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David D Dore - One of the best experts on this subject based on the ideXlab platform.
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age sex and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents
Journal of the American Medical Directors Association, 2017Co-Authors: David D Dore, Andrew R Zullo, Vincent Mor, Yoojin Lee, Sarah D BerryAbstract:Abstract Objective The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents. Design and Setting Case-crossover study in US NHs. Participants A total of 691 women and 179 men with hip fracture sampled from all US long-stay NH residents. Measurements Measures of patient characteristics were obtained from linked Medicare and the Minimum Data Set (2007–2008). The outcome was hospitalization for hip fracture with surgical repair. We estimated rate ratios (RRs) and 95% confidence intervals (CIs) from conditional logistic regression models for nonbenzodiazepine hypnotics (vs nonuse) comparing 0 to 29 days before hip fracture (hazard period) with 60 to 89 and 120 to 149 days before hip fracture (control periods). We stratified analyses by age, sex, and dose. Results The average RR of hip fracture was 1.7 (95% CI 1.5–1.9) for any use. The RR of hip fracture was higher for residents aged ≥90 years vs Conclusions The rate of hip fracture in NH residents due to use of nonbenzodiazepine hypnotics was greater among older patients than among younger patients and, possibly, with higher doses than with lower doses. When clinicians are prescribing a nonbenzodiazepine hypnotic to any NH resident, doses of these drugs should be kept as low as possible, especially among those with advanced age.
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Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents.
JAMA internal medicine, 2013Co-Authors: Sarah D Berry, Yoojin Lee, Shubing Cai, David D DoreAbstract:Importance It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents. Objective To conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics. Design and Setting Case-crossover study performed in an academic research setting. Participants The study participants included 15 528 long-stay US nursing home residents 50 years or older with a hip fracture documented in Medicare Part A and Part D fee-for-service claims between July 1, 2007, and December 31, 2008. Main Outcome Measures Odds ratios (ORs) of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). Analyses were stratified by individual and facility-level characteristics. Results Among the study participants, 1715 (11.0%) were dispensed a nonbenzodiazepine hypnotic drug before the hip fracture, with 927 exposure-discordant pairs included in the analyses. The mean (SD) age of participants was 81.0 (9.7) years, and 77.6% were female. The risk for hip fracture was elevated among users of a nonbenzodiazepine hypnotic drug (OR, 1.66; 95% CI, 1.45-1.90). The association between nonbenzodiazepine hypnotic drug use and hip fracture was somes greater in new users (OR, 2.20; 95% CI, 1.76-2.74) and in residents with mild vs moderate to severe impairment in cognition (OR, 1.86 vs 1.43; P = .06), with moderate vs total or severe functional impairment (OR, 1.71 vs 1.16; P = .11), with limited vs full assistance required with transfers (OR, 2.02 vs 1.43; P = .02), or in a facility with fewer Medicaid beds (OR, 1.90 vs 1.46; P = .05). Conclusions and Relevance The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs. Caution should be exercised when prescribing sleep medications to nursing home residents.
Sarah D Berry - One of the best experts on this subject based on the ideXlab platform.
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age sex and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents
Journal of the American Medical Directors Association, 2017Co-Authors: David D Dore, Andrew R Zullo, Vincent Mor, Yoojin Lee, Sarah D BerryAbstract:Abstract Objective The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents. Design and Setting Case-crossover study in US NHs. Participants A total of 691 women and 179 men with hip fracture sampled from all US long-stay NH residents. Measurements Measures of patient characteristics were obtained from linked Medicare and the Minimum Data Set (2007–2008). The outcome was hospitalization for hip fracture with surgical repair. We estimated rate ratios (RRs) and 95% confidence intervals (CIs) from conditional logistic regression models for nonbenzodiazepine hypnotics (vs nonuse) comparing 0 to 29 days before hip fracture (hazard period) with 60 to 89 and 120 to 149 days before hip fracture (control periods). We stratified analyses by age, sex, and dose. Results The average RR of hip fracture was 1.7 (95% CI 1.5–1.9) for any use. The RR of hip fracture was higher for residents aged ≥90 years vs Conclusions The rate of hip fracture in NH residents due to use of nonbenzodiazepine hypnotics was greater among older patients than among younger patients and, possibly, with higher doses than with lower doses. When clinicians are prescribing a nonbenzodiazepine hypnotic to any NH resident, doses of these drugs should be kept as low as possible, especially among those with advanced age.
