Health Care Guidelines Research Articles

Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above.

This scientific review paper explores international and country-specific healthcare guidelines for non-communicable diseases with the highest burden among individuals aged 75 years and above. The study aims to identify the best vaccination practices and standardize healthcare practices to improve vaccination adherence in this vulnerable population. Given that older people are more prone to infectious illnesses and have higher rates of morbidity and mortality, vaccinations are essential for disease prevention. Despite the proven efficacy of vaccinations, adherence has plateaued in recent years, partly due to a lack of accessibility, public education, and variability in disease-specific guidelines. This paper highlights the need for a more robust and standardized international vaccination model to improve quality of life and reduce disability-adjusted life years among the elderly. The findings of this study call for further research to review the guidelines as more implementations are put in place, including non-English guidelines.

Perceived Stress and Associated Factors Among Pregnant Women in Western Ethiopia: Community Based Cross-Sectional Study, 2021

Background: Ethiopian health care guidelines did not include antenatal perceived stress as a component of routine antenatal care, and this results in under-diagnosis of antenatal perceived stress during routine antenatal care follow-up. As a result, the purpose of this study to assess the prevalence of perceived stress and associated factors among pregnant women in the western Ethiopia. Methods: A community-based cross-sectional study was conducted among 451 pregnant women in West Shewa Zone, Oromia Region, Ethiopia. From September 20, 2021, to October 19, 2021, Pregnant women were recruited using cluster sampling techniques. Data was collected by using a standardized questionnaire that had been pre-tested. The data were entered into Epi data version 4.6 and then exported to SPSS version 26. Bivariate and multivariate logistic regression analyses were used to identify significantly associated factors. Result: The prevalence of perceived stress during pregnancy was 21.2% at 95% CI (20.1,23). Unplanned pregnancies (AOR: 5.43; CI 2.61-10.77), early ANC booking (AOR: 3.02 CI; 1.66-5.48) and obstetric complications during the current and previous pregnancies (AOR: 3.53CI; 1.9- 6.56) were significantly associated with perceived stress. Conclusion: The prevalence of perceived stress during pregnancy was higher, indicating a need to screen perceived stress and its predictors in routine antenatal care. Strengthening the counseling service and increasing access and availability of modern contraceptive methods may reduce the rates of unplanned pregnancies. This, in turn, plays a significant role in alleviating perceived stress in Ethiopia.

Assessing medical doctors' knowledge about medical ethics in health practices

Background: When it comes to protecting patients' rights and ensuring the quality of healthcare, medical ethics are of the utmost importance. Clinical specialists need a solid understanding of clinical morals to adhere to moral guidelines in the delivery of medical care. Objective: The study aims to determine, how well doctors in Lahore, Pakistan, are aware of medical ethics in health practices and their comprehension of healthcare ethical principles, guidelines, and decision-making processes knowledge and contribution. Methods: A cross-sectional review was conducted in Lahore with 350 health professionals from various medical services settings. The survey had unconditional and different decision inquiries to evaluate the comprehension specialists might interpret clinical morals using Medical Ethics Attitude Scale (MEAS). Results The findings of this analysis suggest that the opinions of medical professionals regarding how they adhere to medical ethics vary significantly. The professional respondents' mean score of 2.01 indicates a moderate level of agreement regarding medical ethics. To determine the significance of the differences in the assessment scores, an analysis of variance (ANOVA) was conducted. The ANOVA test resulted in an F-value of 69.87, indicating a highly significant association between the assessment scores and the variables related to knowledge of medical ethics practice.

