Medication Counseling Research Articles

Assessing Public Awareness, Utilization and Satisfaction with Community Pharmacy Services.

The Saudi Community pharmacy sector has been changing towards patient-centred care rather than depending solely on dispensing medications. Accordingly, pharmacies can now provide many services that they previously could not offer. The aims of this study were to identify all pharmacy services provided in a community setting and to assess public awareness and utilization of and satisfaction with these services. This was a cross-sectional study in which the authors first purposively visited community pharmacies to identify the services offered. Pharmacists were asked about pharmacy services currently provided to community. Fieldnotes were used to document pharmacists' responses. After identifying pharmacy services, a questionnaire was desgined and reviewed by experts in the field, piloted and approved by the Ethics Committee at King Faisal University, then disseminated via Google Forms. The satisfaction level with pharmacy services was assessed using a five-point Likert scale. Data were collected from 24 January 2023 to 2 March 2023. Eighteen community pharmacies offering 17 different services were visited across Alahsa Governorate. The number of participants who completed the questionnaire was 350. Of those (232 [66.3%]) were female, and the majority of the sample (80.5%) were younger than 40 years old. The majority of the participants were unaware of pharmacy services. Out of 17 services, six received a score of 50% or higher regarding participant awareness. The most utilized services were the medication dispensing service "Wasfaty" (250 [71.4%]), medication counselling provided by pharmacists (232 [66.3%]) and minor ailment service (231 [66%]). The overall satisfaction score for pharmacy services was 87.2%. The majority of the participants were unaware of the full range of available pharmacy services. There is a potential for community pharmacists to fill the capacity gap in the healthcare system since, overall, the participants rated the pharmacies' clinical services as satisfactory. Commissioners of pharmacy services may consider extending the scope of community pharmacies to include services that best utilize the expertise of clinical pharmacists.

약사의 복약지도에 관한 형사법적 고찰

약사의 복약지도에 관한 형사법적 고찰

Enhancing parental understanding of congenital heart disease through personalized prenatal counseling with 3D printed hearts.

In addition to a correct prenatal diagnosis of congenital heart disease (CHD), comprehensive parental counseling is crucial to ensure that parents are well-informed about the condition of the fetus. This study aims to investigate whether there is a significant difference in the information acquired by parents through traditional counseling, utilizing 2-dimensional (2D) illustrations and images, compared to an advanced approach utilizing personalized three-dimensional (3D) printed models of the fetal heart developed from 3D ultrasound imaging. This study, designed as a pilot randomized control trial, enrolled pregnant women with gestational ages greater than 18weeks, whose fetuses were diagnosed with CHD and referred to our center between November, 2020 and June, 2021. Two groups of patients were included in the study. The first group received standard medical counseling with 2D images and illustrations, while the second group underwent advanced counseling with 3D-printed patient-specific heart models. Both groups were then required to complete the same survey in which the knowledge of the CHD was investigated. The 3D models were created from 3D ultrasound imaging and printed using resin materials in both 1:1 and 5:1 scale. A comparison of the scores obtained from the two groups revealed that 3D visualization of the fetus's heart has the potential to increase parental knowledge about CHD and the required surgical procedures. Furthermore, all couples expressed interest in receiving a 1:1 scale model of their baby's heart. Personalized prenatal counseling with 3D-ultrasound-based heart models positively impacts parents' understanding of CHD. The use of 3D models provides a more comprehensive and accessible representation of the condition, contributing to an increased knowledge gain, and potentially helping to support informed decisions regarding their child's care.

Смыслы ценности достоинства человеческой жизни и геноевгенизация

Background: Among the areas of modern scientific and technological development, one of the leading places is occu-pied by new technologies of medical genetics: genetic editing of the human embryo genome (embryoengineering), medical genetic counseling, prenatal, neonatal, preconception diagnosis of hereditary diseases, technologies for the selection and selection of embryos, therapeutic and reproductive cloning human, etc. The question arises: how do genetic technologies and the development of genomic medicine affect changes in public and individual consciousness, and, above all, on the meaning of the meaning of the value and dignity of human life? Aim: To consider the main results of the development of genomic medicine technologies, such as the increase in the detection of genetic diseases, the increasing need for eugenic abortions and the use of embryos in research, and the introduction of genetic testing. Materials and methods: The historical and logical research method, as well as the historical and philosophical approach, allow the author to identify not only the ethical novelty of the geneticization of healthcare, but also a new form of social embodiment of the ideas of naturalistic-pragmatic ethics. Results: The value-worldview understanding of the consequences of the development of genomic medicine technologies leads to the need to introduce the concept of «genoeugenization» as a characteristic of the moral meaning of processes occurring in society un-der the influence of new medical genetic practices.Conclusion: The author substantiates the importance of the humanitarian-educational, legal and moral-philosophical level of knowledge for solving the problems of preserving the traditional moral value of the dignity of human life.

Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial.

The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent's problematic behaviors, including internet addiction. This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents' hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9.

Qualitative study of the lived experience of methylphenidate prescribed for children with a fetal alcohol spectrum disorder.

Fetal Alcohol Spectrum Disorders (FASD) refer to physical, cognitive, and behavioural symptoms in an individual whose mother consumed alcohol during pregnancy. It is the leading cause of non-genetic avoidable mental disability, with an estimated worldwide prevalence of 1%. Attention Deficit Hyperactivity Disorder (ADHD) diagnostic criteria are met for 50-80% of patients with FASD. Methylphenidate (MPH) is the first-line pharmacological treatment for ADHD. This study aims to explore the lived experience of children with FASD taking MPH and their caregivers to adapt prescribing modalities by considering different ways to administer the drugs. We hope to improve the therapeutic alliance between the children and their caregivers by gaining an insiders' view of the medication perception. Semi-structured interviews with children and their caregivers were conducted in this qualitative study. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data were analysed using interpretative phenomenological analysis. We conducted 16 semi-structured interviews: 8 with the children aged 7-12, 5 boys and 3 girls and 8 with their caregivers. The analysis showed that inadequate palatability and capsule form experiences were the leading causes of children's non-adherence to the treatment. MPH appeared to be a valuable aid for caregivers even if they had concerns about its potential toxicity. However, it is necessary to identify caregivers' expectations concerning MPH to adapt the prescription in terms of choice of specialty and intake modalities. Regular support was required to reduce caregivers' fears of dependence, personality transformation and long-term adverse effects. Information on palatability should be given when prescribing MPH to children with ADHD as well as its possible side effects or toxicity. It highlights the need for further studies of the experience of palatability of drugs prescribed to children. When prescribing a treatment, children should be more involved in medical counselling and it is necessary to understand the child's perspectives to co-construct common representations for better therapeutical adherence.

Genome-wide sequencing in children with epilepsy and developmental disorders

The progress of genetic diagnostic methods and a significant improvement in the quality of next-generation sequencing (NGS) have led to a revolution in the study of the genetics of epilepsy. Genome-wide sequencing (PSG) is the «gold standard» in genetic research in epilepsy.Material and methods. Genome-wide sequencing was performed in 168 probands aged from 1 month to 18 years with a suspected diagnosis of genetic epilepsy. PSG was prescribed to patients who, alongside with epilepsy, had delayed intellectual/speech development and/or motor disorders and behavioral disorders.Results. According to the results of PSG, genetic variants related to the phenotype of the disease were detected in 137 out of 168 (81.5%) children, variations in the number of DNA copies were noted in 14 out of 168 (8.3%) patients. Variants with unclear clinical significance were described in 35 of 137 (25.54%). In the remaining 102 out of 137 (74.45%) patients, the identified causative genetic variants were described as probably pathogenic and pathogenic. Monogenic developmental and epileptic encephalopathies (DEE) were detected in 37/137 or 27% of all patients, while the spectrum of these genetic encephalopathies was extremely wide (from DEE type 1 to DEE type 97). In 52/137 (37.9%) children, the presence of a specific genetic syndrome outside the framework of the DEE, classified in OMIM, was confirmed.Conclusion. The results confirm the high informative value of genome-wide sequencing in a group of children with a combination of epilepsy, intellectual, speech, motor and behavioral disorders. In most cases, the results allow either to prescribe a genotype-oriented symptomatic (less often pathogenetic) treatment, or rationally justify the tactics of further observation and examination, as well as to increase the effectiveness of medical and genetic counseling. The authors express their sincere gratitude to the Charity foundation for medical and social genetic aid projects «Life Genome” for assistance in conducting genome-wide sequencing of most of the described patients.

