Changes In Drug Therapy Research Articles

Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study

BackgroundOrthogeriatric patients have an increased risk for complications due to underlying comorbidities, chronic drug therapy and frequent treatment changes during hospitalization. The clinical pharmacist (CP) plays a key role in transmural communication concerning polypharmacy to improve continuity of care by the general practitioner (GP) after discharge. In this study, a pharmacist-led transmural care program, tailored to orthogeriatric patients, was evaluated to reduce drug related problems (DRPs) after discharge.MethodsAn interventional study was performed (pre-period: 1/10/2021-31/12/2021; post-period: 1/01/2022-31/03/2022). Patients (≥ 65 years) from the orthopedic department were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. The DRP reduction rate one month after discharge was calculated. Associated factors for the DRP reduction rate were determined in a multiple linear regression analysis. The GP acceptance rate was determined for the proposed interventions, as well as their clinical impact using the Clinical, Economic and Organizational (CLEO) tool. Readmissions one month after discharge were evaluated.ResultsOverall, 127 patients were included (control n = 61, intervention n = 66). The DRP reduction rate was statistically significantly higher in the intervention group compared to the control group (p < 0.001). The pharmacist’s intervention was associated with an increased DRP reduction rate (+ 1.750, 95% confidence interval 1.222–2.278). In total, 141 interventions were suggested by the CP, of which 71% were accepted one month after discharge. In both periods, four patients were readmitted one month after discharge. 58% of the interventions had a clinical impact (≥ 2 C level using the CLEO-tool) according to the geriatrician and for the CP it was 45%, indicating that they had the potential to avoid patient harm.ConclusionsThe pharmacist-led transmural care program significantly reduced DRPs in geriatric patients from the orthopedic department one month after discharge. The transmural communication with GPs resulted in a high acceptance rate of the proposed interventions.

Effectiveness of buffered acetylsalicylic acid compared to other drugs in diseases patients in clinical practice: results of the CARDINAL observational retrospective study

Aim. To evaluate the effectiveness of acetylsalicylic acid (ASA) drugs for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in clinical practice and compare the effectiveness of the Cardiomagnyl with other ASA drugs.Material and methods. This observational, non-interventional, retrospective study included data from electronic medical records of 18199 patients with ASCVD who were divided into 2 following groups: patients who received ASA 75-100 mg (n=9784) and patients who did not receive ASA (n=8325). The prescription rate of ASA, the choice of the first drug, the duration of ASA therapy, the frequency of switching ASA during treatment, and the choice of the second ASA drug when changing therapy were assessed. Due to the heterogeneity of patients in the above groups, to assess the clinical outcomes, propensity score matching was performed and comparable groups were selected to evaluate the effectiveness of ASA drugs 75-100 mg in patients with ASCVD (n= 427) in comparison with patients not receiving ASA (n=427) and to assess the effectiveness of Cardiomagnyl 75 mg (n=1308) in comparison with enterosoluble ASA 100 mg (CRA) (n=1308) taking into account 24 parameters.Results. The average proportion of patients with ASCVD taking ASA drugs was 58%. During treatment, 54% of patients underwent a change in drug therapy from one ASA drug to another. The prescription rate of Cardiomagnyl as a first-choice drug was 33%, and as a second drug when changing therapy — 21%. The duration of Cardiomagnyl therapy was the longest compared to other ASA drugs and amounted to 16,3 months. The incidence of ischemic stroke, myocardial infarction and major adverse cardiovascular events in the group of patients who received ACS 75-100 mg was significantly lower than in patients who did not take ASA drugs and amounted to 4,7% vs 8,7%, 0,9% vs 3,3%, 5,6% vs 11,9%, respectively. Significantly lower incidence of unstable angina (0,8% vs 2,0%), myocardial infarction (1,5% vs 3,9%) and major adverse cardiovascular events (5,4% vs 7,8%) in group of patients who received Cardiomagnyl 75 mg as opposed to enterosoluble ASA.Conclusion. Significant advantages of buffered ASA (Cardiomagnyl) were revealed in comparison with enterosoluble ASA in clinical practice.

