Dose Of Medication Research Articles

COVID-19 Pandemic Detrimentally Affects Craving and Quality of Life in Patients Under Medication-Assisted Treatment with Buprenorphine and Methadone: The Issue of Medication Dose

The COVID-19 pandemic crisis has increased the vulnerability and decreased the retention in treatment of patients receiving medication-assisted treatment (MAT). Therefore, the aim of the present study was to investigate the impact of COVID-19 on craving and quality of life (QoL) of MAT patients and to reveal the potential role of medication dose. Thus, 562 volunteers were divided into the control group (n = 100) comprising healthy volunteers without prior contact with substances of abuse, and into the experimental group (n = 462), which included patients receiving MAT, who were stratified into sub-groups of patients under methadone and buprenorphine. The groups were further divided into two sub-groups, based on whether the participants were infected by SARS-CoV-2 or not. The heroin craving questionnaire (HCQ), and the Nottingham health profile (NHP) instrument were used for craving assessment and QoL evaluation respectively. The MAT patients who were infected by SARS-CoV-2 had higher levels of craving compared to their non-infected counterparts, and COVID-19 restriction measures reduced QoL mainly of non-infected MAT patients. Furthermore, low craving and high QoL were largely associated with medium or low medication dose. It appears that focused interventions and modifications to medication doses could lead to better clinical outcomes of the MAT programs and relapse prevention.

Abstract 4137768: Evaluation of Therapeutic Intensification for Uncontrolled Hypertension Using Different Sources of Electronic Health Records

Background: Healthcare system level interventions to monitor therapeutic intensification for uncontrolled blood pressure (BP) may address potential therapeutic inertia, however, the best methods to evaluate therapeutic intensification using different sources of electronic health records are unknown. Question: To what extent do medication orders and pharmacy data provide comparable or distinct evaluations of therapeutic intensification? Methods: We identified adults with uncontrolled hypertension (systolic BP ≥140 or diastolic BP ≥90 mm Hg) in an outpatient encounter (index) from Kaiser Permanente Southern California in 2018. We included patients with new antihypertensive medication orders at the index encounter. We calculated therapeutic intensification score (TIS), a proportional measure of prescribed daily dose to maximum recommended daily dose of antihypertensive medications using two data sources: (1) medication orders including dose, directions for use, discontinuation order; (2) pharmacy fill data including strength, days’ supply, and quantity within 14 days after the index. Therapeutic intensification was determined by comparing the new dose at index and the previous dose [delta TIS (new dose – previous dose) >0]. Differences in TIS and the percentage of concordance using two methods were compared using descriptive statistics. Results: We included 75,935 patients with medication orders at the index encounter. Using medication order data, 84% increased the dose of antihypertensive medications with a median TIS (25 th , 75 th ) of 0.25 (0.13, 0.50). Among the total, 80% (n=61,485) filled their prescriptions. Among those who filled their prescriptions, 84% and 85% increased the dose using medication order and pharmacy data, respectively, with 95% concordance between the two methods. Mean (SD) differences in dose change was -0.06 (0.55) between the two methods ( p <0.001). Conclusion: A large portion of patients with uncontrolled BP failed to fill their new prescriptions, underscoring the value of utilizing medication order data to evaluate therapeutic intensification. For those who filled prescriptions, only minimal differences were observed between the evaluations using medication orders and pharmacy data.

Abstract 4135113: Referral to a Heart Failure Clinic Substantially Increases the Use of Angiotensin Receptor Neprilysin Inhibitor (ARNi) and Sodium-glucose cotransporter-2 Inhibitor (SGLT2i) in Heart Failure Patients.