Initiative to deprescribe high-risk drugs for older adults presenting to the emergency department after falls.

Over 35 million falls occur in older adults annually and are associated with increased emergency department (ED) revisits and 1-year mortality. Despite associations between medications and falls, the prevalence of fall risk-increasing drugs remains high. Our objective was to implement an ED-based medication reconciliation for patients presenting after falls and determine whether an intervention targeting high-risk medications was related to decreased future falls. This was an observational prospective cohort study at a single site in the United States. Adults 65 years and older presenting to the ED after falls had a pharmacist review their medicines. Pharmacists made recommendations to taper, stop, or discuss medications with the primary clinician. At 3, 6, and 12 months, we recorded the number of fall-related return ED visits and determined if recommended medication changes had been implemented. We compared the rate of return visits of patients who had followed the medication change recommendations and those who received recommendations but had no change in their medications using chi-square tests. A total of 577 patients (mean age 81 years, 63.6% female) were enrolled of 1509 potentially eligible patients. High-risk medications were identified in 310 patients (53.7%) who received medication recommendations. High-risk medications were associated with repeat fall-related visits at 12 months (risk difference 8.1% [95% confidence interval 0.97-15.0]). A total of 134 (43%) patients on high-risk medications had evidence of medication modification. At 12 months, there was no statistically significant difference in return fall visits between patients who had modifications to medications compared with those who had not implemented changes (p = 0.551). Our findings identified opportunities for medication optimization in over half of emergency visits for falls and demonstrated that medication counseling in the ED is feasible. However, evaluation of the effect on future falls was limited.

Care of The Older Fighter: Position Statement of the Association of Ringside Physicians

ABSTRACT Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes’ risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.

Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital.

Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

Does small talk with a medical provider affect ChatGPT's medical counsel? Performance of ChatGPT on USMLE with and without distractions.

Efforts are being made to improve the time effectiveness of healthcare providers. Artificial intelligence tools can help transcript and summarize physician-patient encounters and produce medical notes and medical recommendations. However, in addition to medical information, discussion between healthcare and patients includes small talk and other information irrelevant to medical concerns. As Large Language Models (LLMs) are predictive models building their response based on the words in the prompts, there is a risk that small talk and irrelevant information may alter the response and the suggestion given. Therefore, this study aims to investigate the impact of medical data mixed with small talk on the accuracy of medical advice provided by ChatGPT. USMLE step 3 questions were used as a model for relevant medical data. We use both multiple-choice and open-ended questions. First, we gathered small talk sentences from human participants using the Mechanical Turk platform. Second, both sets of USLME questions were arranged in a pattern where each sentence from the original questions was followed by a small talk sentence. ChatGPT 3.5 and 4 were asked to answer both sets of questions with and without the small talk sentences. Finally, a board-certified physician analyzed the answers by ChatGPT and compared them to the formal correct answer. The analysis results demonstrate that the ability of ChatGPT-3.5 to answer correctly was impaired when small talk was added to medical data (66.8% vs. 56.6%; p = 0.025). Specifically, for multiple-choice questions (72.1% vs. 68.9%; p = 0.67) and for the open questions (61.5% vs. 44.3%; p = 0.01), respectively. In contrast, small talk phrases did not impair ChatGPT-4 ability in both types of questions (83.6% and 66.2%, respectively). According to these results, ChatGPT-4 seems more accurate than the earlier 3.5 version, and it appears that small talk does not impair its capability to provide medical recommendations. Our results are an important first step in understanding the potential and limitations of utilizing ChatGPT and other LLMs for physician-patient interactions, which include casual conversations.