A prospective study evaluating the clinical utility of tau‐PET in the diagnostic work‐up of patients with cognitive symptoms

AbstractBackgroundDetermining the added value of tau‐PET in the diagnostic work‐up of patients with cognitive symptoms is of great importance before implementation of the method in clinical practice. We therefore aimed to prospectively study the added clinical value of including tau‐PET in the clinical work‐up.Method878 patients referred for cognitive complaints to secondary Memory clinics in southern Sweden were consecutively recruited to the Swedish BioFINDER‐2 cohort study (May 2017 – Sept 2021). Participants underwent a baseline diagnostic work‐up including clinical examination, medical history, cognitive testing, blood and CSF sampling, and MRI of the brain. A tau‐PET ([18F]RO948) scan was added onto this clinical diagnostic work‐up. The tau‐PET scans were visually read as: normal, early AD pattern, late AD pattern or inconclusive scan. The primary end points were change in diagnosis and change in Alzheimer disease drug therapy or other drug treatment between the pre‐ and post‐PET visits. Secondary end point was the change in diagnostic certainty between the pre‐ and post‐PET visits.ResultThe tau‐PET visual read result led to a change in diagnoses in 66 participants (7.5%, p&lt;0.001) and a change in medication in 48 participants (5.5%, p&lt;0.001) (Figure 1). There was an overall increase in the diagnostic certainty after tau‐PET in the whole dataset [6.9±2.3 vs 7.4±2.4; p&lt;0.0001]. The certainty was higher in participants with a pre‐PET diagnosis of AD [7.6±1.7 vs 8.2±2.0; p&lt;0.0001] (Figure 2) and increased, as expected, even further in participants with a tau‐PET positive result supporting an AD diagnosis [8.0±1.4 vs 9.0±0.9; p&lt;0.0001]. The impact of tau‐PET results was strongest in participants with pathological Ab‐status, whereas no significant change in diagnoses was seen in participants with normal Ab‐status.ConclusionWe report a significant change in diagnoses and medication of patients when tau‐PET is added to an already extensive diagnostic work‐up that included CSF AD biomarkers. Tau‐PET led to a significant increase in certainty of underlying etiology. The additive effect on certainty of etiology and to diagnosis was predominantly seen in Ab‐positives and we suggest that clinical use of tau‐PET is limited to populations with biomarkers indicating Ab‐positivity.

Optimizing Hypertension Treatment in Older Patients Through Home Blood Pressure Monitoring by Pharmacists in Primary Care: The MINOR Clinical Trial

Incorporating technology such as home blood pressure monitoring (HBPM) into the clinical routine generates opportunities to improve BP monitoring and control in primary health care. It is also important to prevent overtreatment. However, the combination of HBPM with collaborative drug therapy management (CDTM) has not yet been studied. This study aimed to assess the efficacy of combining HBPM with CDTM to optimize hypertension treatment for older patients. This open-label, parallel-group, randomized clinical trial was conducted between June 2021 and August 2022 in a Brazilian community pharmacy and included older patients (aged ≥60 years) with hypertension. Those who were classified as poorly adherent or nonadherent to the prescribed drug treatment or who were unable to perform HBPM were excluded. In the control group, participants received a BP monitor and instructions on how to perform HBPM. A general practitioner, who was provided a report with the obtained BP values, determined any changes to the treatment protocol. In the intervention group, a pharmacist enrolled participants in a drug therapy management protocol and provided the general practitioner with suggestions to optimize the antihypertensive drug therapy, in addition to the report with the BP values. The following outcomes were considered: the proportion of participants receiving deprescriptions of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between the groups 45 days after performing HBPM. The study used a t test combined with Levene's test to calculate mean intergroup differences in BP, the paired t test to calculate mean intragroup differences in BP, and Pearson's χ2 test to determine intergroup differences in changes in drug therapy. In each group, 161 participants completed the trial. Antihypertensive agents were deprescribed for 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (P=0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (P=0.52). The mean office systolic BP and HBPM values were lower in the intervention group (P=0.22 and P=0.29, respectively). Combining HBPM with a CDTM protocol effectively optimized antihypertensive treatment for older patients in a primary health care setting. gov identifier: NCT04861727.