Introduction: Addressing access to life-saving therapy is crucial in influencing health outcomes. The stark reality of limited access to pharmacological therapy for heart failure with reduced ejection fraction (HFrEF), particularly novel drugs such as angiotensin receptor neprilysin inhibitors (ARNi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) for patients with heart failure (HF), underscores the challenges we face. Hypothesis: We analyze the impact of referring patients diagnosed with HF to our HF clinic by evaluating access to the 4 pillars of HFrEF, emphasizing cost-prohibiting pharmacological therapy, and assessing the efficacy of these medications when applied. Methods: This study compared 314 patients who live in counties within and outside the Penn State Health System. The data collected included healthcare insurance coverage, HF etiology, comorbidities, onset, initial and within six months post titration of guideline-directed medical therapy (GDMT) echocardiogram, and medication dose. Results: Among patients referred to our HF clinic, 184 live in counties within, and 130 live outside the Penn State Health System. The average age was 64, 69.4% were male, and a significant number of patients had HFrEF (92.7%). The prevailing comorbidities between the 2 groups were hypertension, hyperlipidemia, and diabetes. Upon completion, there was a significant increase in ARNi (83.1%) and SGLT2i (65.3%) use in both groups. They both (within vs. outside) reached almost similar percentages of triple therapy (77.9% vs. 79.2%; p-value=0.78), except for quadruple therapy (36.4% vs. 44.6%; p-value=0.16) and maximum tolerated dose (83.3% vs. 75%; p-value=0.11). The overall mean ejection fraction (EF) in both groups demonstrated significant improvement from pre-EF (30.5%) to post-EF (45.9%). Conclusion: Despite their location, patients referred to the HF clinic experienced intensified use of cost-prohibiting medications such as ARNi and SGLT2i, compared to the current gap in GDMT use. After optimizing GDMT, both groups had markedly improved EF. These findings suggest that referral to a HF clinic is a promising strategy for addressing the use of life-saving therapy and potentially reducing adverse health outcomes.

Abstract 4137191: Association of Cost-Related Medication Non-Adherence with Food Insecurity in U.S. Adults with Atherosclerotic Cardiovascular Disease

Background: The association of cost-related medication non-adherence (CRN) with food insecurity (FI) is not well described in those with atherosclerotic cardiovascular disease (ASCVD). Research Questions: Is FI associated with CRN in those with ASCVD, and does enrollment in the Supplemental Nutrition Assistance Program (SNAP) modify this effect? Methods: Data from the National Health Interview Survey (NHIS) 2011-2018 cycles were analyzed. A total of 22,304 adults (weighted: 17.7 million) with ASCVD and available food security, medication adherence and linked mortality data from the National Death Index were included. FI was defined as 3 or more affirmative responses to the USDA food security survey. CRN was identified by an affirmative response to delayed prescription filling, took less medication, or skipped medication doses to save money in the past 12 months. Analyses accounted for the complex survey design to obtain nationally representative estimates. Survey-weighted logistic regression was used to determine predictors of CRN, and Cox regression was used for mortality analyses. Results: Among adults with ASCVD, 13.3% (95% CI 12.7-13.9%; 2.34 million) reported CRN, 15.0% (95% CI 14.3-15.7%; 2.65 million) reported FI, and 5.7% (95% CI 5.3-6.2%; 1.01 million) reported both concomitantly. Those reporting CRN were more likely to be younger, female, non-white, without health insurance, below the federal poverty limit, have lower educational attainment, more comorbidities, and report FI. FI and SNAP enrollment were significantly associated with CRN after multivariable adjustment (adjusted odds ratio [aOR] 4.35 [95% CI 3.74-5.05] and 1.28 [95% CI 1.06-1.55], respectively). A significant interaction was observed between FI and SNAP enrollment (Pint = 0.001), and FI was associated with lower odds of CRN among the SNAP-enrolled versus unenrolled (aOR 2.50 [95% CI 1.98-3.14] vs 5.74 [95% CI 4.82-6.85]) (Figure 1). CRN and food security were not significant predictors of all-cause or cardiovascular mortality in the fully adjusted models. Conclusion: Among adults with ASCVD, FI and SNAP enrollment independently predict CRN. Among adults with ASCVD and FI, more than one third reported CRN and those without SNAP had more than twice the odds of CRN. Greater SNAP enrollment may improve medication adherence in those with ASCVD and FI.

Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001

ABSTRACTBackgroundSpanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented.MethodsThe ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow‐up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate.ResultsThe planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers.ConclusionsThe implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.

