Medical Care Management Research Articles

A qualitative study of the home-based time burdens faced by persons affected by GI cancer.

822 Background: As cancer care is increasingly delivered at home, more tasks and responsibilities fall on patients and informal care partners. This is especially relevant for people with GI cancer who often have specific home-based care needs such as feeding, ostomy care, 5-fluorouracil chemotherapy, and complex medication management. Home-based time costs are undercounted in current measures of time toxicity that only include care received in formal healthcare settings. Methods: We conducted semi-structured interviews with patients with GI cancer and their care partners at a single tertiary cancer center in MN, USA from March-Oct 2023. Interviews explored cancer care tasks at home, associated time burdens, and how they compare to in-facility care. We analyzed interview transcripts using a grounded theory approach to identify themes. Results: We included 33 individuals (11 aged >60y, 21 female, 25 white) including 15 patients (8 colorectal cancer, 8 ECOG 0) and 18 care partners (15 lived with the patient, 7 working at least part-time). We identified 5 themes (Table). Conclusions: This foundational work characterizes time burdens of home-based cancer care for persons affected by GI cancer. In addition to providing the first input on incorporating home-based time burdens into objective measures of time toxicity, we highlight the complexity of assessing time burden which is context and role-dependent. Theme Subtheme Quote Unexpected home-based care is time burdensome Challenge with home as a site of healthcare, difficult transition from hospital to home ‘’What they would do at the clinic behind the scenes she was doing on my kitchen table.” (Patient) Other burdens compound time burdens Logistic/administrative, emotional, symptom “The time spent on administrative things and coordinating [...] are more stressful than going to the clinic.” (Patient) Time burdens evolve over the disease course and differentially impact patients and care partners Cancer care constantly changes, discomfort with some tasks at home, less support provided if more competent, home-based care allows for connection “They’re in a season of remission and [...] we want to live as normal a life as we can. And then there are other seasons where it’s the absolute opposite.” (Care partner) Factors influencing the choice of home-based care Need to manage family duties, supportive care partners matter, value connection with nurses, decreased travel “There is a different cost when you start doing things at home, especially when you have small children because if they’re witnessing it, that’s emotional.” (Patient) Home-based care is generally perceived as less time-burdensome than similar cares provided in-facility Different opinions on whether home-based care should be included in time toxicity measure “If you’re just talking about video visits I wouldn't consider that time toxic. But if I’m going [to the clinic], I’ve pretty much lost the whole day.” (Patient)

Interprofessional approach to personalized medication management and therapy optimization in IBD care

A considerable number of patients with chronic inflammatory bowel diseases (IBD) are required to manage extensive polypharmaceutical regimes, which significantly elevates the risk of drug–drug interactions. Also, the disease’s impact often leads to the consumption of additional self-medication by the patients such as naturopathic remedies to alleviate disease-induced suffering and nutritional supplements to compensate for malabsorption syndromes inherent to the condition. There is a well-established consensus that polymedication coupled with unregulated supplementary intake can jeopardize the safety of drug therapy. Despite this, pharmaceutical co-supervision—proven to mitigate adverse drug events and enhance patient adherence to treatment—is generally lacking in routine clinical settings. Furthermore, the assessment of individual therapy adherence, a crucial predictive factor for therapeutic outcomes, is frequently suboptimal. In response to these issues, this study implemented an interdisciplinary approach wherein a team comprising medical and pharmaceutical professionals conducted a comprehensive survey coupled with a medication review for patients attending an IBD outpatient clinic. Employing an IBD-specific questionnaire alongside the patients’ documented medication regimens enabled the identification and subsequent discussion of current therapeutic concerns and potential medication-related risks during follow-up consultations. This intervention aimed to bolster individual patient satisfaction and enhance medication safety, ultimately fostering sustained success in IBD management.

Psychiatric Home Hospitalization: The Role of Mental Health Nurses—A Scoping Review

