Medical Management Research Articles

Approach to the patient with a difference of sexual development.

Available pre- and postnatal tests for obtaining a molecular genetic diagnosis for differences of sexual development (DSD) have largely expanded over the last decade. More importantly, the medical management of these conditions has taken a different approach, with greater emphasis on patient autonomy, holistic care, and psychosocial support. These changes are illustrated through the discussion of two cases with a common form of DSD. While the principles and recommendations for the diagnosis and medical management of DSD are universal in nature, they need to be translated into clinical care pathways that align with the specific sociocultural background of patients and their caregivers to ensure the best possible outcome. Considering the inherent global differences in the organisation and accessibility of healthcare and available resources, this requires an individualised approach based on shared decision-making and clinical guidelines that are in line with local facilities and societal context.

How Women Discuss Heavy Menstrual Bleeding in Online Forums ("It's Like Revenge of the Uterus"): Template Approach to Thematic Analysis.

Heavy menstrual bleeding (HMB) is a common condition that affects approximately 20% to 30% of women globally. However, despite significant physical, mental, and social impacts on the quality of life of women who experience HMB, they face barriers to both diagnosis and treatment. With current challenges to female reproductive autonomy growing on a global scale and with the stigma that surrounds menstruation, women with HMB may turn to online communities to access peer support and information. Online forums such as Reddit, which support the use of anonymous posting, may offer a space where those affected by HMB can share their experiences, seek support, and offer advice to others. This study aimed to explore how those experiencing HMB use Reddit to share experiential knowledge, provide support, and share experiences of HMB within an online community space. Data were collected from discussion threads on the TwoXChromosomes subreddit on Reddit. Publicly accessible posts were identified through a systematic search conducted on August 13 and 14, 2024, using keywords related to HMB. A template approach to thematic analysis was used to analyze the data. A priori codes were developed from existing literature on HMB and the research objective. The template was refined after further examination of the transcripts, with all transcripts being analyzed using the final template. The search initially identified 434 discussion threads. Threads were screened for relevance and user engagement, resulting in a final 13 (2.99%) threads being analyzed for this research. These comprised 1505 individual comments from 1115 unique users. Four central themes were identified: validation and camaraderie, life impacts of HMB, practical support, and medical treatment and management. In the validation and camaraderie theme, users frequently shared personal experiences and validated the experiences of others, challenging the normalization of debilitating symptoms and creating a shared sense of solidarity. When discussing the life impacts of HMB, users emphasized how it disrupts daily functioning, including work, relationships, and mental well-being, and poses serious physical health risks. In the theme of practical support, Reddit users exchanged strategies for managing symptoms, including recommending specific menstrual products, home and workplace adaptations and adjustments, and self-advocacy. The final theme of medical treatment and management explored Reddit users' frustration with health care experiences, particularly around the prioritization of fertility over quality of life. Hormonal contraception, intrauterine devices, and surgical interventions were discussed with varying degrees of satisfaction and concern. Overall, Reddit users reported a general dismissal of HMB within medical and social contexts. Reddit serves as an important platform for individuals with HMB to validate their experiences, share practical knowledge, and seek peer support in the face of medical dismissal. This research provides insight into the usefulness of online spaces for people discussing HMB.

Addressing the risks of polypharmacy in the community nursing setting.

Polypharmacy is a common and growing issue, particularly among older adults with multiple chronic conditions. While polypharmacy is often necessary for managing complex health needs, it can lead to adverse drug reactions, harmful interactions and prescribing cascades, which increase the risk of hospitalisations, disability and death. Nurses play a pivotal role in identifying polypharmacy, monitoring medication use and facilitating communication between patients, prescribers and pharmacists to ensure safe and effective medication management. Addressing polypharmacy requires a collaborative approach across the healthcare system, involving the use of accurate medication lists, deprescribing unnecessary drugs and applying tools such as the STOPP/START criteria for medication reviews. Medication reconciliation, especially during care transitions, is also essential for reducing medication errors and improving patient outcomes. This article explores the impact of polypharmacy, highlights the role of nurses in its management and outlines strategies to mitigate the risks associated with multiple medications. By incorporating shared decision-making, structured medication reviews and improved communication across care teams, healthcare systems can enhance patient safety and optimise medication management for older adults.

Management ocular trauma among patients attending eye care services at Jinja regional refferal hospital. A cross-sectional study.

