Medication Regimens Research Articles

Complexity of the Therapeutic Regimen in Older Adults with Cancer: Associated Factors

Background/Objectives: Population aging is a worldwide phenomenon and is often associated with multimorbidity and polypharmacy. Complex medication regimens are common among older adults and contribute to the occurrence of harmful health outcomes. Age is one of the main risk factors for cancer. This study aimed to determine and characterize the therapeutic complexity in older patients with cancer, and analyze the factors associated with high complexity and the impact of the oncological context. Methods: A cross-sectional study with patients aged ≥65 years with cancer was conducted in three hospitals in northern Portugal. Data collection was obtained using self-reports. The medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI). Descriptive and association statistical analysis were performed. Logistic, linear, simple and multiple regression analysis were conducted, with and without automatic variable selection. Results: A total of 552 patients were included (median age, 71; IQR, 68–76). The mean MRCI before the oncological context was 18.67 (SD 12.60) and 27.39 (SD 16.67) after the oncological context, presenting a statistically significant difference in the values obtained (p < 0.001). An elevated complexity was significantly associated with polypharmacy, chronic diseases and with the administration of high-risk medications (p < 0.05). High MRCI values showed a relationship with the occurrence of potential drug interactions (p < 0.001). There was no relationship with the existence of cardiac risk comorbidity. Conclusions: This study demonstrated the existence of high therapeutic complexity in older patients with cancer, suggesting the need for intervention to prevent medication-related problems in this vulnerable population.

Yoga-Based Group Intervention for Inpatients with Schizophrenia Spectrum Disorders-Feasibility, Acceptability, and Preliminary Outcomes of a Rater-Blinded Randomized Controlled Trial.

The efficacy of yoga as an adjunctive treatment for schizophrenia spectrum disorders (SSD) has garnered interest. While yoga may positively influence various symptom domains, further investigation is needed due to the limited number, quality, and generalizability of studies. This study assessed the feasibility and acceptability (primary outcome) of a yoga-based group intervention (YoGI) developed in a participatory approach and explored its preliminary effectiveness. In addition to the primary outcomes, this preregistered randomized controlled trial examined rater-blinded general psychopathology, positive- and negative symptoms, and self-rated depression, anxiety, stress, body mindfulness, mindfulness, psychological flexibility, cognition, social functioning, quality of life, and medication regime at baseline and postintervention as secondary outcomes. Fifty inpatients with SSD received either TAU (n = 25) or YoGI + TAU (n = 25) for four weeks. Outcomes showed 95% protocol adherence of YoGI, feasibility, and retention rates of 91% and 94%, respectively, and a dropout rate of 6%. ANCOVA revealed significant between-group postintervention improvements for YoGI + TAU in positive symptoms, depression, cognitive fusion, and a mindfulness subscale. Medium-to-large pre- to postintervention effects were found for body mindfulness, positive, negative, and general psychopathology, cognitive fusion, depression, anxiety, stress, quality of life, and attention in YoGI + TAU, while within-group changes were consistently smaller in TAU. No severe adverse events were reported. This trial supports the feasibility and acceptability of YoGI for inpatients with SSD and provides preliminary evidence of YoGI's benefits beyond TAU. Further robust, multicentric RCTs are warranted to deepen our understanding of YoGI's therapeutic potential and inform clinical interventions for SSD.

Education based on the theory of planned behavior to improve medication regimen adherence, hope and marital quality in patients with substance use disorder.

Regarding the psychosocial aspect of treating those with substance use, it is crucial for them to exhibit a capacity for personal transformation, fully utilize their remaining capabilities, and eradicate societal discrimination. We aimed to assess the efficacy of educational instruction grounded in the theory of planned behavior (TPB) in enhancing adherence to medication regimens, fostering hope, and improving marital quality among people with substance use disorders. This study was conducted at the Rapid Addiction Closure Center in Fasa city, Iran, involving a sample of 140 patients undergoing addiction treatment with methadone and buprenorphine in 2021-2022. Subjects were randomly allocated to intervention and control groups. The intervention group participated in 15 weekly educational sessions, each lasting 50 to 55min, covering topics such as quitting strategies, social support, problem solving, communication skills, and coping mechanisms. Data were collected using demographic questionnaires, TPB construct questionnaires, Miller's Hope Survey, and the Revised Dyadic Adjustment Scale. The study included 140 individuals receiving treatment for addiction. No differences were seen among the two groups in education, occupation, marital status, and living conditions before the intervention. However, six months later, the intervention group showed improvements in attitude, subjective norms, perceived behavioral control, behavioral intention, medication regimen adherence, hope, and marital quality compared to controls. The results indicate that family-based educational interventions grounded in TPB are effective in improving medication regimen adherence, hope, and marital quality among patients with substance use disorders. Significant increases in attitude, subjective norms, perceived behavioral control, and behavioral intention positively impacted medication regimen adherence in these patients.