Validity and Execution of Stress Ulcer Prophylaxis in Surgical Patients: A Single-Center, Retrospective Cohort Analysis in Islamabad, Pakistan

Introduction: Stress ulcer prophylaxis (SUP) is recommended in critically ill patients to prevent stress-related mucosal damage, however, there is inconsistent adherence to established standards and guidelines for those who receive SUP medications outside of this patient group. The present study aimed to evaluate the appropriateness of SUP medications for surgical patients at the tertiary care hospital in Islamabad, Pakistan. Methodology: A 1-year, retrospective cohort study was conducted, using a convenience sampling approach, involving patients undergoing surgical procedures at the Surgical Wards of a tertiary care hospital located in Islamabad. Data collection was performed using a pre-designed checklist, with main areas including demographic characteristics, data on their presenting complaint, SUP medications (dosage, route of administration and duration) and presence of stress ulcer risk factors.Results: n=418 patient records were assessed: the majority of the patients were female (62.6%; n=262), with a mean age was 53.6±11.7 years, treated at the General Surgery department (81.8%; n=342). All patients managed for SUP were prescribed PPIs; the most commonly used PPI was omeprazole, both orally (37.7%; n=158) and parenterally (39.7%; n=166). The majority of patients (72.2%; n=302) were prescribed SUP for an appropriate indication or an associated risk. 46.1% (n=193) received SUP as a discharge medication with no records showing a follow-up, and there was no clear evidence that suggested that SUP had been stopped. Conclusions: This study highlights the irrational prescribing of PPIs in non-critical patients and the improper continuing of PPI prescriptions after discharge in a real-world setting, indicating the need to address suggested protocols for rationalizing the use of SUP and limiting the use of PPIs for appropriate purposes.

Evaluation of barcode-assisted medication preparation technology for liquid medication doses

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to evaluate the outcomes associated with barcode-assisted medication preparation (BCMP) technology and practice workflows for oral syringe dose preparation in a health-system pharmacy department. Methods This evaluative study was conducted at a flagship quaternary academic medical center. An electronic medical record (EMR)–integrated BCMP workflow was implemented in the central pharmacy operational area to enhance the safety of oral syringe dose preparation. The primary endpoints assessed compliance with BCMP implementation and the rate at which potential preparation errors were identified. The secondary endpoints evaluated operational markers of dose preparation batching, information technology enhancement needs, and medication waste avoidance. Results A 95% rate of compliance with the BCMP workflow was observed over 2 years. The composite near-miss detection rate improved from year 1 to year 2 of implementation (0.89% vs 0.94%). The composite rate was influenced by increased yearly compliance with BCMP (93.8% vs 95.3%). A total of 176,679 preparations were reviewed in the 2-year period, including 81,240 in year 1 and 89,638 in year 2. The rate at which orders were rejected by pharmacists decreased over time (0.26% in year 1 vs 0.24% in year 2). Of the 1,005 wrong ingredient warnings, only 4 were overridden; in all other instances, the order was rejected at pharmacist checking due to use of an incorrect product in the preparation history. Wrong ingredient warnings led to canceled preparations in 96.1% of alert instances. Conclusion EMR-integrated BCMP technology aligned with safety efforts in the oral syringe dose preparation process reduced potential waste of medications and allowed insight into operational performance and volume indicators.

Using medications to prevent or reduce the impact of poor air quality on health: a systematic review

Abstract Introduction Particulate matter (PM) is a mixture of tiny solid materials and liquid particles in the air that can trigger inflammatory reactions in multiple body systems, including the respiratory, cardiovascular and endocrine systems. Currently, there are no licensed pharmacological interventions to prevent or modify the effects of PM on different organs. However, several existing medications have shown promising results towards modifying or preventing the negative impact of PM. Aim To conduct a systematic review to explore pharmacological interventions that could potentially prevent, delay or treat the effects of PM on human health. Methods This systematic review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and was registered with PROSPERO database (CRD42023476448). Four databases were searched including; MEDLINE, Embase, PsycINFO and Scopus. Keywords were arranged into different relevant sets such as ‘air pollution’, ‘medication’ and ‘prevention’/’treatment’. All the resulting titles, abstracts and full-texts were screened independently by two researchers. Only peer reviewed articles published in English were included. A tailored data extraction sheet was used to collate all relevant data, including the study description (i.e. country, year), study design (i.e. prospective), medication information (i.e. type of medication, dose, indication), population (i.e. demographics and disease), effect on air pollution (i.e. treatment or prevention). Quality assessment was conducted using Newcastle Ottawa tool. Ethical approval was not required to undertake this systematic review. Results The search produced 689 articles, 676 of which were removed at the title (n=463), and abstract (n=184) and full-text (n=29) stages. Thirteen articles were included, 10 of which were rated ‘good’ quality, two ‘fair’ quality, and one ‘poor’ quality. There was a range of pharmacological interventions evaluated, including beta blockers, oral anti-diabetic agents, statins, non-steroidal anti-inflammatory drugs (NSAIDs), systematic glucocorticoids, inhalers (adrenergic, glucocorticoid and anticholinergic inhalers) and theophylline. All studies focused only on PM, with six providing information on the particle diameter (e.g., PM10, PM2.5 and PM0.1). Statins, NSAIDs and bronchodilators demonstrated the most significant impact on reducing the damage caused by PM on both the cardiovascular and respiratory systems through anti-inflammatory, vascular re-modelling, and broncho-dilating effect. These medications had already been prescribed in these study patients for other indications (e.g., diabetes or asthma). None of the included studies used a medication for the prevention or treatment of air pollution effects as an indication. Conclusion Some medications significantly prevented/treated the effects of poor air quality; however, this was inconsistent across studies. However, all studies were conducted in high to middle-high income countries; findings may have been different in low-income countries. More research is required on the effective medication dose, duration of administration, if being prescribed solely for air pollution protection, and benefits and risks for more vulnerable populations (i.e. multimorbid).