The lack of evidence synthesis studies on the role of psychiatric mental health nursing in the context of psychiatric home hospitalization underscores the limited research on nurses providing care in these teams, particularly concerning their experiences and responsibilities and the actual role of nurses in this context. This knowledge has the potential to improve the quality of mental healthcare by guiding nursing practices. Objective: To map the concepts related to the role of mental health nurses in psychiatric home hospitalization. Methods: A scoping review was conducted using the methodology proposed by the JBI, involving five methodological stages. No search limits were applied except for language. Results: The review identified five key dimensions of nursing in psychiatric home hospitalization: satisfaction; care models; the therapeutic relationship; the care environment; the organization of care. These interconnected dimensions influence quality care. Satisfaction among nurses, patients, and families is associated with improved outcomes and reduced stigma. The therapeutic relationship is characterized by a humanistic approach, emphasizing dialogue, empathy, and shared decision making. Additionally, the importance of care organization is highlighted, including individualized care plans, medication management, and intersectoral collaboration. Discussion: The five nursing dimensions align with the Quality Standards of the Portuguese Nursing Council and are consistent with the scientific literature. Conclusions: Although there is a shortage of studies on this topic, this review allows for the synthesis of nursing interventions and reflection on the paradigm shift in care within the scope of psychiatric mental health nursing interventions. Future studies highlighting the value of mental health nursing interventions, with a particular focus on nursing-sensitive indicators and employing quantitative or mixed methods, will be crucial to furthering the analysis conducted thus far.

Clinical update in critical care of pulmonary medicine 2024

This review outlines significant clinical research developments in the field of critical care respiratory medicine from October 2023 to September 2024. In the post-pandemic era, the new global definition of acute respiratory distress syndrome (ARDS) has improved practicality and early warning capabilities, although further refinement through respiratory mechanics and multi-omics approaches is required. Novel patterns of pulmonary microbiota distribution in ARDS patients have emerged, with microbiota-host immune interactions significantly influencing clinical outcomes. Limitations of conventional antiviral and broad-spectrum immunosuppressive therapies have prompted exploration of novel approaches in cell survival regulation and immune maintenance, while modulation of fibroblast phenotypic transformation holds promise for effective repair after severe lung injury. The development of risk prediction tools and machine learning models, which integrate multidimensional bioinformatics data, presents novel opportunities for stratified patient management in critical care and the implementation of intelligent ICU systems. Personalized respiratory support has progressed in the areas of optimal oxygenation targets, positive end-expiratory pressure titration, and extracorporeal membrane oxygenation. While breakthrough therapeutic agents remain elusive, innovations in traditional critical care medication management (vasopressors, sedatives, and proton pump inhibitors) have yielded significant benefits, demonstrating that the field continues to evolve towards more personalized approaches.

Effectiveness of Personalized Multifactorial Fall Risk Assessment and Intervention in Reducing Fall Rates Among Older Adults: A Retrospective Study

Objective: This study aimed to investigate the effectiveness of personalized multifactorial fall risk assessment and intervention in reducing the incidence of recurrent falls after one year. Materials and Methods: This retrospective study reviewed medical records from the Geriatric Rehabilitation Clinic at Siriraj Hospital, including data from patients with a history of falls (fallers) or gait instability (non-fallers) between April 2016 and April 2021. Upon entering the clinic, older patients received personalized multifactorial fall risk assessment and intervention. Functional mobility was also evaluated using the Timed Up and Go (TUG) test, Functional Reach, and 30-second Chair Stand test. Fallers were followed for one year, and classified into recurrent fallers or zero-fallers based on whether they experienced at least one fall during the follow-up period. Results: Of the 134 patients initially reviewed, 105 met the criteria for analysis. The cohort was predominantly female (65.5%) with an average age of 81.5 years (SD 6.8). Common risk factors included hypertension, back/leg pain, and cognitive impairment. After 12 months, 27.4% of fallers experienced recurrent falls. Sedative medication use was significantly associated with increased fall risk (OR 4.15[1.5,11.44]; P < 0.05). Other risk factors were not statistically significant. The fall rate reduced from 80% to 27.4% following personalized intervention. Conclusion: Personalized multifactorial fall risk assessment and intervention significantly decreased the fall rate among older patients. Sedative medications were notably linked to increased fall risk, highlighting the need for careful medication management and targeted fall prevention strategies.gies.

Integrated Care Implemented in the Children's Hospital From the Interwar Period as the Source of Good Practices for the Contemporary Concept of Coordinated Care Based on the WHO Model.