Clinical Utility of Tau Positron Emission Tomography in the Diagnostic Workup of Patients With Cognitive Symptoms

It is important to determine the added clinical value for tau positron emission tomography (PET) in the diagnostic workup of patients with cognitive symptoms before widespread implementation in clinical practice. To prospectively study the added clinical value of PET detecting tau pathology in Alzheimer disease (AD). This prospective cohort study (Swedish BioFINDER-2 study) took place from May 2017 through September 2021. A total of 878 patients with cognitive complaints were referred to secondary memory clinics in southern Sweden and then recruited to the study. In total, 1269 consecutive participants were approached, but 391 did not meet inclusion criteria or did not complete the study. Participants underwent a baseline diagnostic workup, including clinical examination, medical history, cognitive testing, blood and cerebrospinal fluid sampling, magnetic resonance imaging of the brain, and a tau PET ([18F]RO948) scan. The primary end points were change in diagnosis and change in AD drug therapy or other drug treatment between the pre- and post-PET visits. A secondary end point was the change in diagnostic certainty between the pre- and post-PET visits. A total of 878 participants with a mean age of 71.0 (SD, 8.5) years (491 male [56%]) were included. The tau PET result led to a change in diagnoses in 66 participants (7.5%) and a change in medication in 48 participants (5.5%). The study team found an association with overall increased diagnostic certainty after tau PET in the whole data set (from 6.9 [SD, 2.3] to 7.4 [SD, 2.4]; P < .001). The certainty was higher in participants with a pre-PET diagnosis of AD (from 7.6 [SD, 1.7] to 8.2 [SD, 2.0]; P < .001) and increased even further in participants with a tau PET positive result supporting an AD diagnosis (from 8.0 [SD, 1.4] to 9.0 [SD, 0.9]; P < .001). The association with tau PET results had the largest effect sizes in participants with pathological amyloid-β (Aβ) status, whereas no significant change in diagnoses was seen in participants with normal Aβ status. The study team reported a significant change in diagnoses and patient medication when tau PET was added to an already extensive diagnostic workup that included cerebrospinal fluid AD biomarkers. Including tau PET was associated with a significant increase in certainty of underlying etiology. The effect sizes for certainty of etiology and diagnosis were largest in the Aβ-positive group and the study team suggests that clinical use of tau PET be limited to populations with biomarkers indicating Aβ positivity.

Significant Improvements in SEIzure InterVAL (Time Between Seizure Clusters) Across Time Irrespective of Age or Change in Concomitant Treatments in a Long-Term, Open-Label Safety Study of Diazepam Nasal Spray (P9-1.010)

Significant Improvements in SEIzure InterVAL (Time Between Seizure Clusters) Across Time Irrespective of Age or Change in Concomitant Treatments in a Long-Term, Open-Label Safety Study of Diazepam Nasal Spray (P9-1.010)

Effect of Amyloid PET on Clinical Management of Alzheimer’s Disease Medication Therapy: The Khatib Study (P11-6.009)