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Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents.
JAMA internal medicine, 2013Co-Authors: Sarah D Berry, Yoojin Lee, Shubing Cai, David D DoreAbstract:Importance It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents. Objective To conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics. Design and Setting Case-crossover study performed in an academic research setting. Participants The study participants included 15 528 long-stay US nursing home residents 50 years or older with a hip fracture documented in Medicare Part A and Part D fee-for-service claims between July 1, 2007, and December 31, 2008. Main Outcome Measures Odds ratios (ORs) of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). Analyses were stratified by individual and facility-level characteristics. Results Among the study participants, 1715 (11.0%) were dispensed a nonbenzodiazepine hypnotic drug before the hip fracture, with 927 exposure-discordant pairs included in the analyses. The mean (SD) age of participants was 81.0 (9.7) years, and 77.6% were female. The risk for hip fracture was elevated among users of a nonbenzodiazepine hypnotic drug (OR, 1.66; 95% CI, 1.45-1.90). The association between nonbenzodiazepine hypnotic drug use and hip fracture was somes greater in new users (OR, 2.20; 95% CI, 1.76-2.74) and in residents with mild vs moderate to severe impairment in cognition (OR, 1.86 vs 1.43; P = .06), with moderate vs total or severe functional impairment (OR, 1.71 vs 1.16; P = .11), with limited vs full assistance required with transfers (OR, 2.02 vs 1.43; P = .02), or in a facility with fewer Medicaid beds (OR, 1.90 vs 1.46; P = .05). Conclusions and Relevance The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs. Caution should be exercised when prescribing sleep medications to nursing home residents.
Yoojin Lee - One of the best experts on this subject based on the ideXlab platform.
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age sex and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents
Journal of the American Medical Directors Association, 2017Co-Authors: David D Dore, Andrew R Zullo, Vincent Mor, Yoojin Lee, Sarah D BerryAbstract:Abstract Objective The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents. Design and Setting Case-crossover study in US NHs. Participants A total of 691 women and 179 men with hip fracture sampled from all US long-stay NH residents. Measurements Measures of patient characteristics were obtained from linked Medicare and the Minimum Data Set (2007–2008). The outcome was hospitalization for hip fracture with surgical repair. We estimated rate ratios (RRs) and 95% confidence intervals (CIs) from conditional logistic regression models for nonbenzodiazepine hypnotics (vs nonuse) comparing 0 to 29 days before hip fracture (hazard period) with 60 to 89 and 120 to 149 days before hip fracture (control periods). We stratified analyses by age, sex, and dose. Results The average RR of hip fracture was 1.7 (95% CI 1.5–1.9) for any use. The RR of hip fracture was higher for residents aged ≥90 years vs Conclusions The rate of hip fracture in NH residents due to use of nonbenzodiazepine hypnotics was greater among older patients than among younger patients and, possibly, with higher doses than with lower doses. When clinicians are prescribing a nonbenzodiazepine hypnotic to any NH resident, doses of these drugs should be kept as low as possible, especially among those with advanced age.
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Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents.
JAMA internal medicine, 2013Co-Authors: Sarah D Berry, Yoojin Lee, Shubing Cai, David D DoreAbstract:Importance It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents. Objective To conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics. Design and Setting Case-crossover study performed in an academic research setting. Participants The study participants included 15 528 long-stay US nursing home residents 50 years or older with a hip fracture documented in Medicare Part A and Part D fee-for-service claims between July 1, 2007, and December 31, 2008. Main Outcome Measures Odds ratios (ORs) of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). Analyses were stratified by individual and facility-level characteristics. Results Among the study participants, 1715 (11.0%) were dispensed a nonbenzodiazepine hypnotic drug before the hip fracture, with 927 exposure-discordant pairs included in the analyses. The mean (SD) age of participants was 81.0 (9.7) years, and 77.6% were female. The risk for hip fracture was elevated among users of a nonbenzodiazepine hypnotic drug (OR, 1.66; 95% CI, 1.45-1.90). The association between nonbenzodiazepine hypnotic drug use and hip fracture was somes greater in new users (OR, 2.20; 95% CI, 1.76-2.74) and in residents with mild vs moderate to severe impairment in cognition (OR, 1.86 vs 1.43; P = .06), with moderate vs total or severe functional impairment (OR, 1.71 vs 1.16; P = .11), with limited vs full assistance required with transfers (OR, 2.02 vs 1.43; P = .02), or in a facility with fewer Medicaid beds (OR, 1.90 vs 1.46; P = .05). Conclusions and Relevance The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs. Caution should be exercised when prescribing sleep medications to nursing home residents.