The article tests the hypothesis that we can draw practical knowledge from the experience of service providers operating in the past. The research questions were formulated: can the historical example of the organization of medical care in the Polish Children's Hospital named after Karol and Maria be used as a viable example today? Is it relevant for contemporary practitioners? And do we still use the knowledge of predecessors? The authors decided to use the interwar Hospital and an operating paediatric ward of the Child-Friendly Hospital for a comparative analysis. The model of the European Regional Office of the World Health Organization for integrated delivery of health services was adopted as the analysis framework. We based the analysis on descriptive methods, starting with a literature review of routine activities of the Karol and Maria Hospital (historical example) and a paediatric hospital in Poland (contemporary example), then we conducted a comparative transversal study concerning the extent to which integrated care occurs in the WHO model. Finally, the elements of the process evaluation were used in the work. The research model used enabled us to provide answers to the research questions formulated. The comparative study of a historical hospital and a contemporary one has shown that some problems and ways of solving them constantly reappear in the discussion on the management of evidence-based medical care. Sourcing good practices from the past can be a good research method for current practitioners. It seems that while the technical aspects of integrated care initiated in the past are developing perfectly, the approach to the evidence-based medicine is waiting to be developed again.

Applying Large Language Models to Assess Quality of Care: Monitoring ADHD Medication Side Effects.

To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD). Retrospective population-based cohort study of electronic health records. Cohort included children aged 6 to 11years with ADHD diagnosis and 2 or more ADHD medication encounters (stimulants or nonstimulants prescribed) between 2015 and 2022 in a community-based primary health care network (n = 1201). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n = 15 628 notes). Model performance was assessed using holdout and deployment test sets, compared with manual medical record review. The LLaMA model accurately classified notes that contained side effects inquiry (sensitivity = 87.2, specificity = 86.3, area under curve = 0.93 on holdout test set). Analyses revealed no model bias in relation to patient sex or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; characteristics were mostly similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower for telephone encounters than for in-clinic/telehealth encounters (51.9% vs 73.0%, P < .001). Side effects inquiry was documented in 61.4% of encounters after stimulant prescriptions and 48.5% of encounters after nonstimulant prescriptions (P = .041). Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality of care and uncovered opportunities to improve psychopharmacological medication management in primary care.

Evaluating diclofenac's risks in COVID-19: strategies for mitigating adverse outcomes.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac, during the COVID-19 pandemic has raised concerns due to its potential to worsen disease progression. This commentary evaluates key risks associated with diclofenac and highlights the critical role of pharmacists in mitigating adverse outcomes through careful medication management and patient education. Diclofenac poses unique risks due to its ability to generate reactive oxygen species (ROS), leading to oxidative stress and mitochondrial dysfunction. In COVID-19, a disease characterized by hyperinflammation, these effects may exacerbate systemic inflammation, contributing to severe outcomes. Moreover, diclofenac's known association with increased cardiovascular risks, such as myocardial infarction and stroke, is especially concerning in patients with COVID-19, who are predisposed to thrombotic complications. The drug's hepatotoxic potential adds another layer of concern, particularly in patients with pre-existing liver dysfunction or those at higher risk due to COVID-19-related liver involvement. Pharmacists play a pivotal role in addressing these risks by conducting thorough medication reviews and assessing patient-specific risk factors. They can guide clinicians and patients toward safer alternatives, such as ibuprofen or naproxen, which demonstrate a lower oxidative and cardiovascular burden. Patient education is equally critical; pharmacists should counsel individuals on potential adverse effects of diclofenac, such as cardiovascular symptoms, renal dysfunction, and liver complications, while advising on lifestyle modifications and adjunctive therapies to reduce NSAID dependence. Additionally, pharmacists contribute to pharmacovigilance by monitoring patients for adverse drug reactions and reporting safety concerns to improve NSAID usage guidelines during the pandemic. By adopting a personalized approach to NSAID therapy, pharmacists can minimize risks and enhance patient safety, ultimately improving outcomes in the management of COVID-19 and other inflammatory conditions. This underscores their indispensable role in optimizing care during complex clinical scenarios.

Study on the co-occurrence of multiple health service needs throughout the lifecourse of rural residents in China based on association rules.

To understand the multiple health service needs of rural residents in China and explore the co-occurrence patterns of these needs throughout the entire life course, providing a basis for the formulation and optimization of health service packaging policies. This study utilized a stratified random sampling method, resulting in a final sample size of 15,125 individuals. The R statistical software was employed to apply the Apriori algorithm to mine the co-occurrence relationships among multiple health service needs across the life course and to explore the packaging model of these services. The health service needs rate among rural residents in China is 86.76%, with a multiple health service needs rate of 78.72%. The most needed services are health exercise guidance (17.10%), Traditional Chinese Medicine health care (15.53%), and internet health information services (14.40%). The highest combined health service need is for "exercise guidance need + internet health information need + Traditional Chinese Medicine health care need," followed by "exercise guidance need + internet information need." There are significant differences in the content and strength of associations in the co-occurrence structure of multiple health service needs across different age groups. During the life preparation stage, the need for multiple health services is high, with modern medical care and child management having the highest support. In the life protection stage, the focus shifts to preventive health needs, with strong associations among co-occurring needs (the highest support rule being Traditional Chinese Medicine health care + exercise guidance, support = 21.12%). The co-occurrence of medical and preventive health service needs among the older adult is diverse, with the strongest association being between chronic disease management services and rehabilitation services (support = 31.24%). The multiple health service needs rate among rural residents in China is high, with the greatest needs being for exercise guidance, Traditional Chinese Medicine health care, and internet health information services. There are significant differences in health service needs across different life stages. It is essential to enhance the integration and packaging of health service resources to promote diversity in health services and meet the multiple health service needs of residents throughout their life courses.