Quality of medical care for patients with arterial hypertension and type 2 diabetes mellitus in outpatient medical organizations

BACKGROUND: The course of arterial hypertension and diabetes mellitus depends on the medical care quality since its poor provision increases the risk of unfavorable outcomes. Identifying and analysing defects in the management of such patients is an urgent task. AIM: To assess the medical care quality provided to patients with hypertension and type 2 diabetes mellitus on an outpatient medical organizations. MATERIALS AND METHODS: The assessment of the medical care for patients with hypertension and type 2 diabetes mellitus in outpatient medical organizations in St. Petersburg and the Leningrad region was carried out by analyzing primary medical records for 175 cases. RESULTS: The quality of medical care is recognized as appropriate only in 25% of the cases. The errors in collecting information were the most common (95% of the cases of poor quality medical care): in cases of hypertension and type 2 diabetes mellitus no information about the course of the disease, previous treatment, risk factors, anthropometry, ophthalmoscopy or referral to an ophthalmologist; neurological examination and assessing cognitive functions - in the patients with hypertension; foot examination – in the patients with diabetes. The most common defects of the examination included the absence of lipidogram, uric measurement and electrolyte levels in hypertension, determination of albuminuria in diabetes mellitus, electrocardiography and echocardiography. Diagnosis errors were detected in 7–15% of the cases, treatment defects — in 33–53%. The information collection error is the most common defect in case of the patients with hypertension and type 2 diabetes mellitus, which is comparable with the previously published data. Treatment errors mainly consisted in the absence of lifestyle modification recommendations necessary for the treatment of hypertension and type 2 diabetes mellitus since these measures reduce the risk of complications and improve the prognosis.The revealed defects in medication therapy were comparable to the previous data and consisted in the appointment of insufficient doses of medications and in the use of monotherapy in the presence of indications for combination therapy. CONCLUSIONS: The assessment of the medical care revealed an insufficiently high level of outpatient medical care for the patients with hypertension and type 2 diabetes mellitus, which requires a detailed analysis of the causes for future prevention.

Change in striatal functional connectivity networks across 2 years due to stimulant exposure in childhood ADHD: results from the ABCD sample.

Widely prescribed for Attention-Deficit/Hyperactivity Disorder (ADHD), stimulants (e.g., methylphenidate) have been studied for their chronic effects on the brain in prospective designs controlling dosage and adherence. While controlled approaches are essential, they do not approximate real-world stimulant exposure contexts where medication interruptions, dosage non-compliance, and polypharmacy are common. Brain changes in real-world conditions are largely unexplored. To fill this gap, we capitalized on the observational design of the Adolescent Brain Cognitive Development (ABCD) study to examine effects of stimulants on large-scale bilateral cortical networks' resting-state functional connectivity (rs-FC) with 6 striatal regions (left and right caudate, putamen, and nucleus accumbens) across two years in children with ADHD. Bayesian hierarchical regressions revealed associations between stimulant exposure and change in rs-FC of multiple striatal-cortical networks, affiliated with executive and visuo-motor control, which were not driven by general psychotropic medication. Of these connections, three were selective to stimulants versus stimulant naive: reduced rs-FC between caudate and frontoparietal network, and between putamen and frontoparietal and visual networks. Comparison with typically developing children in the ABCD sample revealed stronger rs-FC reduction in stimulant-exposed children for putamen and frontoparietal and visual networks, suggesting a normalizing effect of stimulants. 14% of stimulant-exposed children demonstrated reliable reduction in ADHD symptoms, and were distinguished by stronger rs-FC reduction between right putamen and visual network. Thus, stimulant exposure for a two-year period under real-world conditions modulated striatal-cortical functional networks broadly, had a normalizing effect on a subset of networks, and was associated with potential therapeutic effects involving visual attentional control.