(384) International Clinical Guidelines for Sexual Health Care in Prostate Cancer Survivorship

Abstract Introduction During the past 20 years, researchers have studied various aspects of the impact of prostate cancer therapies on patients, partners and couples. Patients and partners reported distress and negative consequences for their relationships resulting from treatment-related sexual side-effects of prostate cancer therapies. Research on rehabilitation strategies in prostate cancer survivorship has focused largely on biomedical interventions although psychosexual intervention research is also gaining ground. This research has never been summarized in such a way that clinicians can use the findings to provide evidence-based support for prostate cancer patients and their partners in survivorship. Objective An international panel of experts has developed a guideline that informs clinicians, patients and partners about the impact of prostate cancer therapies on the sexuality of patients and partners, and on their sexual relationships. It provides guidance for biopsychosocial rehabilitation strategies that help patients and partners recover sexual intimacy after prostate cancer therapy. Methods The guideline panel included international, multidisciplinary clinical experts and researchers in prostate cancer, a reference librarian and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995-2022). The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection is reported, based on PRISMA guidelines. Evidence for each statement was assigned a strength (A-C) and a level of recommendation (strong, moderate, conditional) which was based on benefit/risk balance. Data synthesis included meta-analyses of high-quality studies (determined by the Cochrane Risk of Bias tool). Results The guideline is contextualized within cultural, ethnic and racial diversity. The needs of individuals with diverse sexual orientations and gender identities are also recognized. Forty-seven statements were generated, guided by a theoretical model of sexual recovery after prostate cancer therapies and by principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. The statements focus on counseling about the impact of prostate cancer therapies on patients’ and partners’ sexuality and couples’ relationships as well as on biomedical and psychosocial treatment strategies for sexual dysfunction. The guideline statements address the assessment of sexual function and distress, and barriers to providing sexual health care in prostate cancer survivorship in globally varied health care systems. Conclusions The guideline documents the distressing sexual sequelae of prostate cancer therapies and makes evidence-based recommendations for sexual rehabilitation in prostate cancer survivorship. Areas for future research are also outlined. The guideline was supported and funded by the Movember Foundation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Author disclosures 1. Capogrosso 2. Northouse 3. Matthew 4. Elliott 5. Mulhall 6. Capellari 7. Incrocci 8. Faraday 9. Loeb 10. Mehta 11. Howell 12. McPhail J 13. McPhail S 14. Brandon 15. Paich 16. Erickson 17. Shifferd 18. Duby 19. Yap 20. Goltz 21. Odiyo 22. Salter 23. Nelson 24. McLeod 25. Trost 26. Wittmann – 10% salary paid by Movember 27. Bober – honorarium from UpToDate 28. Bennett - Endo Pharma - speaker 29. Coloplast - speaker, training grant. 30. Glode – Janssen, Aurora Oncology, Bayer, Exelixis, ProTechSure Scientific, Gonex, Patents, Seattle Genetics 31. Kirby – Lilly, Astra Zeneca, GSK, others 32. Wang – Boston Scientific, Teleflex, Coloplast 33. Pollack – Gilead 34. Burnett - Grant/research support: Endo Pharmaceutical, Boston Scientific, NIH Consultant/advisor: Boston Scientific, Coloplast, Reflexonic, Astellas, Novartis, Futura Medical, Comphya SA, Myriad Genetics Patent Holder: MHN Biotech Boards: UCF, AUA PAC, Mentoring Mae teens in the Hood Editor/editorial board: Urology Practice, Andrology, Canadian Journal of Urology, International Urology and Nephrology, Urology Times Other: UroMissionsWorks Inc (Non-profit) 35. Skolarus – UpToDate 36. Koontz - receives research funding from Janssen Scientific Affairs, Merck Pharmaceuticals, Blue Earth Diagnostics, and has received personal fees (ie advisory board) for Blue Earth Diagnostics.

A scoping review of institutional policies and recommendations for trans inpatient mental health care.

INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.

Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care.

Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using "best fit" framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.

Designing Healing Environments: A Literature Review on the Benefits of Healing Gardens for Children in Healthcare Facilities and the Urgent Need for Policy Implementation

Despite the well-known benefits of healing gardens for children in healthcare facilities, policies and guidelines for their implementation are lacking, leading to their undervaluation by policymakers. This literature review investigates the advantages of healing gardens for children’s health and wellbeing, with a focus on public-funded healthcare facilities. The review explores the definition of a healing garden, theories, the value of play, the impact on children’s development, and the environmental benefits of healing gardens. Additionally, the review presents successful examples of healing gardens in practice, while acknowledging potential arguments against them and associated risks. During the literature review, research gaps were identified, and areas for future research were also examined. Finally, this review calls for evidence-based guidelines for policymakers and designers to incorporate healing gardens into healthcare facilities, providing a comprehensive argument for their adoption and regular access for children.