Evidence for preventing EVRB in cirrhotic patients: A systematic review.

Systematic strategies for preventing and treating esophagogastric variceal rebleeding (EVRB) are currently inadequate. This systematic review aimed to update this critical gap by searching contemporary studies from major guideline websites, databases, and professional associations focused on EVRB prevention in cirrhosis patients. Key findings highlight evaluation methods, risk management, preventive measures, health education, and follow-up strategies. Notably, a hepatic venous pressure gradient exceeding 18 mmHg is identified as a reliable predictor of gastroesophageal varices (GOV) rebleeding. Effective management of primary diseases is crucial, with methods including antiviral and anti-fibrotic therapies, alcohol avoidance, vaccination, and careful medication management. The combination of nonselective β-blockers (NSBBs) and endoscopic variceal ligation (EVL) is established as the gold standard for secondary EVRB prevention. For patients experiencing recurrent bleeding despite NSBBs and EVL, transjugular intrahepatic portosystemic shunt (TIPS) therapy is recommended. Surgical options, such as surgical shunt and devascularization, are advised for those unsuitable for endoscopic therapy or TIPS, particularly in Child-Pugh A and B patients unresponsive to treatment. Additionally, traditional Chinese medicine options, such as Fufang Biejia Ruangan Tablets, Fuzheng Huayu Capsules, and Anluo Huaxian Pills, have shown promise in improving hepatic fibrosis and GOV in cirrhotic patients. This review offers a comprehensive overview of current prevention and treatment strategies for EVRB, providing valuable insights for clinicians and healthcare professionals.

Exploring Health Care Professionals' Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals.

With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. This study aims to explore health care professionals' perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated.

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

General practitioners’ views on inappropriate prescribing for older patients: a qualitative study through focus groups

BackgroundInappropriate prescribing (IP) is a common problem in the older population. Despite numerous attempts to tackle this issue, it remains a public health concern. In most European countries, general practitioners (GPs) are responsible for global primary care and are thus gatekeepers for the adequacy of medicines, specifically for older people. An in-depth analysis of the situation is necessary to understand why this phenomenon is still prevalent and to identify solutions that could help avoid IP in primary practice.MethodA qualitative study based on five focus groups (FG) comprising nine to thirteen general practitioners was conducted in the French-speaking part of Belgium. Participants were recruited among the Local Medical Evaluation Groups (LMEG) and selected to guarantee heterogeneity in working organisations, years of professional experience, gender and age. All interviews were recorded with prior agreement and transcribed in verbatims. The transcripts were coded and analysed to highlight the primary themes, considering dominant and marginal discourses.ResultsFifty four GPs participated in the study, with an average experience of 30 years. IPs are perceived as a significant problem in the older population, leading to dangerous health situations. The issue is associated with polypharmacy and multimorbidity, and GPs stated to manage IP using their clinical experience. Most of the study participants faced difficulties managing IP, mostly due to the specificity and complexity of elderly care. Indeed, managing an older patient is challenging due to medical complexity, poor adherence to drug regimes, or low medical literacy. In addition, the medical environment of general practice is challenging, with multiple providers, lack of time, prescribing routine and the absence of effective communication with specialists or other care providers. Additionally, the tools and support available to help medication management in primary care are inadequate. Enhancing collaboration with pharmacists is perceived as a strong potential facilitator.ConclusionThis article addresses the complex management of IP in the old age, from the point of view of GPs. Interesting clues were highlighted, like the need to clarify roles of healthcare providers, the better fit of tools to facilitate medication’s review with particularities of GPs needs and the empowerment of pharmacist collaboration.

The Potential of Artificial Intelligence in Unveiling Healthcare's Future.