Improving health and well-being through over-the-counter counselling – an observation study

Abstract Introduction The use of over-the-counter (OTC) medication in self-care gives patients empowerment in their healthcare. However, if the patients do not know enough about the medication, it may lead to misuse.[1] Pharmacies are easily accessible, low threshold first-line health providers, where these products are sold. Considering the United Nations Sustainable Development Goals (SDGs),[2] pharmacy personnel are in an excellent position to educate the public on correct self-care, increasing good health and well-being (3rd goal). By ensuring that the customer buys the correct product and does not self-treat unnecessarily, pharmacies may contribute to responsible consumption (12th goal).[2] Aim Assessing the impact of OTC medication counselling in the 3rd and 12th SDG context: which aspects help promote good health and well-being, and how can counselling influence responsible consumption of OTC medication? Methods Observations with detailed notes of encounters on OTC medications were performed by two observers, for validity, in 7 pharmacies in and around a Nordic capital city. Pharmacies were recruited through convenient sampling, aiming to include pharmacies of different sizes and locations. The study population consisted of 253 observations. Results were analysed using thematic analysis focusing on evidence-based advice concerning the 3rd and 12th SDGs. Results The theme “customer autonomy” shows that most customers come to the pharmacy with a known product in mind. Employees rarely address the appropriateness of the customers’ chosen product, and only correct the customer if they clearly found the wrong one. Responsible consumption is not addressed. Considering good health and well-being, the theme “Presumed Knowledge” contains how employees most often ensure that the customer has previous experience, taking this as proof of the customer´s health literacy. When the employee informs about the product, they rarely give explanations for the advice, as described in the theme “Coaching opportunity”. Conclusion Pharmacy employees rarely take advantage of the opportunity to educate the public on proper OTC medication use, and thus do not contribute sufficiently to increase knowledge of good health. There is a lot of potential for pharmacies to utilise evidence-based advice in everyday practice, and ways of promoting good health knowledge in pharmacy practice need to be explored. Pharmacy employees do not contribute substantially to reducing consumption, as they most often sell the product the customer asks for without considering the necessity. Tailored OTC counselling could shape consumer behavior towards responsible OTC medication use, ultimately contributing to improved health outcomes, reduced waste, and a more sustainable healthcare landscape. A strength of using the observation method is that it is possible to examine how pharmacy personnel work in everyday situations. One limitation might be that since both the customer and employee were informed that observers were present, the employee might be inclined to improve their performance. However, the observers could clearly see the instances where the employee changed their conduct, and in most instances, the extra effort did not improve the information exchange.

Improving medication dispensing and counselling for patients with vision impairment: a qualitative study of pharmacist-reported barriers and facilitators

BackgroundPeople with vision impairment encounter many difficulties when it comes to medicines use. However, evidence indicates that there are major gaps in pharmaceutical care service provision worldwide and limited research on interventions to optimise medication use for this patient population. The Theoretical Domains Framework (TDF) provides a method for theoretically understanding individuals’ behaviour and informing development of interventions. The aim of this research was to (a) identify the barriers and facilitators to the provision of medication dispensing and counselling services by pharmacists to patients with vision impairment, and (b) identify key TDF domains to be targeted in a future intervention.MethodsSemi-structured interviews were conducted with pharmacists from different pharmacy practice settings/areas in Saudi Arabia. The 14-domain TDF was utilised as the theoretical lens through which pharmacists’ behaviours were examined. Interviews were conducted in Arabic or English, either face-to-face or over the telephone based on the participant’s preference. Following transcription, interviews conducted in Arabic were translated into English before analysis. Data analysis involved using the framework method and content analysis to identify important barriers and facilitators to the provision of dispensing and counselling services to those with vision impairment. Key TDF domains that could be targeted in a future intervention were then identified using a consensus-based approach.ResultsTwenty-six pharmacists were interviewed. Pharmacists’ experience in pharmacy practice ranged from two to 28 years. A range of barriers and facilitators were highlighted as important in providing services to those with vision impairment. Eight domains were identified as ‘key domains’ including: ‘Knowledge’, ‘Skills’, ‘Beliefs about capabilities’, ‘Goals’, ‘Memory, attention, and decision processes’, ‘Environmental context and resources’, ‘Social influences’, and ‘Behavioural regulation’.ConclusionsBarriers and facilitators identified by pharmacists will inform the development of an intervention to ensure its applicability to everyday practice. Future research will focus on the process of developing the proposed intervention through targeting key TDF domains to improve medication dispensing and counselling by pharmacists to patients with vision impairment.