<h3>Objective:</h3> Evaluate the role of amyloid-beta PET scans as a diagnostic tool in clinical settings and its influence on patient care management with respect to Alzheimer’s disease drug therapy. <h3>Background:</h3> The NIA-AA 2018 guidelines for clinical research define Alzheimer’s disease (AD) on a biological basis, requiring the presence of amyloid deposition in the brain. This framework helps to more precisely define the processes underlying cognitive impairment, and is particularly poignant given the advent of amyloid-beta PET scans which allow the visualization of amyloid-beta in vivo. It is unclear how this framework may lead to changes in management of patients, particularly in an ethnically and culturally diverse location such as in South Florida. <h3>Design/Methods:</h3> We included 102 cognitively impaired patients from the multi-site Khatib Study (mean age 77+/−7 years, 45% women, 15% Hispanic). Patients were evaluated for AD drug therapy (cholinesterase inhibitors and memantine) before and after amyloid-beta PET scan by neurologists. The probabilities of change in AD drug therapy by amyloid-beta PET scan results were estimated using Wilson intervals for binomial proportions and tested using the McNemar test. <h3>Results:</h3> For amyloid PET positive patients (n=68), the use of AD drug therapy increased significantly (<i>p</i>&lt;.05), from 78% (95%CI [67,86]) to 91% (95% CI [82,96]). A total of 15% (95%CI [8,25]) started AD drug therapy and 2% (95%CI [0.3,8]) stopped AD drug therapy. For amyloid PET negative patients (n=34), the use of AD drug therapy decreased significantly (<i>p</i>&lt;.05), from 76% (95%CI [60,88]) to 53% (95%CI [37,69]). A total of 29% (95%CI [17,46]) stopped AD drug therapy and 6% (95%CI [2,19]) started AD drug therapy. <h3>Conclusions:</h3> Clinical confirmation of patients’ amyloid PET status resulted in increases in prescribed AD drug therapy for amyloid positive patients and decreases in the amyloid negative patients. This study highlights the significant bidirectional influence of amyloid PET scans on patient care management. <b>Disclosure:</b> Ms. Ariko has nothing to disclose. Miss Modjeski has nothing to disclose. Dr. Chang has nothing to disclose. Ms. Merrifield has received personal compensation for serving as an employee of The Council on Aging of Martin County - The Kane Center. Ms. Ripper has received personal compensation for serving as an employee of the council on aging of Martin County Inc. Mrs. Clark Dowd has nothing to disclose. James Galvin has nothing to disclose. Dr. Camargo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Camargo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GE Health. The institution of Dr. Camargo has received research support from American Academy of Neurology.

The Impact of Clinical Pharmacy Services on Direct Oral Anticoagulant Medication Selection and Dosing in the Ambulatory Care Setting

Background: Off-label dosing of direct oral anticoagulants (DOACs) is both common and associated with adverse patient outcomes. Evidence describing best practices to support optimal direct oral anticoagulant (DOAC) dosing is limited. Objective: To describe the impact of clinical pharmacist intervention on DOAC prescribing. Methods: This retrospective study was a descriptive analysis conducted within an integrated healthcare system with a centralized, pharmacist-led Anticoagulation Management Service (AMS). Patients prescribed a DOAC between January 1, 2020 and December 31, 2020 were included. Pharmacy dispensing reports were generated for pharmacist review and anticoagulant drug therapy changes were recommended to physicians where appropriate. The primary objective was to describe the number and type of recommendations made. Secondary objectives were to determine the provider acceptance rate based on the intervention type and on clinical vs formulary recommendations. Results: Clinical pharmacists made 147 recommendations for 2331 unique patients included in the analysis. Twenty-three recommendations (16%) were to decrease the dose, 46 (31%) were to increase the dose, 14 (10%) were to change the medication due to clinical scenario, 62 (42%) were to change the medication due to cost, and 2 (1%) were another issue. One hundred twenty-three (84%) recommendations were accepted. The provider acceptance rate was similar for clinical and formulary recommendations (85% and 82% respectively). Conclusion: Implementation of report-driven clinical pharmacist intervention led to an improvement in appropriate DOAC medication selection and dosing.

Current Approaches to The Treatment of Chronic Diseases: Prospects for The Use of Innovative Methods and Technologies in Medicine

