Medication-related Side Effects Research Articles

Analysis of patient experiences regarding JAK inhibitors for atopic dermatitis, psoriasis, alopecia areata, and vitiligo.

The use of medications which target the JAK-STAT signaling pathway, also known as janus kinase (JAK) inhibitors, has rapidly increased in recent years. Patient perceptions, opinions, and concerns regarding the use of JAK inhibitors are largely uninvestigated. Our objective is to better understand patient concerns, reported side effects, and sentiments regarding the use of JAK inhibitors for dermatologic disease. The authors performed a cross-sectional analysis of the most frequented subreddits for dermatologic disease in which JAK inhibitors have obtained FDA approval (r/atopic dermatitis, r/psoriasis, r/alopecia areata, r/vitiligo, and r/eczeJAKS). The sentiment, central theme, and engagement level of each post was evaluated using previously utilized methods. Nine hundred twenty-three posts were analyzed, with the majority focusing on efficacy (433, 47%) and medication-related side effects (150, 16%). Other themes of interest to patients were Payment/Insurance (84, 9%), Study Results/News (69, 7%), Administration/Dosage (33, 4%), and Medication Interactions (31, 3%). The most frequently reported side effects were acne/folliculitis (24, 22%), nausea/gastrointestinal disturbance (11,10%), and fatigue/muscle aches (10, 9%). At the same time, the medication interactions garnering the most concern were sunscreens/facial moisturizers (5, 16%), topical calcineurin inhibitors (4, 13%), and Marijuana/THC (3, 9.%). This analysis highlights that patients are most concerned about the efficacy and side effects of JAK inhibitors in addition to issues regarding access to JAK inhibitors. Providers can use the insights gained from this study to address hesitancy better and guide comprehensive, patient-centered discussions with patients regarding JAK inhibitor use.

Physician-Reported Facilitators and Barriers for Side Effect Management of Heart Failure Medications.

Physician underprescribing and patient nonadherence are major barriers to the benefits of guideline-directed medical therapy. An important contributor to both underprescribing and patient nonadherence is concern about medication-related side effects. Yet, there are few to no data on approaches used by physicians to: (1) elicit medication-related side effects, (2) attribute these side effects to specific medications, and (3) take appropriate action. The authors conducted semistructured interviews with physicians to identify facilitators and barriers to each critical step of heart failure medication management: elicitation of side effects, attribution of side effects to a medication, and action in response to attributed side effects. Interviews were transcribed and coded using directed content analysis. For elicitation of potential side effects, limited patient communication and family discordance in reporting were key barriers, whereas guiding questions, measurement, and open channels of communication were key facilitators. For attribution of side effects, confounding from other medications, limited time for clinical encounters, and nonspecific symptoms were key barriers, whereas time-limited medication discontinuation trials and medication rechallenges were key facilitators. For taking action, challenges with weighing risks and benefits and physician fear about causing harm or interfering with other clinicians were barriers, whereas patient-physician communication and the results of a medication discontinuation trials and medication rechallenge were facilitators. This study generated key facilitators and barriers to 3 key aspects of heart failure medication management related to side effects that should drive future work to improve heart failure medication management.

Natural Language Processing Accurately Differentiates Cancer Symptom Information in Electronic Health Record Narratives.

