{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T13:46:13Z","timestamp":1772891173558,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K01HL141538"],"award-info":[{"award-number":["K01HL141538"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG064199"],"award-info":[{"award-number":["P30AG064199"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010risk medications like benzodiazepines, sedative hypnotics, and antipsychotics are commonly prescribed for hospitalized older adults, despite guidelines recommending avoidance. Prior interventions have not fully addressed how physicians make such prescribing decisions, particularly when experiencing stress or cognitive overload. Simulation training may help improve prescribing decision\u2010making but has not been evaluated for overprescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this two\u2010arm pragmatic trial, we randomized 40 first\u2010year medical resident physicians (i.e., interns) on inpatient general medicine services at an academic medical center to either intervention (a 40\u2010minute immersive simulation training) or control (online educational training) groups. The primary outcome was the number of new benzodiazepine, sedative hypnotic, or antipsychotic orders for treatment\u2010na\u00efve older adults during hospitalization. Secondary outcomes included the same outcome by all providers, being discharged on one of the medications, and orders for related or control medications. Outcomes were measured using electronic health record data over each intern's service period (~2\u2009weeks). Outcomes were evaluated using generalized estimating equations, adjusting for clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 522 treatment\u2010na\u00efve older adult patients were included in analyses. Over follow\u2010up, interns prescribed \u22651 high\u2010risk medication for 13 (4.9%) intervention patients and 13 (5.0%) control patients. The intervention led to no difference in the number of new prescriptions (Rate Ratio [RR]: 0.85, 95%CI: 0.31\u20132.35) versus control and no difference in secondary outcomes. In secondary analyses, intervention interns wrote significantly fewer \u201cas\u2010needed\u201d (\u201cPRN\u201d) order types for the high\u2010risk medications (RR: 0.29, 95%CI: 0.08\u20130.99), and instead tended to write more \u201cone\u2010time\u201d orders than control interns, though this difference was not statistically significant (RR: 2.20, 95%CI: 0.60\u20137.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although this simulation intervention did not impact total high\u2010risk prescribing for hospitalized older adults, it did influence how the interns prescribed, resulting in fewer PRN orders, suggesting possibly greater ownership of care. Future interventions should consider this insight and implementation lessons raised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov(NCT04668248).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18862","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T06:34:48Z","timestamp":1709879688000},"page":"1420-1430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pragmatic trial evaluating the impact of simulation training on high\u2010risk prescribing to older adults by junior physicians"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4940-4140","authenticated-orcid":false,"given":"Julie C.","family":"Lauffenburger","sequence":"first","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew F.","family":"DiFrancesco","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gauri","family":"Bhatkhande","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-0645","authenticated-orcid":false,"given":"Katherine L.","family":"Crum","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7597-2432","authenticated-orcid":false,"given":"Erin","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ted","family":"Robertson","sequence":"additional","affiliation":[{"name":"ideas42  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Oran","sequence":"additional","affiliation":[{"name":"ideas42  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlin E.","family":"Hanken","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Haff","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxwell D.","family":"Coll","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Cardiology, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"Avorn","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niteesh K.","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2196\/31464"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/11598420\u2010000000000\u201000000"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2021.06.001"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.244"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0163224"},{"issue":"3","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.4212\/cjhp.v73i3.2997","article-title":"Point prevalence survey of benzodiazepine and sedative\u2010hypnotic drug use in hospitalized adult patients","volume":"73","author":"Neville HL","year":"2020","journal-title":"Can J Hosp Pharm"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2014.925444"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102014\u2010006544"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15767"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.5535"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2825"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2021.07.004"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10880\u2010014\u20109415\u20102"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888\u2010200102000\u201000010"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.14845"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.36834\/cmej.36777"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/wcs.1406"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1314455110"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278\u20106133.24.4.S49"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467\u20109280.2008.02178.x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100038\u20101667315"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooy026"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/SIH.0000000000000096"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010152\u201011\u2010201006010\u201000232"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010199008000\u201000005"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044\u20108260.1992.tb00997.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20561"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12425"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318255e550"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010012\u20102264\u20105"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282081"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2011.0446"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2011.08.006"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16413"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.18862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:15:10Z","timestamp":1762197310000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.18862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,8]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/jgs.18862"],"URL":"https:\/\/doi.org\/10.1111\/jgs.18862","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,8]]},"assertion":[{"value":"2023-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}