A RELEVÂNCIA DOS FARMACÊUTICOS NO AVANÇO E NOS DESAFIOS DO DESENVOLVIMENTO DE ANTIDEPRESSIVOS: EFICÁCIA, SEGURANÇA E ADESÃO AO TRATAMENTO.

Introduction: This article explores the crucial role of pharmacists in advancing and managing the challenges related to antidepressant development, focusing specifically on efficacy, safety, and treatment adherence. The collected data highlight how pharmacists contribute to the efficacy of antidepressants through appropriate medication selection, dose adjustment, and continuous patient monitoring. Additionally, it discusses the merit of pharmacists in ensuring patient safety, inferring the identification and management of side effects, as well as strategies to achieve better treatment adherence, which is often compromised by adverse effects and the complexity of therapeutic regimens. Methodology: Studies from 2020 to 2024 were included, employing a combination of quantitative and qualitative approaches, with data gathered from bibliographic references within the platforms: PubMed, Scielo, Lilacs, and DeCS from BVS, which provided a cohesive basis for the creation of this work. Results: The research revealed that pharmacists play a fundamental role in optimizing antidepressant efficacy and reducing associated safety risks, as well as in implementing strategies to improve treatment adherence, such as patient education and personalized support. Conclusion: Despite advancements in antidepressant development, challenges related to efficacy, safety, and adherence remain significant. Pharmacists are essential in overcoming these challenges and ensuring more effective and safe treatment for patients. Continued research is necessary to explore new management strategies and support the ongoing advancement of antidepressant pharmacotherapy.

Efficacy of XEN gel stent implantation combined with mitomycin C injection in the treatment of open-angle glaucoma: a meta-analysis

ObjectiveTo assess the efficacy of XEN gel stent implantation combined with mitomycin C (MMC) injection in controlling intraocular pressure (IOP) and the dosage of postoperative medication for open-angle glaucoma (OAG) patients.MethodsThe PubMed, Embase, Cochrane Library, and Science Direct databases were searched from inception to August 2022 without any language restriction. All studies that compared IOP and the dose of medication before and after XEN gel stent implantation and MMC injection for OAG patients were included. Data extraction and methodological quality evaluation were performed.ResultsA total of 26 studies (2329 eyes) were involved in meta-analysis. It was revealed that IOP at 1 month after XEN implantation was significantly lower than preoperative IOP [group 1, IOP between 19.2 and 21.2 mmHg: mean difference (MD) = 7.60, 95% confidence interval (CI) [6.55, 8.66], I2 = 0%, P < 0.01; group 2, IOP between 21.6 and 22.8 mmHg: MD = 5.83, 95% CI [4.94, 6.71], I2 = 0%; group 3, IOP between 23.5 and 24.3 mmHg: MD = 9.22, 95% CI [8.33, 10.10], I2 = 0%; group 4, IOP between 24.4 and 26.2 mmHg: MD = 11.64, 95% CI [10.49, 12.80], I2 = 0%)]. Moreover, IOP at 3 months after XEN implantation was also significantly lower than preoperative IOP (MD = 8.31, 95% CI [2.54, 8.46], Z = 13.92, P < 0.00001). IOP at 6 months after XEN implantation was significantly lower than preoperative IOP, and no heterogeneity was found between two groups (group 1, IOP between 17.8 and 21.8 mmHg: MD = 5.71, 95% CI: [5.05, 6.36], I2 = 0%, P < 0.01); group 2, IOP between 22.1 and 23.9 mmHg: MD = 7.92, 95% CI [7.15, 8.70], I2 = 0%, P < 0.01). Low heterogeneity was noted in one group (group 3, IOP between 24.3 and 26.2 mmHg: MD = 9.32, 95% CI [8.66, 9.97], I2 = 30%). It was found that IOP at 12 months after XEN implantation was significantly lower than preoperative IOP (MD = 8.11, 95% CI [7.09, 9.12], Z = 15.68, P < 0.00001). There was high heterogeneity among the different baseline IOP groups at 24-month post-surgery (CHi2 = 41.74, df = 1, I2 = 97.6%, P < 0.01), while no heterogeneity was identified in two groups (group 1, IOP between 19.2 and 22.1 mmHg: MD = 6.30, 95% CI [5.76, 6.85], I2 = 0%, P < 0.01); group 2, IOP between 22.8 and 23.8 mmHg: MD = 9.11, 95% CI [8.45, 9.77], I2 = 0%). Subgroup analysis indicated that the dosage of medication was significantly reduced at 6 months after XEN implantation (group 1, the amount of medication was 2.3–2.96: MD = 1.90, 95% CI [1.78, 2.02], I2 = 0%, P < 0.01); group 2, the amount of medication was 3.2–3.3: MD = 2.59, 95% CI [2.43, 2.75], I2 = 0%). Furthermore, the dosage of medication at 12 months (MD = 1.96, 95% CI [1.72, 2.21], Z = 15.80, P < 0.01) and 24 months (group 1, the amount of medication was 1.89–2.7: MD = 6.30, 95% CI [5.76, 6.85], I2 = 0%, P < 0.01); group 2, the amount of medication was 2.72–3.07: MD = 9.11, 95% CI [8.45, 9.77], I2 = 0%) after XEN implantation was significantly lower compared with the preoperative level.ConclusionXEN implantation combined with MMC injection significantly decreased IOP in OAG patients at 1, 6, 9, 12, and 24 months after treatment. In addition, XEN implantation combined with MMC injection decreased the amount of medication used at 6, 12, and 24 months after treatment in OAG patients.