Identifying cancer symptoms in electronic health record (EHR) narratives is feasible with natural language processing (NLP). However, more efficient NLP systems are needed to detect various symptoms and distinguish observed symptoms from negated symptoms and medication-related side effects. We evaluated the accuracy of NLP in (1) detecting 14 symptom groups (ie, pain, fatigue, swelling, depressed mood, anxiety, nausea/vomiting, pruritus, headache, shortness of breath, constipation, numbness/tingling, decreased appetite, impaired memory, disturbed sleep) and (2) distinguishing observed symptoms in EHR narratives among patients with cancer. We extracted 902,508 notes for 11,784 unique patients diagnosed with cancer and developed a gold standard corpus of 1,112 notes labeled for presence or absence of 14 symptom groups. We trained an embeddings-augmented NLP system integrating human and machine intelligence and conventional machine learning algorithms. NLP metrics were calculated on a gold standard corpus subset for testing. The interannotator agreement for labeling the gold standard corpus was excellent at 92%. The embeddings-augmented NLP model achieved the best performance (F1 score = 0.877). The highest NLP accuracy was observed in pruritus (F1 score = 0.937) while the lowest accuracy was in swelling (F1 score = 0.787). After classifying the entire data set with embeddings-augmented NLP, we found that 41% of the notes included symptom documentation. Pain was the most documented symptom (29% of all notes) while impaired memory was the least documented (0.7% of all notes). We illustrated the feasibility of detecting 14 symptom groups in EHR narratives and showed that an embeddings-augmented NLP system outperforms conventional machine learning algorithms in detecting symptom information and differentiating observed symptoms from negated symptoms and medication-related side effects.

Patient Preference for Catheter-Based Hypertension Therapy and Subgroup Analysis: A Pilot Study Based on Taiwan Consensus on Renal Denervation.

To understand hypertensive patients' preference for catheter-based therapy to manage hypertension. Survey data regarding catheter-based therapies performed at MacKay Memorial Hospital in Taipei, Taiwan, between 2019-2020 were analyzed. The questionnaire was circulated either in the clinics or during admission. A total of 46 patients completed the questionnaire. A total of 46 patients (mean age 53.4 ± 13.5 years, 78.3% male) completed the questionnaire. In subgroup analysis according to Taiwan renal denervation (RDN) consensus, patients with drug intolerance (61.8% vs. 31.3%, p = 0.02) were more likely to choose RDN. Moreover, although lacking statistical significance, it is noteworthy that numerically more of the resistant hypertension group (55.6% vs. 28.0%, p = 0.09) and non-adherence group (38.5% vs. 30.0%, p = 0.20) were willing to undergo RDN. Conversely, numerically fewer patients with hypertension-mediated organ damage accepted RDN compared to those who did not have hypertension-mediated organ damage (26.1% vs. 43.5%, p = 0.21), although this disparity did not reach statistical significance. Approximately one-third of the patients expressed interest in considering RDN in this study. The most influential factor in patients' preference for RDN was drug intolerance due to medication-related side effects.

A study comparing the effectiveness of ondansetron versus ondansetron combined with dexamethasone for preventing postoperative nausea and vomiting in laparoscopic surgeries

Abstract Background: Postoperative nausea and vomiting (PONV) frequently occur as a side effect of general anesthesia, which can be intensified by the introduction of gas into the peritoneal cavity to create pneumoperitoneum during laparoscopic surgeries. Aims and Objectives: This study examines the comparative effectiveness of ondansetron as a standalone treatment versus its combination with dexamethasone in preventing PONV during laparoscopic surgeries. The research aims to assess the efficacy and duration of anti-nausea and anti-vomiting effects provided by ondansetron alone and in combination with dexamethasone. Materials and Methods: The Institutional Ethics Committee (IEC) approved the trial materials and methods following thorough deliberation. Before surgery, written informed consent was obtained from all patients. Sixty patients were recruited for the study and randomly allocated into groups, denoted as Group O and Group D, each consisting of 30 patients. Group O received intravenous administration of 4 mg of ondansetron, while Group D received a combination of 4 mg of ondansetron and 4 mg of dexamethasone intravenously 30 min before extubation. Duration of Study: The research was conducted at MGM Medical College and Hospital, located in Navi Mumbai, Maharashtra, India, from May 2016 to May 2017. Results: In this study, mild and moderate nausea were more prevalent in Group O at the 4-h mark, but there was no notable difference at 24 h. Mild and moderate retching showed no significant variance at 4 h, but Group O exhibited significantly more at 24 h. Mild, moderate, and severe vomiting were inconsequential in both groups at 4 h, but Group O showed a higher incidence of mild and moderate vomiting at 24 h. Instances of severe vomiting were absent in both groups. The need for rescue antiemetics after 24 h and medication-related side effects did not show significant differences between the two groups. Conclusion: The incidence of PONV was reduced in the combination group (ondansetron + dexamethasone) compared to ondansetron alone. Consequently, the combination group had a lower requirement for rescue antiemetics. Thus, the effectiveness of combination therapy surpassed that of ondansetron alone.