GLIOMA-RELATED EPILEPSY

Diffuse low-grade gliomas (LGGs), originating from glial tissue, have a propensity to progress to higher-grade tumors over time, presenting a complex challenge in clinical management. Glioma-associated epilepsy is a significant clinical indicator influencing both treatment strategies and prognostication. This study aims to assess the impact of glioma-related epilepsy on treatment outcomes and explore the current management guidelines. Material and Methods A retrospective analysis was conducted on 38 patients diagnosed with LGGs (WHO grades 2 and 3) treated in our neurosurgical department from 2013 to 2023. The focus was on glioma-related epileptic seizures, with outcomes evaluated using the Engel classification six months post-surgery. Additionally, anti-seizure medication (ASM) regimens were reviewed, and current National Institute for Health and Care Excellence (NICE) guidelines on low-grade gliomas were synthesized. Results Of the 38 patients, 30 had diffuse astrocytoma and 8 had oligodendroglioma. Among those with glioma-related epilepsy (n=25), management strategies included biopsy only (8%), gross total resection (GTR) (40%), subtotal resection (StR) (32%), and partial resection (PaR) (20%). No significant correlation was found between seizures and tumor volume, growth rate, or histological findings. However, a positive correlation between the extent of surgical resection and improved Engel outcomes was observed. Discussion Existing research suggests that early seizures may be a favorable prognostic indicator for malignant progression-free and overall survival. Epilepsy significantly impacts the quality of life for glioma patients. Exploring targeted epilepsy surgery for glioma-related seizures could potentially enhance patient outcomes and quality of life posttreatment. Conclusion Advancing approaches in epilepsy surgery for glioma-related seizures holds promise for improving patient quality of life and treatment efficacy. Further investigation into these strategies is warranted.

Abstract 4115015: Hyperpolarized Carbon-13 Metabolic Imaging Detects Changes in Cardiac Mitochondrial Metabolism in Patients Before and After Coronary Artery Bypass Graft Surgery

Background: Coronary Artery Disease (CAD) is a significant global health issue, necessitating improved diagnostic tools for visualizing cardiac energetics. Traditional imaging methods such as PET and dobutamine stress echocardiography do not directly assess mitochondrial metabolism. Hyperpolarized Carbon-13 metabolic magnetic resonance imaging (HP- 13 C MRI) offers a promising non-invasive method for investigating mitochondrial function in CAD. This study utilizes HP- 13 C MRI to detect changes in mitochondrial metabolism in patients undergoing Coronary Artery Bypass Graft (CABG) surgery (Fig.1). Methods: We conducted HP- 13 C MRI examinations on two patients with advanced CAD before and (~4-6 months after CABG surgery and one healthy subject (Fig. 2 A,B). Participating subjects provided informed consent according to a protocol approved by the Institutional Review Board and Protocol Review Committee. Baseline blood samples were analyzed for pyruvate, triglycerides, free fatty acids, and insulin levels. Post-glucose load, patients received an intravenous injection of an IND-approved metabolic probe, [1- 13 C] pyruvic acid, prepared under Good Manufacturing Practice regulations. The HP solution was administered after polarization in a clinical polarizer (SPINlab™, GE Healthcare). Imaging was performed using a GE MR750 MR system with a Helmholtz loop-pair 13 C coil (PulseTeq Limited, UK). Data were reconstructed and analyzed with MATLAB scripts. Results and Discussion: Baseline blood measurements were normal for the healthy subject, but those with advanced CAD showed variable and abnormal values (Fig. 2C). HP- 13 C MRI safely assessed cardiac metabolism in patients with advanced CAD. Patients with advanced CAD exhibited reduced pyruvate metabolism compared to healthy controls, shown by lower myocardial bicarbonate/(bicarbonate+lactate) ratios (Bic/(Bic+Lac)). Following CABG, only Patient 2 showed improved Bic/(Bic+Lac), while Patient 1 did not (Fig. 3A-B). This variability may be influenced by differences in nutrition, hormonal status, medication regimens, or other factors. Changes in % Bic/(Bic+Lac) across different coronary artery segments were observed post-CABG in CAD patients (Fig. 3C). Conclusion: HP- 13 C MRI non-invasively assesses cardiac metabolism in CAD patients, demonstrating the potential to evaluate post-CABG metabolic changes. Our efforts continue to recruit large cohort to understand individual variability.