This article examines current approaches to the treatment of chronic diseases and prospects for the use of innovative methods and technologies in medicine. The paper presents an overview of modern methods of treatment of chronic diseases, such as drug therapy, exercise, diet and lifestyle changes. New methods are also being considered, such as the use of technologies related to AI, biotechnology, gene therapy, nanotechnology, etc. In addition, the authors describe how these methods can help in more accurate diagnosis and the choice of individual treatment for the patient. The article also discusses the advantages and disadvantages of each method, as well as the potential risks and ethical issues associated with their use. The authors conclude that the use of innovative methods and technologies can significantly improve the effectiveness of treatment of chronic diseases and improve the quality of life of patients, but also requires additional research and regulation by medical organizations and governments. One of the most promising areas in the treatment of chronic diseases is the use of AI and machine learning. These technologies can help in more accurate diagnosis, selection of individual treatment, monitoring of the patient's condition and prediction of possible complications. Biotechnologies also provide new opportunities in the treatment of chronic diseases. For example, the use of therapeutic proteins and gene therapy can be effective in the treatment of certain forms of cancer, cystic fibrosis and other diseases. Nanotechnology may also have significant potential in the treatment of chronic diseases. Nanoparticles can be used to deliver drugs to specific places in the body and to diagnose early stages of diseases. However, it should be borne in mind that the use of innovative methods and technologies is also associated with risks and ethical issues. For example, when using gene therapy, unexpected side effects are possible, and the use of AI and machine learning can lead to problems with the confidentiality of patient data. In general, the use of innovative methods and technologies can significantly improve the effectiveness of treatment of chronic diseases and improve the quality of life of patients. However, before the introduction of these methods and technologies into medical practice, it is necessary to conduct thorough research, evaluate the effectiveness and safety, as well as take into account ethical and legal aspects

A retrospective evaluation of the effectiveness of a targeted medicines use review service in improving asthma and COPD control provided by community pharmacists in England

Abstract Objective Medicines Use Reviews (MUR) may benefit asthma and chronic obstructive pulmonary disease (COPD) control. The present study evaluates the effect of respiratory-targeted MUR-plus (MUR+) services delivered by community pharmacists on disease control. Methods A retrospective analysis of MUR+ data in the PharmOutcomes database was conducted. All patients receiving respiratory-targeted MUR+ in Milton Keynes were included. Changes in asthma control test (ACT) and COPD assessment test (CAT) scores were analysed. Key findings A total of 191 asthma and 81 COPD patients received MUR+. Asthma and COPD control improved as shown by the increase in mean ACT [+1.2 (95% CI, 0.6–1.8)] and decrease in mean CAT [−0.2 (95% CI, −1.4 to 1.0)]. Baseline ACT, smoking cessation, absence of change in drug therapy, patient education, healthcare professional referral, device training and baseline ACT score ≤19 were associated with change in ACT, but only smoking cessation was related to CAT change. A multivariable regression model comprising the aforementioned variables explained 19% of the variance in ACT change (P &amp;lt; 0.001). Only baseline ACT was associated with ACT change (beta = −0.34, P &amp;lt; 0.01). Baseline CAT, absence of change in drug therapy, smoking cessation and baseline CAT score &amp;gt;20 accounted for 12% of the variance in changes in CAT (P = 0.046). No variable was significantly associated with CAT change. Conclusions Respiratory-targeted MUR+ service by community pharmacists was associated with improvements in asthma control among patients with poorer baseline ACT, but not in patients with COPD. Several potentially modifiable factors such as education were associated with changes in control.

Association Between Time in Range and Postprandial Glucose Contribution Rate in Non-Insulin-Treated Type 2 Diabetes Patients: Inverse Correlation of Time in Range with Postprandial Glucose Contribution Rate.

Background: Whether time in range (TIR), a parameter derived from continuous glucose monitoring (CGM), is a marker of postprandial hyperglycemia remains to be determined. In this study, we examined the association between TIR and postprandial glucose in non-insulin-treated type 2 diabetic patients. Methods: Our cross-sectional study included 729 non-insulin-treated patients with type 2 diabetes who underwent CGM without any changes in drug therapy on admission. The 24-h CGM record was analyzed for average glucose, standard deviation, percentage coefficient of variation, time above range, TIR, time below range, area under the curve (AUC) of basal glucose, AUC of postprandial glucose, and postprandial glucose contribution rate (%). The primary endpoint was the association between TIR and the postprandial glucose contribution rate. Results: We made TIR groups divided into 10% increments for a 7-group and compared with <40% to >90%. The basal and postprandial glucose AUCs correlated negatively with TIR. The postprandial glucose contribution rate correlated with TIR. The cutoff value for TIR, where postprandial glucose contribution rate was lower than the basal glucose contribution rate, was 66.3%. Conclusions: In non-insulin-treated type 2 diabetic patients, postprandial glucose AUC was higher in the high TIR group, whereas the basal glucose AUC was higher in the low TIR group. Good glycemic control can be achieved with therapeutic interventions that target postprandial glucose and basal glucose in patients with TIR ≥66.3% and <66.3%, respectively. University Medical Information Network [UMIN] ID: UMIN0000254333.