Phenytoin-Induced Ataxia and Diplopia in a Patient with Recent Subarachnoid Hemorrhage: A Case Report

This case report presents a 25-year-old male with a complex medical history, including a recent subarachnoid hemorrhage (SAH) and a prescription for phenytoin. The patient exhibited neurological symptoms, such as ataxia, blurring of vision, and diplopia, prompting an intricate diagnostic evaluation. The medical history encompassed a prior road traffic accident resulting in a jaw injury, adding to the complexity of potential aetiologies, including cerebellar dysfunction, sequelae from the accidents, medication-related side effects (particularly phenytoin), or infectious/inflammatory causes. Given the reported symptoms, there arose a suspicion of phenytoin-induced ataxia and diplopia, common neurological side effects associated with this anticonvulsant. These symptoms, suggestive of cerebellar dysfunction, required a comprehensive examination, including neurological assessments and imaging studies, to elucidate the precise etiology. This case underscores the importance of meticulous medication review, particularly for drugs like phenytoin, and emphasizes the necessity of a multidisciplinary approach involving neurologists to navigate the complexities associated with neurological manifestations in the context of SAH and medication use. The findings contribute to understanding potential complications arising from anticonvulsant therapy in SAH patients and highlight the need for tailored diagnostic and management strategies in such intricate clinical scenarios.

Limitations of GPT-4 as a geriatrician in geri-oncology case conference: A case series.

Generative pre-trained transformer 4 (GPT-4) is an artificial intelligence (AI) system with a chat interface. The number of studies testing GPT-4 in clinical applications has been increasing. We hypothesized that GPT-4 would be able to suggest management strategies for medical issues in elderly oncology patients, similar to those provided by geriatricians. We compared the responses of GPT-4 to those of a geriatrician for four oncological patients. After these case conferences, none of the patients required admission for medical consultation. In three out of four scenarios, GPT-4 was able to offer a multidisciplinary approach in the first prompt. In all three scenarios, GPT-4 identified medication-related side effects and suggested appropriate medications in the first prompt. However, GPT-4 was unable to suggest initial dosages of medications to be used in the first prompt and was unable to suggest a more humanistic and non-pharmacological approach to anorexia, even with a follow-up prompt. In conclusion, GPT-4 may be used as a screening tool to provide potential rudimentary directions for management, which can then be reviewed by medical professionals before considering a formal consultation for more tailored and refined opinions from specialists.

