Medication Categories Research Articles

Racial disparities with PRN medication usage in inpatient psychiatric treatment

Racial disparities in psychiatric diagnoses and treatment have significant public health implications, contributing to inequities in healthcare outcomes. We specifically examined racial disparities regarding pro re nata (PRN), or as needed, medications. Data from 14,616 encounters across 2019–2020 within Community Health Network’s inpatient psychiatric setting in Indianapolis, Indiana were included in this study. Due to the demographic sample size, analyses were narrowed to Black and White patients. Primary outcomes included comparisons across race for all PRN administrations and PRN administrations of antipsychotics vs. non-antipsychotics. Logistic regression was used to examine associations between race and PRN administrations by medication category, including all antipsychotics vs. non-antipsychotics overall, hydroxyzine, and lorazepam, independently. Significant differences in the percentage of administrations between Black and White patients were observed. Black patients received more PRN medications overall (71.0%) compared to White patients (67.7%) (p < 0.01). Further, while 17.7% of Black patients were administered PRN antipsychotics, this was true for only 8.2% of White patients (p < 0.001). When comparing antipsychotic PRNs with non-antipsychotic, hydroxyzine, and lorazepam PRNs, independently, Black patients were 58% (OR 1.58, p < 0.001), 109% (OR 2.09, p < 0.001), and 32% (OR 1.32, p < 0.001), more likely to receive antipsychotic PRNs, respectively, than White patients, controlling for sex, age, length of stay, and psychotic disorder diagnosis. Our study identifies yet another area of medical care with significant racial disparities. In this analysis of PRN medications during psychiatric admission, we identified significant differences in medication utilization by race. This information provides a basis for further investigation of disparities in patient-centered data.

Development of Hospital Formulary for an Emergency Drug List in Tertiary Care Teaching Hospital

Background: In an emergency situation, timing is an important factor that requires sound knowledge about the patient's health condition, diagnosis, and treatment, as well as the administration of an appropriate drug at the appropriate time, which helps save a patient’s life. To ease the workflow, we decided to develop an emergency drug formulary. The study aims to develop a hospital formulary for an emergency drug list and compare it with the WHO standard formulary and the National Formulary of India. Methods: A prospective observational study was carried out at Vivekananda General Hospital, Hubballi, for a period of six months. A monograph of emergency drugs was drafted based on the needs of the hospital and prepared by referring to various different sources of data. The developed hospital formulary was made into electronic copies and handbooks, and a review was obtained from healthcare professionals. Results: The results showed that there were 130 drugs in the emergency drug formulary. It includes various categories of medication given in the case of different emergency conditions (cardiac emergencies, neurological emergencies, endocrine emergencies, poisoning emergencies, respiratory emergencies, fluid and electrolyte emergencies, and miscellaneous emergency drugs). While comparing the contents of the monograph with other formulary monographs, we found that the formulary that we had developed was more effective. There were five fixed-dose combinations (FDCs), 27 drugs that are safe to use during pregnancy, 84 drugs that should be used with caution while pregnant, and 1 drug that was contraindicated. We also found that there were 59 drugs that were compatible with breastfeeding; 63 needed to be used with caution; and 12 should be avoided during breastfeeding. Conclusion: The developed emergency formulary acts as a quick reference, helps in selecting the appropriate drug at the appropriate dose and time, and also helps in selecting low-cost alternative brands.

Electrochemical Monitoring in Anticoagulation Therapy.

The process of blood coagulation, wherein circulating blood transforms into a clot in response to an internal or external injury, is a critical physiological mechanism. Monitoring this coagulation process is vital to ensure that blood clotting neither occurs too rapidly nor too slowly. Anticoagulants, a category of medications designed to prevent and treat blood clots, require meticulous monitoring to optimise dosage, enhance clinical outcomes, and minimise adverse effects. This review article delves into the various stages of blood coagulation, explores commonly used anticoagulants and their targets within the coagulation enzyme system, and emphasises the electrochemical methods employed in anticoagulant testing. Electrochemical sensors for anticoagulant monitoring are categorised into two types. The first type focuses on assays measuring thrombin activity via electrochemical techniques. The second type involves modified electrode surfaces that either directly measure the redox behaviours of anticoagulants or monitor the responses of standard redox probes in the presence of these drugs. This review comprehensively lists different electrode compositions and their detection and quantification limits. Additionally, it discusses the potential of employing a universal calibration plot to replace individual drug-specific calibrations. The presented insights are anticipated to significantly contribute to the sensor community's efforts in this field.