Peroxisome proliferator-activated receptor agonists as an adjuvant for cancer therapy: A review

Cancer is now one of the leading diseases responsible for the highest mortality rates worldwide. Cancer treatment is extremely intricate and is often associated with less targeted effects and more side effects. In the last few years, two significant revolutions in cancer treatment have altered treatment paradigms: immuno-oncology and the pursuit of actionable changes in oncogene-driven cancers. Significant obstacles continue to exist in both areas of cancer treatment. Next-generation sequencing technologies for molecular prescreening in clinical research are advancing, but their widespread clinical use is hindered by challenges related to the clinical interpretation of large genomic data. Moreover, cancer mono-chemotherapy is associated with issues such as inadequate efficacy, drug resistance, and systemic toxicity. It is not possible to administer cytotoxic drugs limitlessly. Combination therapy was developed in response to this circumstance, with the expectation of achieving high therapeutic efficacy at lower dosages of medication. Peroxisome proliferator-activated receptors (PPARs) are a group of essential lipid sensors and metabolic pathway regulators. In addition, they possess the ability to modulate immunity, inflammation, and endothelial nitric oxide synthase activation. Alongside their well-established functions, new insights into the roles of PPAR agonists in cancer research are emerging. After reviewing current research, it is evident that PPAR modulators have significant potential for managing cancer. This review aims to consolidate the functions of PPAR ligands alongside other cancer therapies. We provide a comprehensive perspective on the applicability of PPAR ligands in cancer treatment as an adjuvant.

Long-Term Pattern of Psychotropic Medication Uses Among Swedish Parents of Children Diagnosed With Cancer