Applications of SGLT2 inhibitors beyond glycaemic control.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were initially developed for their glucose-lowering effects and have shown a modest glycaemic benefit in people with type 2 diabetes mellitus (T2DM). In the past decade, a series of large, robust clinical trials of these therapies have demonstrated striking beneficial effects for various care goals, transforming the chronic disease therapeutic landscape. Cardiovascular safety studies in people with T2DM demonstrated that SGLT2 inhibitors reduce cardiovascular death and hospitalization for heart failure. Subsequent trials in participants with heart failure with reduced or preserved left ventricular ejection fraction demonstrated that SGLT2 inhibitors have beneficial effects on heart failure outcomes. In dedicated kidney outcome studies, SGLT2 inhibitors reduced the incidence of kidney failure among participants with or without diabetes. Post hoc analyses have suggested a range of other benefits of these drugs in conditions as diverse as metabolic dysfunction-associated steatotic liver disease, kidney stone prevention and anaemia. SGLT2 inhibitors have a generally favourable adverse effect profile, although patient selection and medication counselling remain important. Concerted efforts are needed to better integrate these agents into routine care and support long-term medication adherence to close the gap between clinical trial outcomes and those achieved in the real world.

P004 Empowering the reproductive choices of patients with rheumatic disease: using the BSR 2022 pregnancy guidelines audit tool to evaluate pre-conception medication advice

Abstract Background/Aims For ideal pregnancy outcomes, patients with inflammatory rheumatic disease require targeted disease control with pregnancy compatible medications. A proactive approach is required given that people often won’t disclose plans for a pregnancy with healthcare professionals unless directly asked, and 45% of UK pregnancies are unplanned. The BSR 2022 guidelines on prescribing drugs in pregnancy and breastfeeding makes various recommendations on pre-pregnancy counselling for people with rheumatic disease with referral to specialists with relevant expertise as appropriate. Therefore, we used the linked BSR audit tool to evaluate documentation of pre-pregnancy counselling in rheumatology clinics lacking obstetric input at our hospital. Methods Inclusion criteria were all females, aged 15-45 years, attending a doctor-led Rheumatology clinic without obstetric input between 24/4/23 - 30/4/23 at University College London Hospital. Exclusion criteria were infertility and those seen as one-off clinic appointments and not commenced on medications. Clinic notes from all Rheumatology reviews over the preceding one year were assessed using the audit tool in the 2022 BSR pregnancy guidelines. People currently pregnant were audited for the year prior to the date of conception of their pregnancy. Results Among 50 clinics reviewed, 42 female subjects were eligible across 19 clinics, 64% of whom were aged 36-45 years and 36% were aged 21-35 years. Six subjects were pregnant. Diagnoses included: 24% systemic lupus erythematosus; 19.5% rheumatoid arthritis; 17% seronegative axial spondyloarthropathy; and the remaining 39% consisted of fibromyalgia, hypermobility, and other inflammatory arthritidies. 70% of people were screened for antibodies that could adversely impact pregnancy (i.e. anti-Ro or anti-phospholipid). Only 26% of subjects had documentation of being asked if they wished to conceive. In subjects who did not express a wish to conceive, only 21% were asked if they were using contraception. A total of 17% of the 42 subjects were referred to a specialist Obstetric-Rheumatology clinic for pre-pregnancy counselling during the study period. Of 35 subjects taking medications, only 22.8% had documentation of appropriate pre-pregnancy drug counselling within the last year. Of patients without documented pre-pregnancy advice, 46% were taking medications considered unsafe in pregnancy. Furthermore, no patients were signposted to sources of further information on drug therapy and/or rheumatic disease in pregnancy. Conclusion This audit highlights a lack of regular documented discussions around family planning and medication counselling in female subjects of childbearing age attending rheumatology clinics lacking obstetric input. Regular discussions are important for those who do and don’t wish to conceive, to appropriately counsel regarding pre-pregnancy measures or contraception. This audit using the BSR audit tool will be used as the baseline for a quality improvement project to support colleagues in providing regular, accurate reproductive health advice, supported by trusted online resources and referral to a specialist obstetric-rheumatology service as required. Disclosure A. Shirazi: None. B. Goulden: Grants/research support; Undertaking a PhD supported by Versus Arthritis (ref. 22975). I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma.