Psychotropic Medication Administration in Pediatric Emergency Departments.

Visits by youth to the emergency department (ED) with mental and behavioral health (MBH) conditions are increasing, yet use of psychotropic medications during visits has not been well described. We aimed to assess changes in psychotropic medication use over time, overall and by medication category, and variation in medication administration across hospitals. We conducted a retrospective cross-sectional study of ED encounters by youth aged 3-21 with MBH diagnoses using the Pediatric Health Information System, 2013-2022. Medication categories included psychotherapeutics, stimulants, anticonvulsants, antihistamines, antihypertensives, and other. We constructed regression models to examine trends in use over time, overall and by medication category, and variation by hospital. Of 670 911 ED encounters by youth with a MBH diagnosis, 12.3% had psychotropic medication administered. The percentage of MBH encounters with psychotropic medication administered increased from 7.9% to16.3% from 2013-2022 with the odds of administration increasing each year (odds ratio, 1.09; 95% confidence interval, 1.05-1.13). Use of all medication categories except for antianxiety medications increased significantly over time. The proportion of encounters with psychotropic medication administered ranged from 4.2%-23.1% across hospitals (P < .001). The number of psychotropic medications administered significantly varied from 81 to 792 medications per 1000 MBH encounters across hospitals (P < .001). Administration of psychotropic medications during MBH ED encounters is increasing over time and varies across hospitals. Inconsistent practice patterns indicate that opportunities are available to standardize ED management of pediatric MBH conditions to enhance quality of care.

EVALUATING PRESCRIPTION PATTERNS IN SURGICAL WARD: A CROSS-SECTIONAL ANALYSIS OF A RESEARCH CONDUCTED AT A SINGLE MEDICAL CENTER

Background: Typically, surgical procedures require the administration of antibacterial and analgesic medications in order to be successfully carried out. Prescribing medication without a valid reason may result in serious consequences after surgery. Materials and Methods: This investigation was conducted retrospectively, using a random selection of 50 cases. investigated case information to determine the trend in prescriptions.. Results; The majority of the patients were between the age range of 21 to 50 years, accounting for 18 cases (36%). The most frequent reason for hospitalization was kidney stone. A total of 255 medication instances were administered, The intravenous route was the most commonly selected method, accounting for 174 medications or 68.2%. The category of medications known as antimicrobials was the most prevalent, accounting for 97 cases (38.0%). This was followed by analgesic/antipyretics, which accounted for 50 cases (19.6%). Ciprofloxacin was the most prevalent antibiotic, accounting for 22.7% of the cases. The dosage of 83 medications (32.6%) was deemed incorrect. Conclusion: Immediate measures such as the implementation of explicit instructions, SOP, guidelines, comprehensive training, and vigilant monitoring of drug usage are necessary to rectify certain erroneous attitudes. KEY WORDS- Surgery, Antimicrobials, Antihistamines, NSAIDs, Ampicillin, Ciprofloxacin,

Prescriptions of psychotropic and somatic medications among patients with severe mental disorders and healthy controls in a naturalistic study