This article examines the transformative potential of artificial intelligence (AI) in shaping the future of healthcare. It highlights AI's capacity to revolutionize various medical fields, including diagnostics, personalized treatment, drug discovery, telemedicine, and patient care management. Key areas explored include AI's roles in cancer screening, reproductive health, cardiology, outpatient care, laboratory diagnosis, language translation, neuroscience, robotic surgery, radiology, personal healthcare, patient engagement, AI-assisted rehabilitation with exoskeleton robots, and administrative efficiency. The article also addresses challenges to AI adoption, such as privacy concerns, ethical issues, cost barriers, and decision-making authority in patient care. By overcoming these challenges and building trust, AI is positioned to become a critical driver in advancing healthcare, improving outcomes, and meeting the future needs of patients and providers.

Cognitive impairment in CKD patients: a guidance document by the CONNECT network

Abstract Cognitive impairment (CI) is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the CONNECT network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis, and clinical management of CKD-related CI. CI is significantly more common in CKD patients compared to the general population, particularly those undergoing haemodialysis. The development of CI is influenced by a complex interplay of factors, including uremic neurotoxins, electrolytes and acid base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of CI, utilizing cognitive assessment tools, neuroimaging, and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments, and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing CI in CKD patients through early detection, careful medication management, and tailored therapeutic strategies to improve patient outcomes.

OPTimising MEDicine information handover after Discharge (OPTMED-D): protocol for development of a multifaceted intervention and stepped wedge cluster randomised controlled trial

BackgroundGeneral practitioners (GP) and community pharmacists need information about hospital discharge patients’ medicines to continue their management in the community. This necessitates effective communication, collaboration, and reliable information-sharing. However, such handover is inconsistent, and whilst digital systems are in place to transfer information at transitions of care, these systems are passive and clinicians are not prompted about patients’ transitions. There are also gaps in communication between community pharmacists and GPs. These issues impact patient safety, leading to hospital readmissions and increased healthcare costs.MethodsA three-phased, multi-method study design is planned to trial a multifaceted intervention to reduce 30-day hospital readmissions. Phase 1 is the co-design of the intervention with stakeholders and end-users; phase 2 is the development of the intervention; phase 3 is a stepped wedge cluster randomised controlled trial with 20 clusters (community pharmacies). Expected intervention components will be a hospital pharmacist navigator, primary care medication management review services, and a digital solution for information sharing. Phase 3 will recruit 10 patients per pharmacy cluster/month to achieve a sample size of 2200 patients powered to detect a 5% absolute reduction in unplanned readmissions from 10% in the control group to 5% in the intervention at 30 days. The randomisation and intervention will occur at the level of the patient’s nominated community pharmacy. Primary analysis will be a comparison of 30-day medication-related hospital readmissions between intervention and control clusters using a mixed effects Poisson regression model with a random effect for cluster (pharmacy) and a fixed effect for each step to account for secular trends.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12624000480583p, registered 19 April 2024.

Единые Государственные Информационные Системы Здравоохранения (ЕГИСЗ) в странах Востока.

The introduction of information technology (IT) in healthcare has led to a real revolution in the provision and management of medical care. However, they are developing with different intensity in different countries. The purpose of the study was to test criteria to determine the degree of IT development in healthcare, as well as to illustrate the assessment of IT development in different countries to compare them with each other. To achieve this goal, we have identified a set of criteria covering key aspects of the implementation and use of IT in medical practice. We have selected the countries of the East for this study. We searched information on the level of IT development in healthcare in the Eastern countries in Google open sources and PubMed databases manually, as well as using GPT-3.5 Turbo. According to the availability and development of criteria, the degree of IT development in healthcare was assessed and the categories «Highly», «Medium» and «Less» developed were assigned. As a result, within the study’s methodology framework, the UAE, Saudi Arabia, Qatar, Israel, Singapore, Indonesia, the Philippines, Laos, South Korea, Japan and China were classified as countries with highly developed IT in healthcare. Countries with medium-developed IT in healthcare included Jordan, Oman, Afghanistan, Iran, Iraq, Bahrain, Vietnam, Thailand, Myanmar, Cambodia, India and Bangladesh. Lebanon, Kuwait, East Timor and Brunei were among the countries with the least developed IT in healthcare.