An Audit of Electroencephalography Requests to a Tertiary Hospital Neurophysiology Department (P6-1.003)

<h3>Objective:</h3> To evaluate whether electroencephalography (EEG) requests to a tertiary hospital neurophysiology department are being made according to National Institute for Healthcare and Excellence (NICE) guidelines. <h3>Background:</h3> EEG is a valuable tool in the diagnosis of epilepsy, when used appropriately. To allow for effective utilization of this limited resource, it is imperative that referrals have a clear indication. The neurophysiology department in this tertiary hospital accepts referrals for current inpatients, and outpatients based locally and rurally. <h3>Design/Methods:</h3> We conducted a retrospective audit of 186 consecutive EEG referrals for 184 patients. All adult patients undergoing EEG between January 1 2022 and March 31 2022 were identified. Data was collected from the patient’s allied health order requisition or referral letter, EEG technical report, and EEG clinical report. Referral indications were compared to NICE guidelines for EEG. <h3>Results:</h3> Preliminary results show that 33% of requests did not meet the NICE guidelines for EEG requests, of which 44% had insufficient clinical evidence to justify the use of EEG. EEG contributed to the diagnosis or management of epilepsy in 21% of cases. Inappropriate requests were mainly based on a history of syncope, funny turns, and provoked seizures in the context of alcohol use. Referrals tended to be more appropriate when coming from specialist epilepsy and neurology teams. <h3>Conclusions:</h3> This audit demonstrates that one third of referrals for EEG services at this tertiary center occur outside the scope of NICE guidelines. This places an additional burden on the service and may contribute to delay in diagnosis, particularly for those awaiting outpatient publicly funded EEG. Additionally, this audit underscores the need for ongoing education across specialist teams to highlight and promote published guidelines in an attempt to improve efficiency of services. <b>Disclosure:</b> Ms. D’Souza has nothing to disclose. Dr. Klaus has nothing to disclose. Ms. Feeney has nothing to disclose. Yvonne Langan has nothing to disclose.

FLAVIA-LCT - Framework for systematic literature review to analyse vast InformAtion in life cycle thinking studies

With the increasing interest in Life Cycle Thinking (LCT) applications for assessing the sustainability of processes, products and services, up-to-date syntheses and evidence-based critical outcomes analysis are required to guide future studies and policymakers. The systematic literature review is probably the most suitable approach for highlighting evidence of effects, impacts, and methodological choices, mapping the current knowledge and gaps in LCT fields, including methods such as Life Cycle Assessment, Life Cycle Costing, Social Life Cycle Assessment and Life Cycle Sustainability Assessment. Although several statements and guidelines for health care and ecology disciplines and one checklist for systematic literature review limited to Life Cycle Assessment (STARR-LCA) exist, it is still missing a framework for conducting systematic literature reviews in LCT field. This paper proposes a “Framework for systematic Literature review to Analyse Vast InformAtion in Life Cycle Thinking studies” (FLAVIA-LCT) to assist and guide researchers in structuring the processes of gathering, synthesising, and reporting outcomes from search strategy development to critical evaluation, considering the essential information to be included in a review manuscript. This framework can be used by anyone planning a literature review on one or more LCT methods.

Scoping review of methods for engaging long-term care residents living with dementia in research and guideline development

ObjectivesTo describe: (1) methods used to engage long-term care (LTC) residents living with dementia in research and guideline development; (2) the outcomes of engagement; and (3) barriers and facilitators to...