Bullous Pemphigoid Associated with Aspirin Drug Reaction: A Case Report

<p>一位有橫斷性脊髓炎病史規律服用免疫抑制劑移護寧(azathioprine)的64歲男性，因心房顫動以阿斯匹靈(aspirin)治療約一年，來到門診主訴軀幹和大腿出現散佈性紅疹和水泡，經診所開立的抗生素和抗病毒藥物治療未改善，以蜂窩性組織炎診斷收治住院，隨後皮膚切片檢查證實為類天皰瘡，經評估停用阿斯匹靈並以靜脈注射類固醇治療，症狀好轉後出院，並持續接受門診追蹤。類天皰瘡為好發於70歲以上老年人的自體免疫疾病，隨著人口老化、多重共病以及可能引發此疾病的藥物增加，類天皰瘡的發病率在過去幾十年中有所增加，阿斯匹靈在病理機轉上也被指出可能引發類天皰瘡，雖然目前的系統性回顧顯示兩者之間並沒有顯著相關，但有鑒於新藥開發，藥物誘發性皮膚反應增多，若發現病人皮膚出現水泡，合併發燒、喘、低血壓、皮膚疼痛、大面積脫皮或成灰紫色，侵犯眼睛、咽喉或消化道黏膜等應立即停用可能誘發此皮膚表現的藥物，並轉介專科醫師。類天皰瘡的治療以類固醇和免疫抑制劑為主，長期使用可能增加高血壓、糖尿病、骨質疏鬆與感染等風險，病人於後續門診追蹤，基層醫師評估皮膚病灶改善狀況，以每2-3週的頻率減低藥物劑量，並根據病人的年齡和狀況安排藥物相關副作用的檢查。</p> <p> </p><p>A 64-year-old male with a history of transverse myelitis and regular use of immunosuppressive agent azathioprine presented to our outpatient clinic with a complaint of disseminated erythematous rash and blisters on the trunk and thighs. He had been treated with aspirin for atrial fibrillation for about a year. Despite treatment with antibiotics and antiviral medications prescribed by the clinic, the symptoms did not improve, and he was admitted to the hospital with a diagnosis of cellulitis. Subsequent skin biopsy confirmed the diagnosis of bullous pemphigoid. After further assessments, aspirin was discontinued, and intravenous corticosteroid therapy was initiated, leading to symptom improvement. The patient was later discharged for follow-up in the outpatient clinic. Bullous pemphigoid is an autoimmune disease that predominantly affects elderly individuals aged 70 and above. Due to multiple comorbidities and increased use of medications that may trigger this disease, the incidence of bullous pemphigoid has been on the rise in recent decades among the elderly population. Aspirin has been suggested to be a potential trigger for bullous pemphigoid in its pathophysiology. Although current systematic reviews do not show a significant association between the two, the increased development of drug-induced skin reactions with the advent of new medications warrants caution. If a patient develops blisters on the skin, along with fever, wheezing, hypotension, skin pain, extensive peeling, or a grayish-purple discoloration, or if the condition affects the eyes, throat, or gastrointestinal mucosa, the medication potentially causing this skin manifestation should be discontinued immediately, and the patient should be referred to a specialist. </p> <p> The treatment of bullous pemphigoid primarily involves steroids and immunosuppressive agents. Long-term use of these medications may increase the risk of side effects such as hypertension, diabetes, osteoporosis, and infections. After patients return to outpatient follow-up, primary care physicians should carefully assess whether the skin lesions have improved. Medication dosage should be gradually reduced with a frequency of every 2-3 weeks, and examinations for medication-related side effects should be arranged based on the patient’s age and condition.</p> <p> </p>

The Effect of Patient Safety Experience on Patient Satisfaction of Patients Using Outpatient Health Services in Hospitals/Clinics

Objectives: The aim of this study is to identify outpatients’ experiences of patient safety, patient satisfaction levels, and examine the factors influencing on patients’ satisfaction. Methods: Data from the Survey on the Experience with Healthcare Service in 2021 were used for this secondary analysis. Data from 6,027 patients aged over 20 who experienced outpatient health services in hospitals or clinics were analyzed. Logistic regression analysis was carried out to explore as influential factors which are patient characteristics, health-related characteristics, and their experiences of patient safety. Results: Generally, the level of patient satisfaction was high as 90.6% of participants were satisfied with the received outpatient care. High patient satisfaction was related to gender (females), job (housewives), education level (below secondary education level) and perceived health status (good status). Besides, those who experience being educated the side effects related to the medications or no checking the safety facilities of medical institutions were more likely to satisfy with the outpatient care. Conclusions: It is revealed that demographic and health-related characteristics, and patient safety experiences affected patients’ satisfaction with outpatient health services. To improve overall patients’ satisfaction with outpatient care, it is needed to enhance nonclinical patient safety activities such as explaining medication related side effects for patients.