Purpose Psychotropic and somatic medications are both used in treating severe mental disorders (SMDs). Realistic estimates of the prevalence of use across medication categories are needed. We obtained this in a clinical cohort of patients with SMD and healthy controls (HCs). Materials and methods Prescriptions filled at Norwegian pharmacies the year before and after admittance to the Thematically Organized Psychosis (TOP) study were examined in 1406 patients with SMD (mean age 32.5 years, 48.2% women) and 920 HC (34.1 years, 46.2% women). Using data from the Norwegian Prescription Database (NorPD), the number of users in different anatomical therapeutic chemical (ATC) categories was compared using logistic regression. Population estimates were used as reference data. Results Use of antipsychotics (N05A), antiepileptics (N03A), antidepressants (N06A), anxiolytics (N05B), hypnotics and sedatives (N05C), anticholinergics (N04A), psychostimulants, attention deficit hyperactivity disorder and nootropic agents (N06B) and drugs for addiction disorders (N07B) was significantly more prevalent in patients with SMD than HC. Use of diabetes treatment (A10), antithrombotic drugs (B01), beta blockers (C07), lipid modifiers (C10), and thyroid and endocrine therapeutics (H03) was also more prevalent in patients with SMD, but with two exceptions somatic medication use was comparable to the general population. Among HC, there was low prevalence of use for most medication categories. Conclusion Patients were using psychiatric medications, but also several types of somatic medications, more often than HC. Still, somatic medication use was mostly not higher than in the general population. The results indicate that HC had low use of most medication types.

Evaluation of prescription medication changes following sleeve gastrectomy surgery.

The increasing global prevalence of obesity, coupled with its association with chronic health conditions and rising healthcare costs, highlights the need for effective interventions; however, despite the availability of treatment options, the ongoing success of primary interventions in maintaining long-term weight loss remains limited. This study examined the prescription medication dispensing changes following sleeve gastrectomy in Australians aged 45years and over. In a retrospective analysis of 847 bariatric surgery patients from the New South Wales 45 and Up Study, the assessment of medication patterns categorizing into three groups: gastrointestinal, metabolic, cardiorespiratory, musculoskeletal, and nervous systems was conducted. Each drug class was analyzed, focusing on patients with dispensing records within the 12months before surgery. This study employed interrupted time-series analysis to compare pre- and post-surgery medication usage. With a predominantly female population (76.9%) and an average age of 57.2 (standard deviation 5.71), there were statistically significant reductions in both unique medications (12.5% decrease, p=0.004) and total medications dispensed (15.9% decrease, p=0.003) from 12months before surgery to 13-24months after bariatric surgery. All medication categories, except opioids, showed reductions. Notably, the most significant reductions were observed in diabetes (38.6%), agents acting on the renin-angiotensin system (40.4%), lipid modifying agents (26.5%), anti-inflammatory products (46.3%), and obstructive airway diseases (53.3%) medications during this time frame. These findings suggest that sleeve gastrectomy provides an effective therapeutic intervention for patients with comorbidities requiring multiple medications, especially for obesity-related diseases such as diabetes, cardiovascular, respiratory and musculoskeletal disorders.

P986 Effectiveness of the adjuvanted recombinant zoster vaccine (RZV) in preventing herpes zoster (HZ) among patients ≥50 years of age with Inflammatory Bowel Disease in the United States: A retrospective real-world database analysis from 2018 to 2021