69 Preliminary Results: Prevalence and Pathophysiologic Mechanisms of Amenorrhea Among Women Survivors of the 2014–2016 Ebola Outbreak in Sierra Leone

OBJECTIVES/GOALS: 1. Establish the prevalence of amenorrhea among women Ebola survivors of reproductive age. 2. Determine whether amenorrhea in Ebola survivors is associated with hyperthyroidism, primary ovarian failure, and/or low weight METHODS/STUDY POPULATION: This study will enroll a cohort of 150 women Ebola survivors and 150 uninfected controls from Kenema, Sierra Leone. Participants will complete women’s health questionnaires with detailed menstruation history and provide blood samples. Serum levels of thyroid stimulating hormone, follicle stimulating hormone, and albumin will be measured in order to explore the role of thyroid dysregulation, ovarian failure, and low weight in amenorrhea associated with prior Ebola infection. RESULTS/ANTICIPATED RESULTS: Enrollment for the study is still in progress. As of November 14, 2022, 68 female Ebola survivors of reproductive age and 124 uninfected controls have been enrolled. Among this preliminary group, there is a high baseline level of menstrual irregularities in both survivors and controls. Prior to the Ebola outbreak, 97% of all participants reported less than 6 periods per year and 59% reported periods lasting 3 days or less. The prevalence of missed periods increased after the Ebola outbreak in both groups. Four Ebola survivors (5.9%) reported missing periods before infection, compared to 16 (23.5%) survivors after infection. Two uninfected controls (1.6%) reported missing periods before the Ebola outbreak, compared to 12 (9.7%) after the outbreak. DISCUSSION/SIGNIFICANCE: The next steps of this project are to complete enrollment, conduct data analysis, and perform laboratory studies. An enhanced understanding of amenorrhea is needed to develop novel medical interventions, to inform healthcare guidelines and policies, and to develop personalized treatment strategies to better care for women who have survived Ebola.

A Multi-Institutional Informed Consent Proposal as a Prevention Tool for Combined Oral Contraceptive Intake and Thrombotic Risk.

The review of relevant literature and international guidelines on prescription of combined oral contraceptives made it possible to create a proposal for informed consent to be used for prescribing. The several sections of our consent proposal were designed according to a rationale in order to cover all the aspects presented by worldwide guidelines: how to take, adverse effects, advertisements, extra-contraceptive benefits and effects, a checklist for condition at risk of thromboembolism, the signature of the woman. An informed consent to standardize combined oral contraceptives prescription can improve women's eligibility, mitigate thromboembolic risk, and assure legal protection to healthcare providers. In this systematic review in particular, we refer to the Italian medical-legal scenario, to which our group of researchers belongs. However, the model proposed was designed in the respect of main healthcare organization guidelines, and it could be easily used by any center in the world.

Cognitive Functioning, Dependency, and Quality of Life Among Older Adults

ABSTRACT The determinants of QoL need serious deliberation in national as well as international healthcare guidelines as few studies have assessed the QoL of older individuals across cultures and countries. The current cross-sectional study aimed to examine the relationships between cognitive functioning and level of dependency with quality of life (QoL) and the moderating effects of gender and housing type on these relationships among older adults in Pakistan. A total of 274 respondents (own homes = 153; care homes = 121; Mage = 68.75 years, SD = 5.78 years) participated in this study. Cognitive functioning was assessed through Montreal Cognitive Assessment (MoCA), while level of dependency was assessed through Incapacity Status Scale (ISS). As for the measurement of QoL, World Health Organization Quality of Life (WHOQOL-BREF) instrument (Urdu version) was adopted. The results of Pearson product-moment correlation revealed the significant relationships of the constructs of interest. Cognitive functioning significantly predicted social QoL for males only but did not significantly predict the overall QoL and its four domains (i.e. physical, psychological, social relationship, and environmental health domains), regardless of housing type (i.e. own homes versus care homes). Meanwhile, the results of regression analysis demonstrated the significance of level of dependency in predicting the overall QoL and its four domains for both male and female respondents. As for those living in their own homes, the level of dependency significantly predicted their overall QoL, as well as physical and environmental QoL. For the older adults living in care homes, cognitive functioning predicted only the social QoL for males, but did not predict the overall QoL or its domains for older individuals in care homes or own homes. Based on these findings, this study demonstrated the significance of cognitive functioning, level of dependency, gender, and housing-type care homes as determinants of QoL among older adults. The study findings have implications for policymakers, practitioners, and public health specialists to cautiously create content that will enhance the older individuals’ QoL. Findings can contribute to designing interventions to motivate and preserve functional mobility in older individuals, and the generate community-based programs to enhance or uphold physical activity in the older individuals.