Якість життя: бюджетний баласт чи державотворча необхідність

The aim of the study is to determine the risks, challenges and threats caused by the genetic liability, environmental conditions and living environment, to establish the importance of their impact on the quality of life in Ukraine, to develop a methodological approach to their assessment and to develop a set of measures within the context of the spatial regeneration of the national socio-economic system under conditions of the military aggression of the Russian Federation and in the postwar period. The research is based on information from open sources, expert opinions, data of the State Statistics Service of Ukraine and the data base of the World Health Organization, on results presented in medical, demographic and economic monographic studies and the materials included in sample surveys. Systemic approach and analysis methods, sociological, genetic population, statistical, comparative analysis, generalizations and expert evaluations were utilized. It has been recognized that factors such as genetic burden and environmental conditions and the environment of life have increased the impact on the quality of life of the population of Ukraine, the effect of which has determined the requirements for societal, demographic, organizational-economic, medical-social and socio-political response to threatening events. Awareness of demographic determinism, general laws and modern economic trends in the formation of the quality of life in the country in the conditions of military aggression of the Russian Federation allowed: a) to form a complex of medical and genetic, social, public and state mechanisms and measures to ensure it; b) specify the negative factors of the spatial evolution of the socio-economic system, which determined the need to take into account the medical and genetic reserves and opportunities and develop measures to eliminate the destructive influence of environmental conditions and living environment in the course of solving the demographic and socio-economic problems of the state; c) propose a medical-genetic concept of quality of life and living environment, the implementation of which will enable the generation of a healthy heritage (physical and psychological), will allow to form potential and build up reserves for improving the quality of life. Taking into account resource limitations and the presence of threats and risks in the internal environment, medical genetic counseling and testing, the creation of satisfactory environmental conditions along with a living environment become necessary levers in the recovery of Ukraine. The constitution and importance of the impact of quality of life factors for Ukraine have been updated: heredity (32.0 %); environmental conditions and living environment (32.0 %); nature of the life and lifestyle of the individual (26.0 %); quality of medical care and socio-economic factors (10.0 %). Systemic conditions for the regeneration of the demographic and economic situation, improvement of the quality of life and well-being to proceed with the development of a healthy society have been formulated. A model for assessing the quality of life has been developed, enhancing the methodological approach in assessing the economic equivalent of the value of living, which also involves calculatiing the economic profit of the state from the preserved working capacity of a person as a result of successful treatment / prevention of a genetic anomaly. This becomes the basis for: substantiating the economic effectiveness of medical and genetic care and other treatment and preventive measures for patients with genetic pathologies; rationalization of pension payments; development of a new social policy. The practical significance of the results becomes the basis to improve: the national model of medical and genetic monitoring; a set of preventative measures within the population; analysis of aggressive environmental conditions and living environment; cost of living estimates; systems for managing loss risk factors.

Healthcare professionals' experiences with the use of antipsychotics in dementia

BackgroundAntipsychotics are commonly administered to nursing home residents with dementia, despite the associated risk of severe adverse events. ObjectiveThis study aimed to explore healthcare professionals' experiences in caring for nursing home residents with dementia, with a focus on rationales behind the use of antipsychotics. MethodTwelve semi-structured interviews with healthcare professionals' from Danish nursing homes were conducted and analyzed using the method Systematic Text Condensation. ResultsNonpharmacological interventions were reported as the primary approach to care and the first-choice treatment for behavioral and psychological symptoms of dementia (BPSD). Use of antipsychotics was considered to serve as a last resort, reserved for residents with severe symptoms. However, most informants preferred a more limited use. The study identified four main barriers to reduce the use of antipsychotics: “Scarcity of resources”, “Perceiving antipsychotic use to provide relieve”, “Reluctance towards deprescribing” and “Limited access to medical counseling”, and three potential enablers: “Updating knowledge and nonpharmacological competencies”, “Management support and clear procedures” and “Regularity in interdisciplinary collaboration”. ConclusionThe treatment and care were reported as primarily following guidelines in BPSD. Several barriers were perceived to challenge the healthcare professionals' preference of limited use of antipsychotics. To further reduce the use, this study highlights the importance of understanding the adverse effects caused by limited resources, enhancing employee knowledge and competencies and ensuring regular interprofessional collaboration for assessing and reassessing the need to use antipsychotics.