Anitha Paleti - One of the best experts on this subject based on the ideXlab platform.
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quantitative structure activity relationship studies on some nonbenzodiazepine series of compounds acting at the benzodiazepine receptor
Bioorganic & Medicinal Chemistry, 1998Co-Authors: S. P. Gupta, Anitha PaletiAbstract:Quantitative structure–activity relationship (QSAR) studies have been made on a few non-benzodiazepine series of compounds such as 3-substituted imidazo[1,2-b]pyridazines, 2-phenylimidazo[1,2-α]pyridines, 2-(alkoxycarbonyl)imidazo[2,1-b]benzothiazoles, and 2-arylquinolines. For the first series of compounds a Fujita–Ban approach has been followed, which revealed the highest activity contribution for 3,4-OCH2O group of 2-phenyl moiety and for a methoxy group at 6-position. For the rest of the series, a Hansch approach has been adopted. The hydrophobic and electronic properties of the various substituents have been found to play major roles in the binding of these compounds with the receptor. Based on these studies, a hypothetical model for the drug–receptor interaction has been proposed.
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quantitative structure activity relationship studies on benzodiazepine receptor binding of some nonbenzodiazepine series of ligands
Quantitative Structure-activity Relationships, 1996Co-Authors: S. P. Gupta, Anitha PaletiAbstract:Quantitative structure - activity relationship (QSAR) studies have been performed on some non-benzodiazepine series of benzodiazepine receptor (BZR) ligands, namely a series of thienylpyrazologuinolines and a series of imidazoquinoxalines. Studies reveal the merits and demerits of the substituents and their physicochemical properties in each case, in addition to the essential requirements for the binding for each type of ligand.
L M Bouter - One of the best experts on this subject based on the ideXlab platform.
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muscle relaxants for nonspecific low back pain a systematic review within the framework of the cochrane collaboration
Spine, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:STUDY DESIGN: A systematic review of randomized and/or double-blinded controlled trials. SUMMARY OF BACKGROUND DATA: The use of muscle relaxants in the management of nonspecific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. OBJECTIVES: The aim of this review was to determine if muscle relaxants are effective in the treatment of nonspecific low back pain. METHODS: A computer-assisted search of the Cochrane Library (Issue 2, 2002), MEDLINE (1966 up to October 2001), and EMBASE (1988 up to October 2001) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Randomized and/or double-blinded controlled trials, involving patients diagnosed with nonspecific low back pain, treated with muscle relaxants as monotherapy or in combination with other therapeutic methods, were included for review. Two reviewers independently carried out the methodologic quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong," "moderate," "limited," "conflicting," or "no" evidence. RESULTS: Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality; 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 Nonbenzodiazepines, and 2 antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute low back pain on short-term pain relief. The pooled relative risk for Nonbenzodiazepines versus placebo after 2 to 4 days was 0.80 (95% confidence interval: 0.71 to 0.89) for pain relief and 0.49 (95% confidence interval: 0.25 to 0.95) for global efficacy. Adverse events, however, with a relative risk of 1.50 (95% confidence interval: 1.14 to 1.98) were significantly more prevalent in patients receiving muscle relaxants and especially the central nervous system adverse effects (relative risk 2.04; 95% confidence interval: 1.23 to 3.37). The various muscle relaxants were found to be similar in performance. CONCLUSIONS: Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or nonsteroidal anti-inflammatory drugs