Risk of antimuscarinic initiation with cholinesterase inhibitor use in Alzheimer's disease

The use of cholinesterase inhibitors (CHEIs) is commonly associated with urinary incontinence in patients with Alzheimer's disease (AD). This study evaluated the risk of antimuscarinic initiation drugs with the use of CHEIs in AD patients. The study used a nested case-control study design involving 2013-2015 Medicare data of AD patients 65 years and older without antimuscarinic use in 2013. Cases were defined as those who initiated antimuscarinic treatment in 2014-2015. Controls with no antimuscarinic use were selected through incidence density sampling and matched to cases on age using a variable-ratio method. The CHEI utilization pattern was classified as current (event-30 days), recent (event-31 to event-90 days), and past (event-91 to event-180 days). Conditional logistic regression was used to assess the association between CHEI use and the risk of antimuscarinic initiation. This study included 1,909 cases and 9,064 controls. The adjusted model found that overall CHEI (Adjusted Odds Ratio [aOR] = 1.90, 95 % Confidence Interval [CI]: 1.58-2.28) and current CHEI use (aOR = 1.62, 95 % CI: 1.18-2.21) were associated with an increase in the risk of antimuscarinic initiation compared to non-CHEI use. In addition, the current use of donepezil and rivastigmine significantly increased the risk of antimuscarinic initiation by 48 % (95 % CI: 1.03-2.12) and 171 % (95 % CI: 1.46-5.03), respectively. The study found an increased risk of antimuscarinic initiation with the current use of CHEIs, particularly with donepezil and rivastigmine. These findings underscore the need for careful medication management to minimize prescribing cascades and associated consequences in AD.

Drug-induced Acute Kidney Injury: A Clinico-etiological Study from a Tertiary Care Center in Northeast India

Abstract Background: Drug-induced acute kidney injury (AKI) poses a significant challenge in clinical practice, necessitating a comprehensive understanding of its epidemiology and underlying mechanisms. This prospective study aimed to elucidate the clinico-etiological profile of drug-induced AKI in a tertiary care center in Northeast India and evaluate patient outcomes. Methodology: Adults diagnosed with AKI following drug exposure were enrolled in this observational study conducted from August 2022 to January 2024 at Department of Nephrology, Gauhati Medical College and Hospital. Demographic data, clinical characteristics, offending pharmaceutical agents, histopathological patterns, and outcomes were meticulously documented. Results: We studied 105 participants (mean age: 45 ± 10 years, 56.2% male) experiencing drug-induced AKI. Antimicrobials (24%), nonsteroidal anti-inflammatory drugs (NSAIDs) (21%), and chemotherapeutic agents (19%) were common causes, leading predominantly to acute interstitial nephritis (58%) and renal tubular epithelial cell injury (30%). Despite challenges, 73% fully recovered, with a 2% mortality rate. Age (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.12–1.63, P = 0.002), male gender (OR: 1.84, 95% CI: 1.09–3.11, P = 0.022), diabetes (OR: 2.21, 95% CI: 1.28–3.82, P = 0.005), smoking (OR: 1.92, 95% CI: 1.06–3.48, P = 0.031), antimicrobial use (OR: 3.68, 95% CI: 2.14–6.32, P &lt; 0.001), NSAID use (OR: 2.77, 95% CI: 1.56–4.92, P &lt; 0.001), and chemotherapeutic use (OR: 1.57, 95% CI: 1.10–2.22, P &lt; 0.001) were significant risk factors. Conclusion: This study highlights the clinico-etiological profile of drug-induced AKI in Northeast India, emphasizing antimicrobials, NSAIDs, and chemotherapeutics as major contributors. Despite the high prevalence, most patients recovered, stressing early recognition and careful medication management. Age, gender, and comorbidities play critical roles, warranting targeted interventions and vigilant pharmacovigilance to mitigate the AKI burden effectively.

Legal analysis of the functioning, organisation and management of modern health resorts and medical spa care

On the surface, it would seem that the operation of a health resort commune does not differ from the majority of local authorities in Poland that do not have health resorts in their area and its activities can be subordinated to the market law of supply and demand. It would seem that it is the health resort gminas that are particularly privileged entities, endowed by nature with unique therapeutic raw materials, unique landscape, clean air and high forest cover, and being the proverbial apple of the sovereign's (the State's) eye, they have versatile development opportunities. A health resort municipality is a municipality whose area or part thereof has been granted the status of a health resort in accordance with the procedure set out in the Act on Health Resort Treatment, Health Resorts and Areas of Health Resort Protection and on Health Resort Municipalities of 28 July 2005. A health resort is an area where spa treatment is carried out, separated for the purpose of utilising and protecting the natural medicinal resources located in its area, which has been granted the status of a health resort. It follows from these definitions that a health resort is a limited area of the territory of a municipality, carrying out a specific activity such as spa treatment.