Abstract Background Patients with inflammatory bowel disease (IBD) are at higher risk of developing HZ compared to general population.1 The US Food and Drug Administration (FDA) approved RZV for adults ≥50 years of age (YOA) in Oct 2017 and for adults ≥18 YOA who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression, as patients with IBD, in Jul 2021. This study addresses an information gap for RZV vaccine effectiveness (VE) in preventing HZ among IBD patients ≥50 YOA. Methods We conducted a retrospective matched cohort study using the Optum Clinformatics Data Mart healthcare administrative claims database from Jan 2018 to Dec 2021. Patients ≥50 YOA with IBD who received 2 RZV doses with dose interval ≥28 days (RZV [2-dose] cohort) were 1:3 matched to their unvaccinated counterparts (non-RZV cohort) by age, medication category, and other confounders (propensity score). The index date for RZV cohort was the date of the second dose and for non-RZV cohort was the same index date as their vaccinated match. Follow-up started from index date +30 days until earliest date of HZ occurrence, end of enrolment, death, receipt of HZ vaccine, or study end. The first HZ episode during follow-up was identified using an algorithm that included ICD-10 diagnosis code, inpatient or outpatient claims and/or HZ antiviral medication used within 7 days pre/post-HZ diagnosis. Incidence rates (IRs) of HZ were calculated overall, stratified by condition (ulcerative colitis [UC], Crohn’s disease [CD]) and age. Cox hazards models were used to estimate overall and stratified hazard ratios (HRs). VE (%) was calculated as (1−HR) × 100. A similar approach was used to evaluate VE for patients who received 1 RZV dose. Results We identified 6501 RZV vaccinated and 19962 matched unvaccinated IBD patients who were included in the 2-dose analysis (Table). The IR of HZ was 2.92/1000 person-years (PY) in the RZV cohort and 10.96/1000 PY in the non-RZV cohort, resulting in a VE of 73.4% (95% confidence intervals [CIs]: 60.8-82.0) for IBD patients (Figure). VE against HZ was 63.5% (95%CIs: 43.0-76.6) and 85.7% (95%CIs: 69.5-93.3) in UC and CD 2-dose cohorts. IRs and VE stratified by condition and age are presented in Figure. Adjusted VE for IBD patients who received 1 RZV dose was 63.4% (95%CIs: 24.9-82.2). Conclusion Our analysis provides real-world evidence that RZV vaccination is effective in preventing HZ in IBD patients ≥50 YOA and reduce the burden in this population with increased risk of HZ. These findings are consistent with the available literature on RZV effectiveness in patients with IBD, suggesting that this population could greatly benefit from RZV vaccination. 1. Yun H et al, Arthritis Rheumatol 2016;68:2328-37 Funding GSK

Exploring the Ocular Absorption Pathway of Fasudil Hydrochloride towards Developing a Nanoparticulate Formulation with Improved Performance.

Rho-kinase (ROCK) inhibitors represent a new category of anti-glaucoma medications. Among them, Fasudil hydrochloride, a selective ROCK inhibitor, has demonstrated promising outcomes in glaucoma treatment. It works by inhibiting the ROCK pathway, which plays a crucial role in regulating the trabecular meshwork and canal of Schlemm's aqueous humor outflow. This study aims to investigate the ocular absorption pathway of Fasudil hydrochloride and, subsequently, develop a nanoparticle-based delivery system for enhanced corneal absorption. Employing the ionic gelation method and statistical experimental design, the factors influencing chitosan nanoparticle (Cs NP) characteristics and performance were explored. Fasudil in vitro release and ex vivo permeation studies were performed, and Cs NP ocular tolerability and cytotoxicity on human lens epithelial cells were evaluated. Permeation studies on excised bovine eyes revealed significantly higher Fasudil permeation through the sclera compared to the cornea (370.0 μg/cm2 vs. 96.8 μg/cm2, respectively). The nanoparticle size (144.0 ± 15.6 nm to 835.9 ± 23.4 nm) and entrapment efficiency range achieved (17.2% to 41.4%) were predominantly influenced by chitosan quantity. Cs NPs showed a substantial improvement in the permeation of Fasudil via the cornea, along with slower release compared to the Fasudil aqueous solution. The results from the Hen's Egg Test Chorioallantoic Membrane (HET-CAM) and Bovine Corneal Opacity and Permeability (BCOP) tests indicated good conjunctival and corneal biocompatibility of the formulated chitosan nanoparticles, respectively. Lens epithelial cells displayed excellent tolerance to low concentrations of these nanoparticles (>94% cell viability). To the best of our knowledge, this is the first report on the ocular absorption pathway of topically applied Fasudil hydrochloride where the cornea has been identified as a potential barrier that could be overcome using Cs NPs.

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study.