Efficacy and safety of remimazolam tosilate in anesthesia for short otolaryngology surgery.

Remimazolam tosilate represents the novel ultrashort-acting benzodiazepine drug. This work focused on exploring whether remimazolam tosilate was effective and safe in anesthesia for short otolaryngology surgery in adults, and optimize its medication regimen, thus providing a theoretical basis for its widespread clinical application. The present unicentric, double-blind, randomized controlled study enrolled altogether 85 otolaryngology surgery patients aged 18-60 years, and they were divided as remimazolam (RM, 42 cases) or midazolam (MD, 43 cases) group. Efficacy outcomes included successful sedation time, sedation effect (Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score), bispectral index values (BIS), and postoperative recovery. The safety outcomes were patient vital signs at each time point (before induction (T0), 2min and 5min after trial drug treatment (T1 and T2 separately), during successful intubation (T3), at the end of surgery (T4), during extubation (T5), and at the time of exiting the room (T6)), any adverse reactions (AEs) during perioperative period, and patient satisfaction with anesthesia experience. Demographics were not significantly different in both groups (P > 0.05). RM group had significantly decreased successful sedation time relative to MD group (P < 0.05), while increased successful sedation rate (100%) relative to MD group (90.70%, P = 0.116). RM group showed decreased MOAA/S score and BIS value compared with MD group at T1 and T2 (P < 0.05). The spontaneous respiration recovery time and extubation time were not significantly different in both groups (P > 0.05), but RM group exhibited decreased discharge time compared with MD group (P < 0.05). Compared with MD group, the RM group had lower blood pressure (BP) at T3 (P < 0.05); whereas higher heart rate (HR) and respiration rate (RR) at T1 and T2 (P < 0.05). Difference in AEs was not of statistical significance. Finally, RM group exhibited the increased satisfaction of anesthesia experience compared with MD group (P < 0.05). Remimazolam tosilate is effective on anesthesia for short otolaryngology surgery. Remimazolam shows the rapid onset, stable circulation, fast postoperative recovery, no increase in perioperative AEs, and high satisfaction with anesthesia experience compared with midazolam. https://www.chictr.org.cn/ (ChiCTR2200067123) on 27/12/2022. This study was consistent with CONSORT guidelines.

A qualitative study on the current status and problems of pharmacists in home healthcare from the viewpoint of care managers in medically underpopulated areas in Japan

BackgroundUnlike in urban areas, community healthcare in medically underpopulated areas in Japan is constantly challenged because of the uncertainty in effectively using the limited resources. However, no study has focused on human resources or identified the actual state of pharmacists’ support in the community. Therefore, our study identified the actual status and problems of pharmacists involved in home medical care in medically underpopulated areas and discussed the roles required of pharmacists and specific methods of support.MethodsThe content of semi-structured interviews with care managers involved in home healthcare in Misugi town, Tsu City, between November 10, 2023 and March 13, 2024, was analyzed qualitatively using the grounded theory approach.ResultsFive care managers participated in the study. Semi-structured interviews on the actual situation and challenges faced by pharmacists indicated that the following roles were required for pharmacists: as in other regions, it was observed that elderly people with dementia and those living alone managed their medicines, adjusted leftover medicines, collaborated with other professions, bridged with physicians, checked medication status through frequent visits, and adhered to internal medication regimens. Issues related to the characteristics of depopulated areas were identified including human resources, limitations of healthcare resources, economic burden, limits on the number of visits by pharmacists. As a characteristic of communities with no pharmacies and only in-hospital prescribing, pharmacists were expected by care managers to manage the problems caused by in-hospital prescribing.ConclusionsOur findings suggest that pharmacists should ensure the number of visits and collaborate with attending physicians, visiting nurses, and care managers to conduct drug management for patients with dementia and older adults living alone. Community healthcare specialists and those involved in the healthcare planning system can also utilize these findings while planning home healthcare to those who live in medically underpopulated areas in Japan.

