Deprescribing at the end of life in older patients.

In the United States, the adult population that will need hospice and palliative care is expected to double in the next 40 years. In primary care, providers are often faced with tough decisions on how to manage patients' medications at the end of life. This article describes how to deprescribe in the last year of life.

Contribution of food additives to sodium and phosphorus content of diets rich in processed foods.

OBJECTIVE: Phosphorus-based food additives increase the total phosphorus content of processed foods. However, the extent to which these additives augment total phosphorus intake per day is unclear. DESIGN AND METHODS: To examine the contribution of phosphorus-based food additives to the total phosphorus content of processed foods, separate 4-day menus for a low-additive and additive-enhanced diet were developed using Nutrition Data System for Research (NDSR) software. The low-additive diet was designed to conform to U.S. Department of Agriculture guidelines for energy and phosphorus intake (∼2,000 kcal/day and 900 mg of phosphorus per day), and it contained minimally processed foods. The additive-enhanced diet contained the same food items as the low-additive diet except that highly processed foods were substituted for minimally processed foods. Food items from both diets were collected, blended, and sent for measurement of energy and nutrient intake. RESULTS: The low-additive and additive-enhanced diet provided approximately 2,200 kcal, 700 mg of calcium, and 3,000 mg of potassium per day on average. Measured sodium and phosphorus content standardized per 100 mg of food was higher each day of the additive-enhanced diet as compared with the low-additive diet. When averaged over the 4 menu days, the measured phosphorus and sodium contents of the additive-enhanced diet were 606 ± 125 and 1,329 ± 642 mg higher than the low-additive diet, respectively, representing a 60% increase in total phosphorus and sodium content on average. When comparing the measured values of the additive-enhanced diet to NDSR-estimated values, there were no statistically significant differences in measured versus estimated phosphorus contents. CONCLUSION: Phosphorus and sodium additives in processed foods can substantially augment phosphorus and sodium intake, even in relatively healthy diets. Current dietary software may provide reasonable estimates of the phosphorus content in processed foods.

Cost of intraocular lens versus contact lens treatment after unilateral congenital cataract surgery: retrospective analysis at age 1 year.

PURPOSE: To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). DESIGN: Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid data and the actual costs of supplies used. PARTICIPANTS: The IATS is a randomized, multicenter (n=12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract. INTERVENTION: Infants underwent cataract surgery with or without placement of an IOL. MAIN OUTCOME MEASURES: The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 12 months of age. RESULTS: The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14 752 versus $10 726 with contact lens correction. The initial cataract surgery accounted for approximately 50% of the treatment costs for both groups. Contact lens costs accounted for 15% ($1600/patient) in the aphakic group, whereas glasses costs represented only 4% ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7302 vs. $5357) and the cost of additional operations. CONCLUSIONS: For IATS patients up to 12 months of age, cataract surgery coupled with IOL implantation and spectacle correction was 37.5% (∼$4000) more expensive than cataract surgery coupled with contact lens correction. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.