Background The study aims to assess the Management of ocular trauma among patients attending eye care services at Jinja Regional Referral Hospital. Methodology In a cross-sectional descriptive study design 100 respondents were selected using a non-probability consecutive sampling process. Data collected was processed quantitatively by tallying and using non-programmable scientific calculators and was presented using tables and figures. The study was conducted from September 2022 to March 2023. Results: The majority received medical management (65%), 20% received surgical management, 10% used self-medication, and 5% used traditional medication. 41% of the respondents had received closed globe injuries, while 59% had received open globe injuries. The majority of the patients (58% ) showed great improvement, 15% showed less improvement, and 12% showed mild improvement. The majority of the patients (40%) presented after 24 hours, 24% were presented to the clinic immediately, 20% were presented after 2 days, and 16% were presented after one week. Among patients who were presented to the clinic after one week, 63% showed a poor prognosis, 25% showed a mild prognosis, and 13% showed a good prognosis. Conclusion Health-seeking behavior after sustaining eye injuries was good. The distance of patients from the Hospital affected their health-seeking ability. Recommendations The government should establish more equipped specialized eye centers (Hospitals) with adequate staff to increase accessibility to eye care services.

Faculty experiences developing and directing a novel multi-campus medication therapy management introductory pharmacy practice experience.

Faculty experiences developing and directing a novel multi-campus medication therapy management introductory pharmacy practice experience.

Endovascular versus medical management of posterior cerebral artery occlusion stroke.

Endovascular versus medical management of posterior cerebral artery occlusion stroke.

Understanding potentially inappropriate medication: A focus group study with general practitioners.

Understanding potentially inappropriate medication: A focus group study with general practitioners.

A system dynamics approach to assess the impacts of COVID-19 on medical waste management systems.

A system dynamics approach to assess the impacts of COVID-19 on medical waste management systems.

2025 Annual Meeting: CEO and Medical Director's Address.

2025 Annual Meeting: CEO and Medical Director's Address.

Appropriate use criteria for neoplastic compression fractures.

Appropriate use criteria for neoplastic compression fractures.

Acute hepatic porphyria: A rare but critical diagnosis

ABSTRACT Acute hepatic porphyria (AHP) is a rare genetic disorder resulting from disruptions in hepatic heme biosynthesis, leading to the accumulation of neurotoxic porphyrins, aminolevulinic acid (ALA) and porphobilinogen (PBG). This accumulation causes acute and chronic neurovisceral symptoms, significantly affecting patient quality of life. Diagnosis is often delayed due to the rarity and nonspecific presentation of AHP, with biochemical and genetic testing serving as key diagnostic tools. For patients with recurrent attacks, prophylactic strategies aim to reduce episode frequency and severity. Although intravenous hemin remains the primary treatment for acute attacks, a major advancement in AHP management is givosiran, a small interfering ribonucleic acid therapy that reduces ALAS1 expression, thereby lowering ALA and PBG levels and decreasing attack frequency. Results from the ENVISION trial demonstrated a 70% reduction in porphyria attacks among patients receiving givosiran compared with placebo, leading to its Food and Drug Administration approval in 2019. Effective management of AHP includes addressing complications such as chronic pain, fatigue, neuropathy, and an increased risk of primary liver cancer. Patient education, medication management, and preventive strategies, including trigger avoidance and early symptom recognition, are critical in improving outcomes. Support groups and patient advocacy networks provide additional resources to enhance disease coping and adherence to care plans. With early diagnosis and comprehensive management, individuals with AHP can mitigate complications and maintain a better quality of life.

Evaluating the implementation of a rapid access atrial fibrillation clinic utilising a pharmacist-physician model of care.

Evaluating the implementation of a rapid access atrial fibrillation clinic utilising a pharmacist-physician model of care.

Long-Term Care Staffing: Associations with Facility Characteristics, Residents' Experience, and Quality Measures.

Long-Term Care Staffing: Associations with Facility Characteristics, Residents' Experience, and Quality Measures.

The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Management of Ebstein anomaly in children and adults.

The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Management of Ebstein anomaly in children and adults.

Management of Bipolar Disorder in Pregnancy and Postpartum: A Clinicians' Guide.

Medication management in women with bipolar disorder (BD) in the perinatal period is challenging, given that many patients taper or stop medication during pregnancy, and the postpartum period is an extremely high-risk period for relapse. The objective of this narrative review was to investigate the perinatal efficacy as well as potential adverse effects on the child of common treatments for bipolar disorder. These treatments include lithium, lamotrigine, other antiepileptics, quetiapine, olanzapine, aripiprazole, other antipsychotics, antidepressants, benzodiazepines, Z-drugs, and other sleep medication. Despite the worldwide decline in lithium use, it remains the gold standard for acute and maintenance treatment of BD, and we continue to advise its use in women of reproductive age. In contrast, medications with a high risk for teratogenicity such as valproate and carbamazepine should be avoided in women of childbearing potential. Women with bipolar disorder are at very high risk of relapse after delivery, but this risk is more than twofold lower with adequate pharmacological prophylaxis. We advise to make a written perinatal bipolar relapse prevention plan in collaboration with the patient, family, and healthcare professionals, which includes a description of: (1) maintenance treatment during pregnancy, (2) preferred mode of delivery, (3) medication immediately after delivery and the first months postpartum for relapse prevention, (4) preferred plan for feeding (breast-feeding versus bottle-feeding), (5) strategies to assist women in ensuring adequate sleep and stable circadian rhythm in the first weeks after delivery, and (6) how to recognize the first symptoms of relapse and which intervention strategies to take.