Literature Review on the Use of Herbal Extracts in the Treatment of Non- Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease is a common chronic liver injury disease, and its incidence is rapidly increasing across the globe, thus becoming a serious threat to human health. So far, the clinical prevention and treatment of non-alcoholic fatty liver disease mainly include single-targeted drug therapy, surgical treatment and lifestyle changes. However, these treatments cannot completely address the complex pathogenesis of non-alcoholic fatty liver disease and have various side effects. Recent studies reveal that many herbal extracts are found to have potential anti-non-alcoholic fatty liver disease activities. This paper presents a review on herbal extracts used for the treatment of non-alcoholic fatty liver disease in experimental studies to provide a theoretical basis for their clinical application in the treatment of non-alcoholic fatty liver disease and for new drug development. Scientific papers were retrieved by searching the PubMed database up to Feb 2021 using the following keywords: 'non-alcoholic fatty liver disease', 'herbal extracts' ('flavonoids', 'saponins', 'quinones', 'phenolic compounds', 'alkaloids', 'polysaccharides', 'ginkgolide B', 'schizandrin B', 'ursolic acid') and 'mechanism'. The pharmacological effects and mechanisms of many herbal extracts can reverse the adverse health effects of non-alcoholic fatty liver disease. In vitro and in vivo experimental studies indicated that herbal extracts can improve the symptoms of non-alcoholic fatty liver disease by inhibiting inflammation, antioxidant stress, improvement of lipid metabolism and insulin sensitivity and regulating intestinal bacteria flora. However, there needs to be sufficient data from human clinical trials to prove their efficacy and safety.

Chronic kidney disease in outpatients with arterial hypertension: clinical characteristics and treatment efficacy (according to the national registry)

The study was carried out on the basis of the AH registry data (n=43 133; 20052019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc). The creatinine level was assessed in 60% of patients, 23.6% of them had decreased eGFR60 ml/ min/1.73 m2. The incidence of co-morbid CVD and type 2 diabetes in patients with hypertension increased markedly with a decrease in eGFR (14 groups): the incidence of coronary artery disease increased 1.8 times (up to 72.5%), myocardial infarction 1.7 times (up to 20.6%), chronic heart failure 2 times (up to 84.0%), atrial fibrillation 10 times (up to 18.3%), history of stroke 3.7 times (up to 15.3%) and type 2 diabetes 2.4 times (up to 32.8%). Achievement of target goals of CV risk factors was not enough: systolic BP less than 50% of patients, triglycerides less than 7%, LDL-C in high and very high CVD risk patients less than 13%. Conducting timely assessment of renal function, drug therapy and lifestyle changes in patients with AH and decreased renal functional could prevent severe kidney damage, the development of CV complications, chronic renal failure and reduce mortality.

The role of exercise right heart catheterization to guide pulmonary hypertension therapy in older adults.

The spectrum of patients referred for suspected pulmonary arterial hypertension (PAH) includes a population with clinical features suggestive of pulmonary hypertension due to left heart disease (PH‐LHD). Even after right heart catheterization (RHC) performed at rest, it can be a challenge to identify patients who will clearly benefit from PAH drug therapy. Therefore, the objective of this study was to evaluate the role of exercise RHC to influence decisions regarding prescription of PAH drug therapy in this population. A retrospective cohort study was conducted of older adults with risk factors for PH‐LHD and suspected PH referred for exercise RHC. One year follow‐up was conducted to record clinical outcomes, all changes in PAH drug therapy, and changes in patient‐reported quality of life. The final cohort included 61 patients, mean age of 69 ± 10; 44% and 34% had a history of coronary artery disease and atrial fibrillation respectively. Exercise changed the proportional breakdown of hemodynamic diagnoses from 36% No PH, 44% PAH, and 20% PH‐LHD at rest to 15% No PH, 36% PAH, and 49% PH‐LHD. Although a significant proportion of patients were reclassified as PH‐LHD, there was an overall increase in the proportion of patients receiving PAH drug therapy, particularly for those with PAH confirmed by exercise RHC. A total of 11 PAH drug prescriptions were employed before exercise RHC increasing to 24 after (p = 0.002). Patients receiving PAH therapy demonstrated significant improvement in self‐reported quality of life. Exercise RHC appeared to influence selection of PAH drug therapy.