The role of a Macmillan senior pharmacy technician in a regional cancer centre in Northern Ireland: an evaluation

Abstract Introduction In the UK, up to two-thirds of all cancer patients have at least one comorbidity, with around half having multiple long-term conditions (LTCs).1 Older people with cancer often require multiple medications including cancer-specific treatments, supportive care medications, and medications for pre-existing LTCs. They are therefore at higher risk of the adverse effects of polypharmacy, inappropriate prescribing, drug-drug interactions, and drug-disease interactions. Complexity of medication regimens and treatment burden can cause confusion and medicines mismanagement, thereby influencing a patient's ability to adhere to treatment with the outcome being an increased chance of treatment failure. It is thus essential that medicines be optimised in these patients.2 The Oncology Pharmacy Team based in the North West Cancer Centre, located on the Altnagelvin acute hospital site in the Western Health and Social Care Trust, Northern Ireland, secured Macmillan funding to provide a specialist medicines optimisation service to older patients about to start cancer treatment (the Medicines Optimisation in Older People with Cancer [MOOC] Service). A pharmacy technician and pharmacist were recruited and the service implemented from October 2023. The roles are new and innovative and require extensive evaluation. Aim To evaluate the introduction of the Macmillan senior pharmacy technician into the oncology pharmacy team, analysing impact on medicines optimisation and patient safety. Methods A census approach was taken to include all patients with a new cancer diagnosis and medicines reconciliation (MedRec) completed by the pharmacy technician during the study period. The technician identified and rectified any issues prior to the patient’s first scheduled treatment. Patients with significant medicines-related concerns, or aged ≥65 years and taking ≥8 drugs, were referred to the Macmillan pharmacist for holistic medication review. Data collected included number of MedRecs completed by the pharmacy technician (relative to total completed by the team weekly), cancer diagnosis, medicines-related problems identified, interventions made, other activities completed, and time directed away from the pharmacist. Analysis of patient age and number of medications taken informed whether inclusion criteria for MOOC pharmacist referral were appropriate. Results The specialist medicines optimisation service started in October 2023, however, data collection for the purpose of this study commenced on 1st January and took place over a two-month period.101 patients (aged 69.0 ± 5.7 years, range 57 -74 years)) taking an average of 12.6 medicines (range = 8-18), and recently diagnosed with cancer were reviewed by the pharmacy technician. On average, the technician completed 76.4% of medicines reconciliations each week. 120 medicines-related problems were identified, and 178 interventions made. The service yielded net cost savings of £826.34 (pharmacist time saved). Nine patients were referred to the MOOC pharmacist service; a further five patients did not consent to referral. Discussion / Conclusion Although the evaluation of the MOOC service is ongoing, this interim analysis demonstrated that integration of the pharmacy technician into the oncology team yielded cost savings and reduced and improved provision of patient-centred healthcare and safety. Inclusion criteria for the MOOC pharmacist review were confirmed via analysis of patient age and number of medicines taken.

An evaluative project of a ward-based pharmacist working within an MDT as part of a ‘Reablement &amp; Frailty’ speciality unit