While several state-based studies have shown that children in foster care are more likely to be prescribed psychotropic medications and experience concomitant medication use both within and among medication class, these patterns have not been explored in the state of Nevada, which lacks state mandated oversight of psychotropic prescribing for foster care enrolled youth. Data from an electronic medical record system from a single institution were analyzed to examine the prevalence of psychotropic prescribing and concomitant medication use in children ages 2 to 19 who were enrolled and received psychotropic prescriptions between July 2019 to June 2022. Out of 569 distinct psychotropic medication treatment episodes within this cohort, the most frequent psychotropic classes prescribed were non-stimulant ADHD medications (alpha-agonists and atomoxetine, 31.5%), atypical antipsychotics (22.1%), antidepressants (20.6%), and stimulants (16.0%). The use of stimulants and non-stimulant ADHD medications decreased in older age groups while the use of antidepressants and antipsychotics increased in older age groups. During the three-year period studied, 24.0% of psychotropic medications prescriptions increased in dosage. Treatments were prescribed for only one month in 43.8% of youth. In children prescribed psychotropic medications, concomitant medication use for at least 60 days occurred in 28.0% of children who had any psychotropic medication prescribed. Within the cohort of 273 foster care enrolled subjects aged 2 to 19 years old who received psychotropic medication prescriptions, non-stimulant ADHD medications (both alpha-agonists and atomoxetine) and atypical antipsychotics were more commonly co-prescribed additional psychotropic medication compared to other co-prescribed medication categories. This study illustrates prescribing patterns in a community mental health clinic focused on judicious prescribing of psychotropic medications in foster care enrolled youth. Despite this, 41% of the youth treated in this clinic received at least one prescription for psychotropic medication, and of those, 27.8% were prescribed more than one psychotropic medication at the same time. More studies are necessary to understand the underlying causes of high prevalence of concomitant medication use and prescribing practices of psychotropic medications use in foster care involved pediatric populations.

Cost-Effectiveness Analysis of Favipiravir and Remdesivir as COVID-19 Treatment in South Tangerang, Banten Province - Indonesia

COVID-19 is a contagious ailment primarily attributed to the severe acute respiratory syndrome coronavirus. Indonesia persists in confronting the COVID-19 pandemic, and South Tangerang City has emerged as one of the municipalities in Indonesia that has been significantly affected. There are two categories of medications employed for COVID-19 treatment according to government policies, namely favipiravir and remdesivir. This study aims to as- sess the cost-effectiveness of favipiravir and remdesivir medications at the South Tangerang General Hospital, Indonesia. The present study employs a retrospective research design characterized by a quantitative approach, utilizing cross-sectional methodologies. The analy- sis mostly consists of descriptive techniques. The sample consisted of 479 individuals, with 246 individuals receiving outpatient treatment and 233 undergoing inpatient treatment. The inclusion criteria for this study consisted of individuals diagnosed with COVID-19 who had tested positive for the antiviral medications favipiravir and remdesivir. The findings indicated that the Average Cost-Effectivenss Ratio (ACER) for inpatients treated with fa- vipiravir was IDR 2,354,319,859, but for those treated with remdesivir, it amounted to IDR 3,501,513,488. Regarding the outpatient population utilizing favipiravir, the total expendi- ture amounts to IDR 420,083,118. Similarly, patients utilizing remdesivir incur a total ex- penditure of IDR 797,282,432. It is worth noting that the Cost-Effectivenss Ratio (CER) for patients using favipiravir is IDR 1,545,621, whereas patients using remdesivir have a CER of IDR 2,309,705. This study makes a valuable contribution to the existing body of research by demonstrating the cost-effectiveness of favipiravir. Consequently, future studies inves- tigating the overall effectiveness of favipiravir in COVID-19 patients must employ more comprehensive criteria.

Mining Bovine Milk Proteins for DPP-4 Inhibitory Peptides Using Machine Learning and Virtual Proteolysis.