Clinical and genetic characteristics of multicentric carpotarsal osteolysis syndrome

BACKGROUND: Multicentric carpotarsal osteolysis (MCTO) syndrome is a rare autosomal dominant disease of skeletal dysplasias caused by heterozygous missense variants in MAFB. Clinical manifestations of the disease are characterized by pain, swelling, and hand and foot deformities as a result of progressive osteolysis of the carpal and tarsal bones. Kidney insufficiency also developed in some patients.
 CLINICAL CASES: Three Russian patients aged 2–39 years with MCTO syndrome caused by pathogenic variants c.176CT, c.184AG, c.203CT in MAFB are presented. All cases were sporadic. Two of our patients with MCTO were typically observed for several years with a diagnosis of juvenile idiopathic arthritis. All patients underwent phenotypic analysis using standard methods, radiography of the upper and lower extremities, ultrasonography of the kidneys, blood and urine tests to assess renal function, and molecular tests to clarify the diagnosis. Molecular genetic analysis included direct automatic Sanger sequencing of MAFB (NM_005461.5).
 DISCUSSION: The clinical manifestations of the disease in the patients included deformities and shortening of the hands and feet and typical signs of osteolysis of the metacarpal and metatarsal bones on radiographs. One of the examined patients had proteinuria in early childhood. Considering the rarity of MCTO syndrome, a description of the clinical and radiological characteristics of newly identified cases of the disease will help optimize its diagnosis and multidisciplinary observation of patients and improve the quality of medical and genetic counseling for affected families.
 CONCLUSIONS: The first clinical manifestations of MCTO syndrome are characterized by significant similarities with those of juvenile arthritis. For their differential diagnosis, a thorough radiographic analysis of the hands and feet for osteolysis is necessary. Early diagnosis of MCTO syndrome is essential because in recent years intensive research aimed at developing therapy for diseases caused by dysfunction of the RANK/RANKL signaling pathway, in which the protein product of MAFB functions.

The role of Lesotho community pharmacists in preventing and controlling cardiovascular diseases: The perceived facilitators and barriers.

Cardiovascular diseases are a leading cause of mortality globally. The impact of cardiovascular diseases can be minimized by addressing modifiable risk factors at primary health care level. Community pharmacists are well-positioned to identify patients at risk of cardiovascular diseases for early detection and initiation of treatment. However, the role of Lesotho community pharmacists in preventing and controlling cardiovascular diseases is not well understood. The purpose of this study was to explore the Lesotho community pharmacists' role in preventing and controlling cardiovascular diseases. The methodological reporting of this study was guided by the consolidated criteria for reporting qualitative studies. A list of registered community pharmacists was obtained from the Ministry of Health. Pharmacists were selected based on their close proximity to the researcher and invited to participate. Semi-structured interviews were conducted until data saturation was reached. The interviews were audio-recorded, transcribed verbatim, and analysed thematically. Five themes were identified namely: 1) Current roles 2) Future role 3) Facilitators, 4) Barriers, and 5) Community pharmacists' perceptions of their roles. Generally, community pharmacists were involved in medication counselling, health promotion, and referral of patients. Lack of support from government, patients' lack of adherence, poor interprofessional relationship, and lack of clear community pharmacy practice guidelines were identified as barriers. Despite the challenges, community pharmacists are motivated by patients' gratitude for their services. Lesotho community pharmacists can potentially improve cardiovascular diseases' health outcomes at primary healthcare level through early detection of CVD risk factors, and health promotion.

Hereditary predisposition syndromes to myeloid neoplasms: diseases, genes and mechanisms of development

With the development of modern next generation sequencing based DNA diagnostic methods, it has become possible to study hereditary predisposition to oncohematological diseases. Germline variants (mutations) of RUNX1, CEBPA, GATA2, ANKRD26, DDX41, FANC- (Fanconi anemia), etc. genes, associated with the development of hereditary hematological malignancies, have been identified. Timely diagnosis of such diseases will allow for medical genetic counseling and testing of the patient’s relatives to identify or exclude the risk of developing the disease, select a donor for the patient (it is undesirable to use a mutation carrier relative as a donor), and personalize the choice of chemotherapy regimens (for example, patients with Fanconi anemia may experience increased sensitivity to chemotherapy). The aim of this review is to present a modern view of the genetic predisposition to the development of hematological malignancies.