Combined Living Donor Liver Transplantation With Coronary Artery Bypass Grafting: Possible but not Without a Struggle.

Combined Living Donor Liver Transplantation With Coronary Artery Bypass Grafting: Possible but not Without a Struggle.

Increasing Life Expectancy in Patients with Genitourinary Malignancies: Impact of Treatment Burden on Disease Management and Quality of Life.

Treatment burden refers to the overall impact of medical treatments on a patient's well-being and daily life. Our objective is to evaluate the impact of treatment burden on quality of life (QoL) in patients with genitourinary (GU) malignancies, highlighting the importance of patient-reported outcomes (PROs) in clinical trials to inform treatment decisions and improve patient care. We conducted a narrative review of clinical trials focused on GU malignancy (prostate, bladder, and kidney) between January 2000 and June 2024, analyzing related PROs and findings regarding treatment burden. Recent landmark clinical trials demonstrate significant improvements in overall survival across GU malignancies with novel therapies. However, the reporting of QoL outcomes in these trials is often inadequate, with many lacking comprehensive data or long-term impact. Current publications are increasingly evaluating treatment burden and its impact on patient well-being as a critical outcome, but most clinical trials to date have failed to assess treatment burden across key domains including financial, time and travel, and medication management. While advancements in treatment have extended longevity in patients with GU malignancies, the treatment burden associated with the receipt of novel agents and its implications for QoL remain inadequately uncharacterized.

TRACER: Transition to Adulthood Through Coaching and Empowerment in Rheumatology, a Feasibility Study

ObjectivesThe transition to adult healthcare is a vulnerable time for youth with chronic disease, with risks of disengagement and complications of inadequately managed disease. Health Coaching helps patients gain knowledge, skills, tools and confidence to become active participants in their care. Transition Coaching may be effective in psychologically and socially supporting youth as they gain the skills and tools necessary to independently manage their health. We designed the TRACER (Transition to Adulthood through Coaching and Empowerment in Rheumatology) study to assess the feasibility of conducting a multicentered RCT of a virtual Transition Coach Intervention (TCI) in youth transferring from pediatric to adult rheumatology care.MethodsYouth 17-18 years old were recruited at their last pediatric rheumatology appointment at McMaster Children’s Hospital or Children’s Hospital at London Health Sciences Centre in Ontario. Participants were randomized to the TCI or control group. Participants in both groups received the Youth Transition Roadmap which informs the differences between pediatric and adult care and discusses 5 domains of healthcare transition: Self-Advocacy, Medication Management, General Health, Lifestyle Issues and Future Planning related to education and vocation. TCI group participants also received virtual one-on-one monthly coaching sessions for 8 months. Six sessions were with an advanced practice physiotherapist (APP) and two were with a social worker. Primary feasibility outcomes were overall consent rate (≥85%), enrollment from the non-primary site (>30%), coaching session attendance (≥90%), and data collection completion (≥90%). Secondary clinical outcomes collected at baseline, 8- and 11-months included the Transition-Q (transition readiness), PedsQL(TM) 4.0 (global functional assessment), active joint count and Physician Global Assessment (disease activity), and PROMIS® self-efficacy measures for people with chronic disease.ResultsOf 65 patients approached, 30 (46.2%) consented, and 16 (53.3%) were from London. Of those who consented, 2 withdrew after consenting but prior to collecting baseline data and starting the intervention (Table 1). TCI sessions had a 95.8% attendance rate. Participants completed 90.7% of outcome assessments. At 8 months, TCI participants appeared to have higher levels of transition readiness, PROMIS® scores were higher in certain domains, and the TCI was well accepted by participants and coaches.Table 1.Feasibility Criteria ObtainedConclusionOur study met all feasibility outcomes except the consent rate, which indicates a large-scale RCT could be feasible. This study’s findings will shape a future multicenter RCT of a virtual TCI, with the ultimate goal of enhancing the physical, mental, and social well-being of adolescents with rheumatic disease transitioning into adult care.

The role of community pharmacists in natural disasters: Experiences from the 2023 Türkiye earthquakes.

The role of community pharmacists in natural disasters: Experiences from the 2023 Türkiye earthquakes.

Managing noninsulin glucose-lowering medications before surgery: A comparison of clinical practice guidelines.

Preoperative management of noninsulin glucose-lowering medications can be challenging as clinicians navigate adjustment amid decreased oral intake while maintaining euglycemia and avoiding hyper- or hypoglycemia. The authors review current published guidelines, along with the local protocol currently in place at Cleveland Clinic, to help clinicians determine which noninsulin glucose-lowering drugs may need to be held preoperatively and for how long.