Abstract Introduction Reablement care aims to prevent hospital re-admissions, costly institutional placements, and increase quality of life for frail patients, as well as preventing long-term decisions being made prematurely based on the patient’s current state of health1. Pharmacist involvement in multi-disciplinary teams (MDT) across other specialities has been demonstrated extensively worldwide as effective in reducing medication errors and providing significant improvements to patient care. However, little research has been conducted specifically within a reablement &amp; frailty setting, and the subsequent impact on the scale and quality of care provided to patients2. Aim To identify the responsibilities of a singular ward-based pharmacist working within a ‘reablement &amp; frailty’ MDT and evaluate the subsequent impact on patient care by categorising and quantifying the significance of pharmacist interventions and contributions. Methods A three-stage, quantitative service evaluation project: 1. Pharmacist development of two data collection tools to capture responsibilities: one for clinical interventions/recommendations and one for structured medication reviews; 2. Collection of daily interventions on 18-bed reablement unit over 13 days (3-day pilot + 10-day data collection period) by ward pharmacist using above data collection tools; 3. Scoring of each intervention based on two adapted, previously validated scales3: I. Severity score –potential severity of harm to the patient if contribution was missed (clinically insignificant, significant, serious, or life-threatening) II. Intervention score –likelihood of contribution preventing hospital re-admission - scale of 1-3 (1 - no likelihood, 2 - possible likelihood, and 3 - high likelihood) Ethical approval was obtained through the Robert Gordon University university ethics committee in addition to local approval via the Epsom &amp; St Helier hospital’s research &amp; development department. Results A total of 88 clinical contributions were made and collected over the 3-day pilot and 10-day data collection period, averaging just under seven contributions per day. Two ‘life-threatening’ interventions were made, both with a high likelihood of preventing a hospital re-admission. Based on potential severity of harm, most entries were scored as ‘significant’ (67%, n=59), followed by ‘serious’ (16%, n=14). Just over half of all clinical interventions (52%, n=46) scored as having either a possible OR high likelihood to prevent a hospital re-admission. The ward doctor actioned 94% (n = 73) of the pharmacist’s recommendations. Discussion / Conclusion With an average of just under 7 clinical contributions made daily, it is clear that pharmacist involvement in the ‘reablement &amp; frailty’ MDT can reduce medication error incidence through prompt identification and resolution, optimise medication regimens, and contribute to reducing patient risk of future re-admissions through effective interventions and medicines optimisation. Due to the different uses of the term ‘reablement’ globally, the findings from this study may not be applicable to all areas of reablement, such as home-based rehabilitation or bed-based respite. However, with this study forming foundation research into a novel reablement unit within secondary care, a promising argument has been made to promote pharmacist inclusion within MDTs across all specialities and the benefit that pharmacist contributions can bring to ensuring holistic care and effective patient reablement.

Cardiac Ablation in the Pediatric Population at a Tertiary Care Center in a Developing Country.

The aim of this study was to describe our experience and outcome of ablation therapy for arrhythmias in pediatrics at a tertiary care center. Data was collected retrospectively from the hospital medical records. All pediatrics presenting to AUBMC between 2000 and 2020 who underwent cardiac ablation were included. The data collected included type of arrhythmia, ablation technique, age and weight at ablation, procedure complications, medications used, and outcome assessment. We had 67 patients who underwent cardiac ablation. Of those, 60% were males with a mean age of 15 years. Structural heart disease was present in 6% of patients. Wolff-Parkinson-White syndrome (WPW) was most prevalent at 31%, followed by atrioventricular nodal reentrant tachycardia (AVNRT) at 24%, atrioventricular reentrant tachycardia (AVRT) at 16%, ventricular tachycardia (VT) at 10%, atrial fibrillation (AF) at 3%, and atrial tachycardia (AT) at 1%. The remaining 15% of patients presented with less common types of arrhythmias, including other supraventricular tachycardias (SVTs), retrograde dual atrioventricular nodal reentry, and premature ventricular contractions (PVC). Antiarrhythmic medications were started before the procedure in 59% of our population. Medication regimens postablation included beta-blockers (68%), type 1c antiarrhythmics (25%), calcium channel blockers (3%), ivabradine (2%), and amiodarone (2%). The completed procedures showed a success rate of 93%. Ablation of arrhythmias in pediatrics is an effective procedure in the treatment of childhood arrhythmias. More studies are needed on cardiac ablation in this age group and those with structural heart disease in the Middle East region.

The role and perception of the caregiver in a specialized pediatric palliative care center in medicine preparation and administration: a survey study