Inclusion of Environmental Spillovers in Applied Economic Evaluations of Healthcare Products

ObjectivesClimate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions. MethodsElectronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process. ResultsFrom the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO2) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process. ConclusionsThere is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.

Reproductive Health Counseling among Youth with Sickle Cell Disease

Study ObjectiveReproductive health counseling is important for youth with sickle cell disease (SCD) given that they experience potential infertility risks from SCD and its treatments and high rates of unplanned pregnancies. Thus, the objective of this study was to describe documented occurrences of reproductive health counseling among youth with SCD and examine differences in counseling by sociodemographic and treatment characteristics. MethodsData were abstracted from 167 electronic medical records of patients (age = 14-21, 54% female) with SCD (1/01/2015-12/31/19) at 2 sites (Nationwide Children's Hospital and Hassenfeld Children's Hospital at NYU Langone). Descriptive statistics, point-biserial correlations, and χ2 tests were used to examine sample characteristics and relationships between sociodemographic factors, clinical characteristics, site, and reproductive health counseling (fertility, contraception, and genetic counseling). ResultsSeven of 167 (4%) youth had documented discussions about the potential impacts of SCD on fertility. Fertility counseling was also low among those who received a bone marrow transplant or hydroxyurea (n = 1/2, 50%; and n = 1/104, 1%, respectively). Only 57% of youth received contraception counseling, and only 55% of sexually active youth used birth control; birth control use was associated with older age (P = .028), severe clinical disease (P = .003), and documentation of contraception counseling (P = .047). Most youth received genetic counseling (80%), although more genetic counseling occurred at Nationwide Children's Hospital (P < .001). There was no association between gender and any type of counseling. ConclusionFindings suggest reproductive health counseling gaps in this population, with important implications for future infertility distress and unplanned pregnancies. Future research should examine barriers to counseling, explore fertility impacts of SCD and treatments, and inform evidence-based guidelines for reproductive health care in SCD.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico.

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

A Sentiment Analysis on Roe v. Wade Twitter Data

In May of 2022, the US Supreme Court case Dobbs v. Jackson Women’s Health Organization threatened to and did overturn Roe v. Wade, the historic 1973 Supreme Court case that created prenatal healthcare guidelines, including specifications for regulation of abortion. This work aims to investigate tweets on Roe v. Wade during a period of interest through posts on Twitter to provide an understanding of general public opinion. This was done primarily by running sentiment analysis on a dataset of 35,999 tweets from May 1st, 2022 to July 8th, 2022 from the #RoeVWade, separating them into negative, positive, and neutral sentiments, then finding collocations and often used hashtags in each category. Although the sentiment analysis model used classified sentiment rather than “pro-choice” versus “pro-life,” negative and neutral tweets were more likely to use phrases associated with “pro-choice” beliefs. In contrast, positive tweets often used hashtags aligned with Republican or conservative views.

Antidepressant drugs-State of the art

Due to their frequency, complications, and sequelae, depressive disorders are of great significance to patients, their environment, and society. They are considered the most frequent form of mental disturbances in old age. The use of antidepressant drugs (AD) represents a cornerstone of the treatment, which is always multidimensional. The classification, mechanism of action, efficacy and tolerability of AD are described. Furthermore, the practical treatment procedure as well as special aspects, such as treatment resistance and special features in old age are presented. Narrative review incorporating the most recent literature and the new edition of the national healthcare guidelines on unipolar depression. In the past 20years, alarge number of so-called 2nd generation ADs have been approved worldwide with comparable efficacy but more favorable side effect profiles than conventional (tricyclic) substances. Almost all ADs act by enhancing monoaminergic, mostly serotonergic, neurotransmission. Other common features include alatency in the onset of action, moderate response rates, and potential efficacy on all core symptoms of depression. Side effects can include cardiovascular, metabolic, or sexual dysfunction, but these may significantly differ between drug classes. This enables individualized treatment taking age, individual risk factors, comorbidities and comedications into account. With the correct interpretation of indications, knowledge of the risks, and consideration of the defined precautionary measures outlined here, treatment with AD is asafe and effective tool in the treatment of moderate and severe depression.