Background: Parents experience a range of mental health disorders following their child’s cancer diagnosis. It is thus essential to explore how the child’s cancer diagnosis affects the dosage of psychotropic medication in both short- and long-term use, as well as potential disparities in utilization patterns between mothers and fathers. Patients and Methods: Using Swedish registers, we identified all parents whose children were diagnosed with cancer from July 2009 to December 2015 in Sweden. We randomly matched up to 5 parents of cancer-free children conditional on their baseline characteristics. All parents were followed up from 4 years before to 4 years after their child’s diagnosis. Psychotropic medication cumulative defined daily doses (DDDs) were retrieved from the Swedish Prescribed Drug Register. Using interrupted time series analyses, we sought to investigate how childhood cancer diagnosis influences the evolving pattern of parental psychotropic medication dosage across time with consideration for potential differences compared with matched parents before the child’s cancer diagnosis. We calculated the attributable proportion due to the diagnosis of childhood cancer. Results: Following a child’s cancer diagnosis, mothers experienced a steady increase in psychotropic medication use, averaging 4.9 DDDs per year compared with matched comparisons, with a 46.0% adjusted attributable proportion in the initial year. Fathers had an abrupt increase in psychotropic medication use in the first year after diagnosis, with an adjusted attributable proportion of 72.1%. Parents with lower education attainment tended to use more psychotropic medication. Conclusions: In response to a child’s cancer diagnosis, parents showed increased use of psychotropic medication compared with matched comparisons. Additionally, utilization patterns differed between mothers and fathers. Timely prevention and early support for parents are needed to alleviate their psychological challenges, potentially mitigating the strain on medical resources associated with increased psychotropic medication use.

Understanding the Biology and Testing Techniques for Pharmacogenomics in Oncology: A Practical Guide for the Clinician

Pharmacogenomic (PGx) testing is a growing area of personalized medicine with demonstrated clinical utility in improving patient outcomes in oncology. PGx testing of pharmacogenes affecting drug pharmacokinetics, pharmacodynamics, and response can help inform drug selection and dosing of several anticancer therapies and supportive care medications. Several PGx testing techniques exist including polymerase chain reaction (PCR), MassARRAY, microarray, and sequencing. This review article provides a clinician-friendly guide of these techniques. Understanding the advantages, limitations, ideal use, and potential clinical applications of each platform can help clinicians choose the appropriate PGx testing platform for specific use cases.

Nutritional support for cancer patients during chemoradiation treatment

An analysis of publications in the medical databases e-Library, PubMed, and Medline (2005–2024) was conducted to evaluate the impact of nutritional support on the tolerability of antitumor chemoradiotherapy. Based on the data collected, it was revealed that chemoradiotherapy is linked to a high risk of developing protein-energy malnutrition. Consequently, the initial nutritional deficiency and sarcopenia result in either a refusal to administer chemotherapy in favor of radiation treatment alone, a forced reduction in the dose of a cytostatic medication, or the disruption of the chemoradiotherapy course. Patients with malignancies of the head and neck who have received chemoradiotherapy with previous induction chemotherapy are in the “red zone” for the risk of developing protein-energy malnutrition. Nutritional support is one of the instruments that enhances the likelihood of treatment implementation and mitigates the risk of drug and radiation toxicity. The fundamental principles of nutritional support during chemoradiotherapy include timely prescription, adequacy, composition of a specialized mixture, and the choice of the most physiological way of its implementation. Supplementing nutritional support with feasible strength physical exercise triggers protein synthesis in skeletal muscles, increases muscular sensitivity to the anabolic properties of amino acids, and mitigates insulin resistance.

Enhancing IVF Outcomes with Artificial Intelligence: Current Advances and Future Possibilities

The integration of Artificial Intelligence (AI) into In Vitro Fertilization (IVF) practices has marked a revolutionary shift in reproductive medicine, offering enhanced precision, efficiency, and personalized treatment plans. The rapid advancement of Artificial Intelligence (AI) has led to significant innovations in the field of reproductive medicine, particularly in In Vitro Fertilization (IVF). Traditional IVF procedures, while effective, often face challenges such as variable success rates, high costs, and the emotional burden on patients due to multiple treatment cycles. AI offers a promising solution to these issues by enhancing accuracy, personalization, and efficiency throughout the IVF process. AI algorithms have shown remarkable capabilities in diagnosing infertility by analyzing complex datasets from hormone profiles, genetic testing, and medical imaging, enabling early identification of conditions like polycystic ovary syndrome (PCOS) and endometriosis. Moreover, one of the most promising applications of AI in IVF is embryo grading. However, AI systems have been developed to objectively evaluate embryos based on time-lapse imaging, morphology, and other parameters, improving the selection process. Additionally, AI has been instrumental in optimizing ovarian stimulation protocols by analyzing patient data to determine the appropriate medication dosage, minimizing the risk of ovarian hyperstimulation syndrome (OHSS). This review discusses the current state of AI integration in fertility treatments, successful case studies, and ongoing research to develop more sophisticated AI models. Overall, AI holds immense promise in making IVF more accessible, affordable, and successful for patients worldwide, ushering in a new era of precision medicine in reproductive health.