Dipeptidyl peptidase-IV (DPP-4) enzyme inhibitors are a promising category of diabetes medications. Bioactive peptides, particularly those derived from bovine milk proteins, play crucial roles in inhibiting the DPP-4 enzyme. This study describes a comprehensive strategy for DPP-4 inhibitory peptide discovery and validation that combines machine learning and virtual proteolysis techniques. Five machine learning models, including GBDT, XGBoost, LightGBM, CatBoost, and RF, were trained. Notably, LightGBM demonstrated superior performance with an AUC value of 0.92 ± 0.01. Subsequently, LightGBM was employed to forecast the DPP-4 inhibitory potential of peptides generated through virtual proteolysis of milk proteins. Through a series of in silico screening process and in vitro experiments, GPVRGPF and HPHPHL were found to exhibit good DPP-4 inhibitory activity. Molecular docking and molecular dynamics simulations further confirmed the inhibitory mechanisms of these peptides. Through retracing the virtual proteolysis steps, it was found that GPVRGPF can be obtained from β-casein through enzymatic hydrolysis by chymotrypsin, while HPHPHL can be obtained from κ-casein through enzymatic hydrolysis by stem bromelain or papain. In summary, the integration of machine learning and virtual proteolysis techniques can aid in the preliminary determination of key hydrolysis parameters and facilitate the efficient screening of bioactive peptides.

Prescription Adherence Rates Across Medication Categories

Prescription adherence is a major public health challenge, as non-adherence to medication instructions can lead to poorer health outcomes and higher healthcare costs. Although prescription adherence is crucial for managing patient compliance and health outcomes, adherence rates differ greatly between medication types. The main objectives of this study were to determine prescription adherence rates across six medication types (antibiotic, cardiac, chronic health, pediatric, and psychiatric) and identify sources of variation. We searched PubMed and Web of Science databases for relevant published articles. Previous research data were selected related to prescription adherences and compliance rates were included in our analysis. Results from twenty-three previous studies were included: four to five studies per medication category to limit the influences of geographic location and difference in adherence measurement. The average prescription adherence rate for antibiotics, cardiac, chronic health, pediatrics, and psychiatric medications were 58.3%, 75.6%, 68.8%, 55.2%, and 29.2% respectively. The data found highlights the medications with the highest and lowest average adherence overall. Factors affecting adherence rates include regimen length, parental control, cognitive impairment, polypharmacy, and understanding instructions. Drug counseling has been shown to improve adherence. These findings provide a foundation for future research aimed at enhancing prescription adherence and improving patient health outcomes.

Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis – real-world evidence from Germany

Background: While evidence highlights the effectiveness of initiating disease-modifying therapy with a high-efficacy medication for multiple sclerosis (MS) patients with poor prognostic factors, it remains unclear whether this approach has been adopted by a broad range of MS providers in Germany yet. Objective: To assess the adoption of the early highly effective treatment (EHT) compared to the treat-to-target treatment approach with the option of escalating treatment efficacy over time in Germany based on real-world evidence data. Design: Patient-level pharmacy dispensing data from the Permea platform were analysed from 2020 to 2022. Methods: In total, 29,529 therapy beginners (&gt;18 years) were included to analyse shifts in treatment approaches over time and switching behaviour. Medication classification adhered to the German Society of Neurology guidelines and designated fumarates, glatiramer acetate, teriflunomide and interferons as low-efficacy category 1 medications; cladribine and S1P-modulators as medium-efficacy category 2 medications; and alemtuzumab, natalizumab, ocrelizumab, ofatumumab and rituximab (off-label) as high-efficacy category 3 medications. Results: Our results show that 70.0% of patients redeemed their first prescription for category 1 medication, 16.3% for category 2 and 13.7% for category 3 medications. The proportion of prescriptions filled shifted from 2020 to 2022 with a decrease of 14.7% for category 1 drugs and an increase of 12.5% for category 3 drugs. 93.2% of patients stayed on their initially prescribed medication category. 3.2% of category 1 and 3.7% of category 2 therapy beginners escalated to category 3 medication. 3.4% of category 3 medication users de-escalated their treatment to category 1 or category 2. Conclusion: While most individuals started their treatment according to the treat-to-target approach and remained on their initially prescribed medication category, there has been a steadily increasing shift towards the EHT approach since 2020. These insights demonstrate that, while not officially recommended by German guidelines, MS providers increasingly adopt the EHT approach.