Multidisciplinary Guidelines for the Rational Use of Topical Non-Steroidal Anti-Inflammatory Drugs for Musculoskeletal Pain (2022)

(1) Background: Topical non-steroidal anti-inflammatory drugs (NSAIDs) are one of the primary drugs for treating musculoskeletal pain. However, there are currently no evidence-based recommendations about drug selection, drug administration, drug interactions, and use in special populations or other pharmacology-related content of such medications. To this end, the Chinese Pharmaceutical Association Hospital Pharmacy Professional Committee developed multidisciplinary guidelines on using topical NSAIDs to treat musculoskeletal pain. (2) Methods: The guidelines development process followed the World Health Organization guideline development handbook, the GRADE methodology, and the statement of Reporting Items for Practice Guidelines in Healthcare. The guideline panel used the Delphi method to identify six clinical questions to be addressed in the guidelines. An independent systematic review team conducted a systematic search and integration of evidence. (3) Results: Based on the balance between the benefits and harms of an intervention, the quality of the evidence, patient preferences and values, and resource utilization, the guideline panel developed 11 recommendations and nine expert consensuses on using topical NSAIDs to treat acute and chronic musculoskeletal pain. (4) Conclusions: Based on the effectiveness and overall safety of topical NSAIDs, we recommend patients with musculoskeletal pain use topical NSAIDs and suggest high-risk patients use topical NSAIDs, such as those with other diseases or receiving other concurrent treatments. The evidenced-based guidelines on topical NSAIDs for musculoskeletal pain incorporated a pharmacist perspective. The guidelines have the potential to facilitate the rational use of topical NSAIDs. The guideline panel will monitor the relevant evidence and update the recommendations accordingly.

Socioeconomic Factors and Adherence to Health Care Recommendations in Adolescent and Young Adult Cancer Survivors.

Purpose: The majority of adolescent and young adult (AYA) cancer survivors do not receive recommended health care surveillance after therapy. We used cross-sectional survey data to evaluate the impact of income, education, marital status, and insurance on health care adherence among AYA survivors. Methods: Eligible survivors were 18-39 years at diagnosis with invasive malignancy, 1-5 years from therapy completion. Online surveys assessed sociodemographic factors and self-report of completion of recommended health care services. Diagnosis and treatment data were abstracted from medical records. Multivariable logistic regression calculated odds ratios (ORs) and 95% confidence intervals (CIs) for adherence in relation to socioeconomic status and support. Results: Of 344 participants, 36% were adherent to at least 80% of recommendations. Adherence varied by cancer type: 34% for breast cancer, 52% for leukemia/lymphoma, 23% for other tumors. Adherence rates were similar among White, Asian, and Hispanic/Latinx patients. Lower adherence was associated with lower education (OR: 0.43; 95% CI: 0.23-0.80 for <4-year college degree) and lower annual income (OR: 0.51; 95% CI: 0.28-0.95 for $41,000-$80,000; OR: 0.40; 95% CI: 0.19-0.86 for ≤$40,000). Adherence decreased with decreasing income levels among those who were 1 to less than 3 years after diagnosis (OR: 0.25; 95% CI: 0.07-0.93 for $81,000-$120,000; OR: 0.24; 95% CI: 0.07-0.84 for $41,000-$80,000; OR: 0.13; 95% CI: 0.03-0.60 for ≤$40,000). Conclusion: Risk of nonadherence to health care guidelines was associated with lower income and lower education among AYA cancer survivors. Identification of these risks and related barriers to adherence in AYA survivors will inform interventions designed to meet needs of these high-risk groups, particularly during the first years after diagnosis. Trial Registration: NCT02192333.