Treatment practice of patients with Parkinson's disease in Saxony : A secondary data-based analysis of utilization in the observation period 2011-2019

The consequences of demographic change are already noticeable in Saxony, the federal state with the highest average age in Germany and predominantly rural areas. In order to improve medical care for patients with Parkinson's disease (PwP), astatus quo analysis of current care practice is required. To what extent does the utilization of medical services by PwP differ a)between urban and rural areas in Saxony and b)between PwP with and without neurologist contact in the observation period from 2011 to 2019? The cohort study was based on extensive routine data for Saxony from the health insurance company AOK PLUS from 2010 to 2019. Acohort of 15,744 PwP (n = 67,448patient-years) was compared to amatched cohort (n = 674,480patient-years; criteria: year of birth, gender, year of insurance, place of residence: urban/rural) without an ICD-10 coding of amovement disorder. Overall, there was asteady increase in the number of PwP in the dynamic cohort from 2011 (n = 6829) to 2019 (n = 8254). Urban-rural differences included asmaller proportion of patients being seen by aneurologist in rural areas. The PwP had a3.5 to 4‑fold higher risk of dying compared to those in the comparison cohort. Changes in drug therapy for Parkinson's disease (i.e., increases in COMT and MAO inhibitors) and in remedy delivery (i.e., increases in occupational therapy and speech therapy) over the observation period were primarily seen in PwP who were seen by aneurologist. The study identified increased morbidity and mortality in PwP who are suitable targets for innovative care concepts. The increasing number of patients and the described differences document the need for this. At the same time, changes in prescription practice show that innovative forms of treatment are being used by neurologists in outpatient care.

Structured self-monitoring of blood glucose is associated with more appropriate therapeutic interventions than unstructured self-monitoring: A novel analysis of data from the PRISMA trial

AimsTo investigate the relationship between single therapeutic interventions and indicatorsofglycemic control in the PRISMA trial, a large study comparing the effects of intensive structured SMBG (ISM) vs. active control (AC) in non-insulin-treated type 2 diabetes (T2D). MethodsInformation was collected at four time points, corresponding to months 3, 6, 9, and 12 and visits 2, 3, 4, and 5, respectively. Data on therapeutic interventions, HbA1c levels and the number of hypoglycemic episodes at each visit were analyzed. ResultsIntensification of drug therapy occurred in 20.3% vs. 15.6%, and no change in 71.8% vs. 78.7% of visits for the ISM and AC groups, respectively. On the other hand, de-intensification and redistribution of drugs and/or drug dose occurred in a similar proportion of visits. Intensification of drug therapy in both groups was associated with significant reductions in HbA1c vs. the previous visit, while de-intensification of therapy led to a significant increase in HbA1c in the AC group only. Conclusions. Our data strongly support that structured SMBG has clinical value in reducing HbA1c in non-insulin-treated T2D and suggest that this clinical benefit may be mediated by more appropriate and timely changes in drug therapy.

Remote Monitoring of the QT Interval and Emerging Indications for Arrhythmia Prevention.

QT interval prolongation is a marker of increased risk for life-threatening arrhythmias, and needs to be promptly recognized. Many effective drugs, however, prolong QTc (QT interval corrected for heart rate) in genetically predisposed subjects. The possibility of remote monitoring and QTc measurement for up to 2 weeks, continuously providing physicians with real time data, allows life-saving interventions or changes in drug therapy. This applies especially to patients with the long QT syndrome and to those taking drugs blocking the IKr current and prolonging the QT interval. Patch monitors recording ECG traces continuously are available and contribute to effective arrhythmic prevention.