Overview on remogliflozin SGLT-2 inhibitor in the management of type-2 diabetic mellitus in human beings

Sodium-glucose transport protein 2 inhibitors have become a significant category of oral medications in order to manage type 2 diabetic mellitus, particularly in people with heart disease or kidney disease, and have been highly advised overall current studies advice on how to treat. They can reduce blood pressure and help people lose weight, but they also come with drawbacks like genitourinary infections. The newly approved remogliflozin combinations are the product study of the pharmaceutical business for a new pharmaceutical class and novel drug combination with a view to managing diabetes. Remogliflozin etabonate is the term for the remogliflozin ester form. This study examines the clinical effectiveness, safety profile, pharmacokinetics, and pharmacodynamics of remogliflozin etabonate. However, itsanalytical profiling using RP-HPLC, UV, RP-UPLC, HPTLC, and LC/MS. this review addresses the individual experiments conducted during the development of analytical method for remogliflozin etabonate.

A preliminary study evaluating self-reported effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury.

Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.

Simplified Pain Management Including Fentanyl TTS in PACU Patients With Hip Fracture Surgery to Improve Patients’ Well-Being: A Double-Blind Randomized Trial

Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study compares postoperative hip fracture patients treated with standard pain management with a variety of medications or an approach with only one option in each medication category (nonopioid: acetaminophen; opioid: fentanyl TTS 12,5 mcg/hour; rescue medication: piritramide) to simplify the treatment algorithm for nurses and improve patient well-being. Double-blind randomized controlled trial. The sample was cognitively intact patients (N = 141) with hip fractures in a tertiary university hospital. Administration of fentanyl12mcg/hourtransdermal therapeutic system was administered by the nurses in the postanesthesia care unit (PACU) to address basal wound pain to improve patientwell-beingand patient treatment inthe PACU for24hours to bettercontrolfor early complications. Well-being was equally increased in both groups in comparison to our preintervention data from 35.7% to over 60% and did not differ significantly between the intervention and control group. No statistically significant differences in numeric rating scale scores, rescue opioid dosage (piritramide i.v.) or in complications were present. This one-size-fits-all simplified pain management approach did not improve patient well-being or any other outcome but highlighted the importance of adequate pain management and a sufficient nurse-to-patient ratio.

Mesenchymal Stem Cells Applications in Alzheimer's Disease

AbstractAlzheimer's disease (AD) is a neurodegenerative disorder that advances gradually and primarily impacts the hippocampus region of the brain. It is defined by a deterioration in cognitive function as well as an observable loss of memory retention. One of the major characteristics of AD is the impairment of neural generation, resulting in the depletion of neurons and synaptic connections within the nervous system. It is unfortunate to say that, at present, no definitive cure is available for AD, and no medication is effective in halting the progression of neurodegeneration associated with it. Nevertheless, it is crucial to highlight that progress has been achieved in addressing the troubling symptoms of AD. The Food and Drug Administration has granted approval for two categories of medications designed to alleviate these symptoms. The scientific community has been inspired by these advancements to investigate alternative therapeutic options, with an emphasis on stem cell therapy in particular. The main focus of this review will be on the potential for the use of a variety of mesenchymal stem cells as a treatment for AD.

Associations between the Use of Pain Management Strategies and Self-Reported Emotional and Behavioral Functioning of Adolescent and Young Adults with Sickle Cell Disease