BackgroundIn pediatric palliative care, the main caregiver is primarily responsible for managing pharmaceutical therapies. Few data are available regarding the influence of this burden on quality of life in terms of time, concerns as well as a considerable risk of administration errors and adverse effects. This study aims to investigate how caregivers prepared and administrated medication, including errors and associated expectations, to identify improvement interventions.MethodsBetween October 2022 and March 2023, a descriptive single-center survey study was carried out in the tertiary care pediatric palliative center of the Padova University Hospital. Participants were the caregivers of the patients followed by our center up to 23 years old, receiving at least one drug daily and who cannot self-administer their therapy. The questionnaire consisted of 18 multiple-choice and semi-closed questions, grouped into 4 main topics: therapy preparation, therapy administration, administration errors and therapy assessment.ResultsA total of 100 caregivers responded to the survey. Mothers represented the main caregiver (91%). The prevalence of polypharmacy was 67% across the patients. 52% of caregivers handled prescriptions at least three times per day and for 32% it took to prepare them more than 5 min each time. Only 59% reported to have been trained for preparing and administrating drugs. 14% reported having made at least a drug administration error due to the tiredness or the complexity of therapeutic regimens in the preceding three months. Nearly one caregiver out of three felt their child was using too many drugs. 73% positively welcomed the possibility of having clinical pharmacist-led counseling.ConclusionsMany caregivers of pediatric palliative care patients frequently have trouble planning, preparing and delivering pharmacological therapy to their children. Attempting to simplify medication regimens, choosing formulations that are simpler to administer and measure, investing in improved caregiver training, talking about therapies with carers, and involving clinical pharmacists to clarify their doubts could be all potential strategies to improve this condition and reduce their burden.

Mechanistic Studies on the Antidiabetic Properties of Gallotannins.

The escalating prevalence of type 2 diabetes (T2DM) has emerged as a global public health dilemma. This ailment is associated with insulin resistance and heightened blood glucose concentrations. Despite the rapid advancements in modern medicine, where a regimen of medications is employed to manage blood glucose effectively, certain treatments manifest significant adverse reactions. Recent studies have elucidated the pivotal role of gallotannins in mitigating inflammation and obesity, potentially reducing the prevalence of obesity-linked T2DM. Gallotannins, defined by their glycosidic cores and galloyl groups, are ubiquitously present in plants, playing diverse biological functions and constituting a significant segment of water-soluble polyphenolic compounds within the heterogeneous tannins group. The structural attributes of gallotannins are instrumental in dictating their myriad biological activities. Owing to their abundance of hydroxyl groups (-OH) and complex macromolecular structure, gallotannins exhibit an array of pro-physiological properties, including antioxidant, anti-inflammatory, antidiabetic, protein-precipitating, and antibacterial effects. Extensive research demonstrates that gallotannins specifically obstruct α-amylase and pancreatic lipase, enhance insulin sensitivity, modulate short-chain fatty acid production, alleviate oxidative stress, exhibit anti-inflammatory properties, and influence the gut microbiota, collectively contributing to their antidiabetic efficacy. This review aims to consolidate and scrutinize the extant literature on gallotannins to furnish essential insights for their potential application in diabetes management.

Ulcerative Colitis Patients are at Increased Risk for Adverse Events Following Total Hip Arthroplasty

BackgroundPatients who have the autoinflammatory bowel disease ulcerative colitis (UC) may become candidates for total hip arthroplasty (THA). Having UC may predispose patients to postoperative adverse events, but it remains unclear if these events are related more to the disease process itself or perhaps related to the medications used to treat the condition. MethodsPatients undergoing THA were identified from a large administrative dataset. Those who did not have and those who had UC were matched 4:1 based on patient age, sex, and the Elixhauser Comorbidity Index (ECI). Matched THA patients who did not have UC (n = 19,482) and those who had UC (n = 4,874) were identified. The matched groups were compared regarding 90-day adverse and five-year survival. Further analyses were performed based on classes of medications. ResultsControlling for patient age, sex, and ECI, UC patients were at significantly higher odds of 90-day adverse events: any (odds ratio [OR] 1.59), severe (OR 1.72), and minor (OR 1.63) (all P < 0.001). Despite this, no differences in 5-year survival were identified. Relative to those who did not have UC, there were increasing odds of any adverse event based on the potency of related medications: no corticosteroids /immunomodulators/5-aminosalicylic acid (5-ASA) (OR 1.42), corticosteroids only (OR 1.58), 5-ASA ± corticosteroids OR (1.72), and immunomodulators ± corticosteroids (OR 1.74, all P < 0.001). ConclusionsTotal hip arthroplasty patients who have UC were at higher odds for 90-day postoperative adverse events relative to those who did not have UC, and this risk was even greater for those on defined classes of medications. Total hip arthroplasty patients who have UC bear specific considerations, and surgeons must carefully consider and manage the patient’s medication regimen in the perioperative period of the THA.