A REVIEW ON CLINICAL MANIFESTATIONS OF COVID-19 VIRUS AND THE POSSIBLE ADAPTIVE IMMUNE RESPONSES

Coronavirus disease 2019 (COVID-19), the highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease has shown to put an enormous burden on the society and is a challenge to the physician owing to its infectivity, complications, morbidity and absence of proper medication. As medicine is an ever-changing science new research and clinical experience broaden our knowledge and bring changes in drug therapy. COVID-19 is now spreading throughout the world because of its high infectivity and communicability. Also there is a lack in the proper management of the disease. Because there is no definite and specific treatment for patients with COVID-19, some antiviral agents are prescribed to the patients, depending on their condition and location. It is widely accepted that the world will not return to its prepandemic normalcy until safe and effective vaccines become available and a global vaccination programme is successfully implemented. As COVID-19 is new to humankind and the nature of protective immune responses is poorly understood, it is unclear which vaccine strategies will be most successful. This review attempts to educate the readers about the molecular and structural complexity of COVID-19 virus; its clinical manifestations in humans; immune responses and a special reference on the various adaptive immune responsive strategies including vaccines and its limitations.&#x0D; Keywords: COVID-19, Vaccine, Spike Protein, Vector, Immune response, Pandemic, SARS-CoV2

Recurrent hiatal hernias. To operate or not?

The recurrence of a hiatal hernia after surgical treatment is the most serious and far from resolved problem in this area of surgery. The validity and effectiveness of surgical treatment of recurrent hiatal hernia of the diaphragm remains the subject of clinical research and scientific discussion. The main problems of such interventions are the difficulty of eliminating the anatomical or functional factors that underlie the failure of the primary operation. The stated provisions determine the need for further searches for a solution of this problem. In the period from 2015 to 2020, 61 patients with recurrent hernia of the gastrointestinal orifice of the diaphragm underwent surgical treatment. Indications for the operation were gastroesophageal reflux refractory to drug therapy or anatomical changes that carry the risk of developing life-threatening conditions. In 58 (95.1%) cases, surgery was performed laparoscopically, in 3 (4.9%) through left-side thoracotomy. In 54 (88.5%) cases, complete restoration of normal anatomy with closure of the hiatal opening with prosthetic material is performed. In 7 (11.5%) cases, when the esophagus was shortened, the fundoplication cuff was created in the chest cavity, and the hiatal opening was performed only with its own tissues. Complications occurred in 11 (18.0%) cases (7 pneumothorax, 2 bleeding, 2 perforation of a hollow organ). Long-term results (12-48 months) were evaluated in 57 (93.4% of operated) people. Repeated recurrence of hiatal hernia of the diaphragm was detected in 6 (10.5%) cases. In 44 (77.2%) cases, the natural anatomical position of the abdominal organs was documented. In 7 (12.3%) patients, with a fundoplication cuff formed in the chest, its initial position was ascertained.

Pharmacogenomics at the Point of Care: A Community Pharmacy Project in British Columbia

In this study 180 patients were consented and enrolled for pharmacogenomic testing based on current antidepressant/antipsychotic usage. Samples from patients were genotyped by PCR, MassArray, and targeted next generation sequencing. We also conducted a quantitative, frequency-based analysis of participants’ perceptions using simple surveys. Pharmacogenomic information, including medication changes and altered dosing recommendations were returned to the pharmacists and used to direct patient therapy. Overwhelmingly, patients perceived pharmacists/pharmacies as an appropriate healthcare provider to deliver pharmacogenomic services. In total, 81 medication changes in 33 unique patients, representing 22% of all genotyped participants were recorded. We performed a simple drug cost analysis and found that medication adjustments and dosing changes across the entire cohort added $24.15CAD per patient per year for those that required an adjustment. Comparing different platforms, we uncovered a small number, 1.7%, of genotype discrepancies. We conclude that: (1). Pharmacists are competent providers of pharmacogenomic services. (2). The potential reduction in adverse drug responses and optimization of drug selection and dosing comes at a minimal cost to the health care system. (3). Changes in drug therapy, based on PGx tests, result in inconsequential changes in annual drug therapy cost with small cost increases just as likely as costs savings. (4). Pharmacogenomic services offered by pharmacists are ready for wide commercial implementation.