Background: Sickle Cell Disease (SCD) often causes significant pain that may require the use of various pain management strategies. These strategies are typically categorized into two broad groups, pharmacological and nonpharmacological, but a need exists to understand how specific strategies may impact an individual's functioning. This understanding is especially critical when considering adolescents and young adults (AYA) with SCD, as this age range may experience increased pain and other SCD complications that coincide with the transition from pediatric to adult care. Methods: Adolescent and young adult patients with SCD completed the Behavioral Assessment System for Children, Third Edition (BASC-3), a measure of emotional and behavioral functioning, and a questionnaire about their pain management strategy use. These strategies were categorized as: Over the Counter Medication (acetaminophen, ibuprofen, naproxen), Prescription Medication (codeine, short-acting morphine, long-acting morphine, oxycodone, hydrocodone, hydromorphone, gabapentin, amitriptyline), Psychological Strategies (deep breathing, imagery, distraction, talking with friends/family, prayer/meditation), and Behavioral Strategies (hydrate, apply heat, apply cold, massage, smoking, rest/sleep). Analyses included Spearman rank correlations to determine the relationship between categories of pain management strategies and self-reported BASC scores. Based on correlation results, independent sample t-tests were conducted to further examine the relationship between the use of specific pain management strategies and self-reported BASC scores. Results: Participants included 94 AYA patients with SCD (Mean age = 18.1 ± 1.5 years; 51.1% female; 52.1% HbSS). Of the pain management categories, Prescription Medication and Behavioral Strategies had significant correlations with self-reported BASC scores. Within the Prescription Medication category, participants that reported use of hydrocodone (40.9%) self-reported higher scores on the Social Stress (p = 0.01) and Somatization (p = 0.001) scales of the BASC-3 as well as lower scores on the Interpersonal Relations (p = 0.048) scale compared to participants that did not use hydrocodone. Those using oxycodone (25%) self-reported higher scores on the Somatization (p = 0.002) scale and lower scores on the Interpersonal Relations (p = 0.036) scale compared to those that did not use oxycodone. Participants that reported use of gabapentin (6.8%) self-reported higher scores on the Social Stress (p = 0.006) and Somatization (p = 0.009) scales compared to those that did not use of gabapentin. Compared to participants that did not use amitriptyline, those that reported use (3.4%) self-reported higher scores on the Somatization (p = 0.017) scale. Within the Behavioral Strategies category, adolescents and young adults that reported the use of smoking to manage pain (7.3%) self-reported higher scores on the Somatization (p &amp;lt; 0.001) and Attention Problems (p &amp;lt; 0.001) scales than those that did not smoke. Additionally, participants that reported the application of cold temperature to manage pain (15.9%) self-reported higher scores on the Attitude to School (p = 0.03) and Attention Problems (p = 0.006) scales compared to those that did not use this strategy. Conclusions: Results indicate that specific pain management strategies may be associated with different social, emotional, and behavioral functioning. Further exploration to understand the mechanisms between specific pain management strategies and patient functioning during the AYA period is warranted. Given the unique challenges of adolescents and young adults with SCD, future work should also investigate how specific pain management strategies may improve the experience of those transitioning from pediatric to adult care.

External validation of newly modified status epilepticus severity score for predicting mortality in patients with status epilepticus in a regional hospital in Taiwan

PurposeTo evaluate and compare the performance of the status epilepticus severity score (STESS), modified STESS (mSTESS), and the newly modified STESS (nSTESS) in predicting mortality in patients with status epilepticus (SE) at a regional hospital in Taiwan. MethodsData were collected from 81 patients with SE, aged over 18 years at a regional medical hospital in Tainan from January 2012 to December 2022. SE were treated following the standard treatment protocol. Exclusion criteria included missing data, lack of adherence to the treatment protocol, and transfer to tertiary medical centers. Outcome measures included differences in characteristics between survivor and non-survivor groups, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of STESS, nSTESS, mSTESS. Receiver operating characteristic (ROC) curve and area under curve (AUC) of scales were generated. Calibration with Hosmer–Lemeshow test was built as well. ResultsThe study found significant differences in seizure types (p = 0.015) and undergoing intubation (p = 0.017) between survivor and non-survivor groups. No significant differences were observed in age, gender, underlying diseases, or the category of antiseizure medications (ASMs) usage. The ROC curve for STESS, nSTESS and mSTESS showed similar predictive values of around 0.75, indicating moderate performance of prediction. The Hosmer-Lemeshow test showed no significant difference between real-world predictions and these three clinical scales. In the aspect of accuracy, sensitivity and specificity, nSTESS has similar overall accuracy as in STESS and mSTESS. ConclusionThis external validation study demonstrates the moderate performance of nSTESS in predicting mortality in SE patients at a regional hospital in Taiwan. These outcomes underscore the practical utility of these scales in clinical practice, with nSTESS demonstrating accuracy on par with the others. Further validation in larger, multicenter cohorts and other healthcare settings is necessary to fully confirm its predictive value.