A Delphi consensus project to capture experts' opinion on hyperkalaemia management across the cardiorenal spectrum.

The main purpose of this project was to capture experts' opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece. A steering committee of nephrologists and cardiologists developed 37 statements. An online questionnaire completed by 32 experts in cardiorenal management in Greece. Median score used to determine the level of agreement and disagreement index (DI) used to determine the level of consensus for each statement. Statements divided in four sectors: hyperkalaemia risk management, preventative measures, treatment and collaboration between specialties. The rate of the first round of the consensus was 94.6%. Median score was >7 for 36 of 37 statements and DI≤1 for 35 of 37. Among other statements, consensus reached for recognizing levels K+>5.0mEq/L as associated with elevated mortality risk; retaining renin-angiotensin-aldosterone system inhibitors (RAASi) on maximum recommended dose for cardiorenal patients; and using novel K+ binders to help enabling guideline-recommended doses of RAASi therapy. Cardiologists compared to nephrologists showed higher reluctance to discontinue down-titrate RAASi and MRA in patients with K+ levels above 5mEq/L. Additionally, 88.9% of nephrologists and 71.4% of cardiologists agreed that cross-specialty alignment on a serum K+ concentration level (K>5.5mEq/L) is needed to initiate hyperkalaemia treatment. Both cardiologists and nephrologists showed disagreement with the statement on keeping titration in cardiorenal patients with K+>5.5mEq/L or preserving fruit and vegetable consumption when moderate or severe hyperkalaemia exhibits. This Delphi project pointed out nephrologists' and cardiologists' agreement on hyperkalaemia management in cardiorenal patients; thus, it can help a cross-specialty optimal management of cardiorenal patients, with hyperkalaemia not being an obstacle for disease-optimizing therapy. Novel potassium binding agents can enable guideline-recommended doses of potassium-sparing medication.

Evaluation of renal function: choosing the right equation

The article presents examples of the difference in estimated GFR (eGFR) results obtained using different CKD-EPI creatinine equations (2009) and (2021). In these examples, the results were not reclassified to a higher level of renal function, but the eGFR obtained remained within the same CKD stage despite the different equations. However, it should be borne in mind that a significant reclassification to higher eGFR categories may have undesirable consequences, such as changes in the composition of the CKD population and for initiation of renoprotection measures, dosing and discontinuation of certain medications, timely referral to a nephrologist and RRT planning.The article presents validated eGFR estimating equations according to the KDIGO 2024 Guidelines for the Evaluation and Management of CKD (CKD-EPI creatinine equation (2009), CKD-EPI creatinine equation (2021), CKD-EPI creatinine-cystatin C equation (2021), EKFC equation et al.), as well as eGFR calculators available on the National Kidney Foundation (NKF) website.

Survey on the distribution of medical imaging frequencies and dose levels for CT examinations in a comprehensive hospital in Shanghai.

With the continuous advancement and clinical application of CT technology, the increasing collective dose burden from CT scans and associated potential health risks have become significant concerns in radiation protection. Current research increasingly focuses on the cumulative effective dose (CED) resulting from multiple CT scans, often revealing patients with high CEDs, even exceeding 100 mSv. However, reports on CEDs from multiple CT scans in China are scarce. Therefore, we investigated the distribution of CT scan frequencies and CEDs at a comprehensive hospital in Shanghai, examining data from October 1, 2022, to April 30, 2024, sourced from the hospital's radiology information system. The effective dose (E) was estimated using conversion factors k and DLP values from Radiation Dose Structured Reports (RDSR). We assessed the number of CT examinations conducted per patient and evaluated the CED over 1.6 years. During this period, 112,339 CT examinations were performed. Significant differences in CT examination frequencies were observed across different age groups and examination regions (P < 0.01). A total of 78.43% of patients underwent only one CT examination in 1.6 years, while 0.03% had more than 10 examinations, with a maximum of 15. Of the patients, 67.78% (76,142 individuals) received a CED less than 10 mSv, 0.05% (53 patients) received a CED over 50 mSv, and one patient exceeded 100 mSv. In conclusion, this study underscored the necessity of monitoring patients with high CT examination frequencies and CEDs, highlighting the importance of justification and optimization in medical radiation protection.