How is gout currently managed, and is there interest in changing the way we deliver care? A qualitative exploratory study.

This study aimed to understand how gout is currently managed in Australian primary care and to assess the level of interest in changing the delivery of care for gout. This pragmatic qualitative study was conducted among Australian general practitioners (GPs), pharmacists and adults living with gout. Semi-structured interviews were conducted and analysed using thematic analysis. The key theme identified was that chronic gout has low priority compared to managing other conditions, and management is often responsive to patient action. Lack of confidence was expressed about medication regimens for multimorbidities. Regarding changing care delivery, there was widespread interest in enhancing pharmacists' role in providing medication reviews and guidance, but there were conflicting views between some pharmacists and GPs about clinical decisions and prescribing arrangements. Interpreting findings based on Wagner's chronic care model, it is apparent that there are multiple potential opportunities to change practice that might improve goutmanagement.

Development and validation of a machine learning model for predicting drug-drug interactions with oral diabetes medications

Diabetes management is often complicated by comorbidities, requiring complex medication regimens that increase the risk of drug-drug interactions (DDIs), potentially compromising treatment outcomes or causing toxicity. Although machine learning (ML) models have made strides in DDI prediction, existing approaches lack specificity for oral diabetes medications and face challenges in interpretability. To address these limitations, we propose a novel ML-based framework utilizing the Simplified Molecular Input Line Entry System (SMILES) to encode structural information of oral diabetes drugs. Using this representation, we developed an XGBoost model, selecting molecular features through LASSO. Our dataset, sourced from DrugBank, included 42 oral diabetes drugs and 1,884 interacting drugs, divided into training, validation, and testing sets. The model identified 606 optimal features, achieving an F1-score of 0.8182. SHAP analysis was employed for feature interpretation, enhancing model transparency and clinical relevance. By predicting adverse DDIs, our model offers a valuable tool for clinical decision-making, aiding safer prescription practices. The 606 critical features provide insights into atomic-level interactions, linking computational predictions with biological experiments. We present a classification model specifically designed for predicting DDIs associated with oral diabetes medications, with an openly accessible web application to support diabetes management in multi-drug regimens and comorbidity settings.

Assessing pain management in total joint arthroplasty using the Detroit interventional pain assessment scale—A prospective cohort study

BackgroundTotal joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.MethodsAn IRB-approved prospective study was conducted at a US academic joint replacement practice. Patients were evaluated by an independent observer at three weeks, three months, and six months postoperatively using the Detroit Interventional Pain Assessment (DIPA) scale. Patients verbally rated their pain with their current medication regimen as 0 (no pain), 1 (tolerable pain), or 2 (intolerable pain) on the DIPA scale. Narcotic usage was verified by the Michigan Automated Prescription System (MAPS). Patients were divided into THA, TKA, previously on opioids, and opioid-naïve groups. Provider efficiency scores reflected pain management satisfaction and were calculated as the percentage of patients reporting no pain or tolerable pain.ResultsOut of 200 patients, the percentage of patients using narcotics and their daily usage (MMEs) significantly decreased from 75.5% (27.5 MMEs) at three weeks to 42.9% (5.3 MMEs) at six months (P < 0.001). In 80% of patients, narcotics taken at six months were prescribed by outside providers. Significantly fewer patients used narcotics at six months for THA (15.4%) compared to TKA (52.7%) (P < 0.021). There was a significant difference in daily narcotic usage between patients who took narcotics preoperatively (22.9 MMEs) and opioid-naïve ones (13.4 MMEs) (P < 0.001). Provider efficiency scores were best at three weeks (76.6%) and three months (70%) but declined at six months (57.2%).ConclusionsNarcotic tapering practices were observed as postoperative daily narcotic intake decreased across six months. However, outside providers prescribed 80% of narcotics at six months, necessitating a better-coordinated practice with surgeons. Patients taking preoperative narcotics experienced higher daily MME requirements than their opioid-naïve counterparts. In terms of the percentage of patients on narcotics, THA is a better procedure for tapering patients off narcotics by six months.

