (IRR) and 95% CIs predicting new anti-TNF therapy using multivariable Poisson regression.ResultsThis nationally representative study of older patients with IBD estimated that only 3.7% received anti-TNFs. New anti-TNF use (1.4%) was associated with younger age, absence of Medicaid coverage, hospitalisation, and higher preceding use of burst (IRR=2.35, CI 1.59 to 3.47) and maintenance steroids (IRR=2.40, CI 1.05 to 5.48). Among anti-TNF users, we observed high rates of concurrent maintenance steroid use (19%).ConclusionsAnti-TNF use was very low in this population of older patients with IBD and, importantly, was often combined with maintenance steroid use despite guidelines suggesting reduced needs. Expanding IBD-specific quality measures to include steroid taper plans may cue appropriate maintenance regimens that include anti-TNFs and other steroid sparing agents while reducing protracted concomitant steroid use as intended by current quality measures.

To date, the inclusion of the patient voice through patient engagement as part of methods in cost-effectiveness research in existing published studies has been limited. Future CEA studies should consider how patient engagement may impact economic models and their implementation into practice. (Hepatology 2017).

The use of mixed methods research (MMR) by health scientists has expanded in recent years. The growth of MMR reflects the complexity of health-related research questions including the need to understand stakeholder perspectives. MMR is further incentivized by the release of the National Institutes of Health's (NIH) first version of "Best Practices for Mixed Methods Research in the Health Sciences" in 2011 and their revised version which was released in early 2018, and the increase in federal funding awarded to MMR projects. Realizing the need to train health scientists, several training initiatives are underway. In this commentary, we discuss: characteristics of MMR; the rise of MMR in the health sciences; the growing need and efforts to train health scientists in MMR approaches; and the graduate-level course in MMR that was launched at the University of Maryland School of Pharmacy.

Findings support the 1964 paradox observing decreased diabetic retinopathy in patients with RA. These findings pose new questions regarding whether RA physiology or treatments protect against diabetic retinopathy and how intraocular factors vary in contrast to adverse vascular changes elsewhere.

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