A Qualitative Study of Type 2 Diabetes Mellitus Outpatients' Perspectives on Readiness, Acceptance and Barriers of Mobile Apps for Medication Adherence

ObjectivesThis qualitative phenomenological study explored the perspectives of type 2 diabetes mellitus (T2DM) outpatients in adopting mobile apps for medication adherence management. MethodsThrough 25 semi-structured in-depth interviews, themes were identified using thematic analysis, guided by the Technology Readiness and Acceptance Model (TRAM). ResultsAnticipated convenience and benefits, openness to new technologies acted as drivers, while limited digital literacy and concerns about data privacy and security served as inhibitors of readiness to adopt health apps. Acceptance was influenced by elements related to medication, patient, healthcare professional, family and app aspects. The identified barriers were related to patient, smartphone and monetary factors. Patients perceived the need to adopt digital apps were for those with poor adherence, complex medication regimen and forgetfulness issues. However, concerns about effectively implementing this approach were noted as T2DM patients were predominantly late middle-aged adults who faced technical challenges, leading to combination approach between digital technology and conventional patient education and counselling. ConclusionThe findings highlighted the factors influencing patient's readiness, acceptance, and barriers on effective utilisation of digital health solutions in managing adherence issues. Practical implicationsThe elements of TRAM provide guidance for strategic actions to enhance digital health technology adoption among T2DM patients.

Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care

The emergence of incretin-based therapies, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP), as a new class of obesity medications, is dramatically changing obesity care. Use of these medications, known categorically as anti-obesity medications, as part of comprehensive obesity management is associated with significantly greater weight loss and health benefits than found with earlier generation obesity medications. The outcomes reported from medication trials were often achieved in conjunction with lifestyle counseling sessions by a registered dietitian nutritionist (RDN) or other qualified health care professional. Research demonstrates that evidence-based obesity care should incorporate lifestyle interventions. Counseling by a RDN, paired with incretin-based therapies, can play a critical role in supporting adherence to the medication regimen, preventing and managing side effects, adequate nutrient intake, and establishment of lifestyle behaviors for long-term weight and health management. To date, minimal research has been reported on the impact of incretin-based therapies on food and nutrient intake. Until that research is conducted, RDNs and other health professionals can apply knowledge and experience from clients who have undergone other intensive treatments. This article provides considerations for lifestyle interventions, with a focus on medical nutrition therapy (MNT) provided by RDNs, for adults prescribed incretin-based therapies. RDNs have the education and training to provide MNT for people with overweight or obesity, as well as lifestyle counseling on physical activity, stress management, sleep hygiene, goal setting, and other behaviors associated with positive health outcomes. RDNs have a critical role in the integration of incretin-based therapies into obesity management.

Nexus of Quality Use of Medicines, Pharmacists’ Activities, and the Emergency Department: A Narrative Review

Acute care provided in the hospital’s emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as “choosing suitable medicines and using them safely and effectively”, remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED.

Co-designing Medication Optimization Patient-Centered Outcomes Research With Older People and Caregivers as Research Partners.

Background: Additional evidence is required to address the unintended consequences of medication use in older people and the required caregiver support. To inform priorities for future research efforts, different stakeholder perspectives are needed, including those of older people, caregivers, clinicians, and researchers. Objective: To develop a co-designed medication-related research agenda. Methods: A 12-member Advisory Council, half of which were older people and caregivers, designed the research. An 11-question survey to identify priorities for medication-related patient-centered outcomes research (PCOR) topics was administered to members of the Elder Care Medicine Network (ECMN) (ie, older people, caregivers, clinicians, and researchers). Respondents were categorized into two groups with hierarchical assignment to the clinician/research group over the older adult/caregiver group. Chi-square tests compared priority areas for medication-related PCOR between the two groups. Results: There were 53 responses (48% response rate) from the ECMN, with 39.6% (n = 21) from the clinician/researcher group and 60.4% (n = 32) from the older adult/caregiver group. The priority areas from both groups included safe ways to simplify medicines (62.2%), communicating with pharmacists and prescribers about medications (58.5%), and information about safe supplements with prescription medications (52.8%). Statistically significant differences existed between the two groups in the proportions choosing the priority areas. Conclusion: Co-design of a survey to identify priority areas for PCOR demonstrated successful engagement of older people and caregivers as research partners. While older people and caregivers may have differing perspectives on the importance of specific medication-related PCOR topics, simplifying medication regimen and health care communications were germane to both groups.