CURRENT ADVANCEMENTS AND COMPLICATIONS IN INTRATHECAL DRUG DELIVERY SYSTEM

Intrathecal drug delivery systems (IDDS) have emerged as a valuable treatment option for patients with chronic pain who have failed to achieve adequate relief with conventional therapies. These systems provide targeted delivery of medications directly to the cerebrospinal fluid, resulting in improved pain control and reduced systemic side effects. However, the use of IDDS is not without potential complications and considerations that must be addressed to ensure optimal patient outcomes. This comprehensive review examines the various complications associated with IDDS and the considerations that healthcare providers and patients need to be aware of. Surgical complications, such as infection, bleeding, spinal fluid leaks, and nerve damage, are discussed, along with strategies to minimize these risks. Device malfunctions, including pump failure, catheter issues, and electronic problems, are explored, highlighting the importance of regular monitoring and maintenance. Medication-related side effects, such as nausea, sedation, and respiratory depression, are addressed, emphasizing the need for close monitoring and appropriate dosage adjustments. Long-term considerations, including tolerance to medication, physical dependence, and withdrawal symptoms, are also examined, emphasizing the significance of gradual tapering and proper discontinuation protocols. The review underscores the importance of regular follow-up appointments to assess the system's functionality, medication dosages, and patient response to treatment. By proactively managing and addressing complications, healthcare providers can optimize pain relief and minimize adverse effects, ensuring the long-term effectiveness and safety of IDDS.

Genetic markers of children asthma: predisposition to disease course variants.

Asthma is a heterogeneous and often difficult to treat condition that results in a disproportionate cost to healthcare systems. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. An important therapeutic focus is to achieve disease control, which is supposed to involve a personalized approach to treatment of asthma of any severity. Asthma is a multifactorial disease with a significant genetic determinant, however, the inheritance of asthma has not been fully elucidated. Polymorphic genes of inflammatory mediators, including cytokines, play an important role in developing various disease forms. In the current study, large-scale original data on the prevalence of cytokine gene genotypes (IL2, IL4, IL5, IL6, IL10, IL12, IL13, IL17A, IL31, IL33, IFNG, TNFA) among Russian children with asthma in Krasnoyarsk region have been obtained. Genotyping was carried out using real-time PCR. We identified markers predisposing to the development of different variants of the course of childhood asthma: the CT genotype and T allele of IL4 rs2243250 are associated with asthma (p < 0.05), especially in mild asthma and in controlled asthma. The TT genotype and allele T of IL13 rs1800925 are associated with severe and uncontrolled asthma (p < 0.05). The AA genotype of IL17A rs2275913, the TT genotype of IFNG rs2069705 and allelic A variants of TNFA rs1800629 are associated with mild asthma, and the TT genotype of IFNG rs2069705 is additionally associated with controlled asthma. The results obtained will supplement information on the prevalence of polymorphic variants of the cytokine genes in the Russian population and in asthma patients with different disease courses, which is likely to be used in order to shape a plan for Public Health Authority to prevent the development of severe uncontrolled asthma and to optimize personalized therapy.

Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure.

Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients. To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan. The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence. Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants. The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.

Standardizing the Diagnostic and Therapeutic Approach to Newly Diagnosed Children with ITP: Prospective Data from the ITP Consortium of North America (ICON) Quality Improvement Initiative

Background Pediatric immune thrombocytopenia (ITP) is an acquired autoimmune disorder which leads to a low platelet count and increased risk of bleeding. Despite published treatment guidelines, there is practice variation among clinicians and institutions due to the low grade of available evidence. The recommended management of newly diagnosed children at low risk of serious bleeding is observation; despite this, these patients are often treated with medication. These medications are only transiently effective with potential for side effects and excess lab monitoring as well as associated with increased costs and overuse of healthcare resources due to hospital admissions and encounters for medication-related side effects. Our objective is to report prospective data from a quality improvement (QI) project of the Pediatric ITP Consortium of North America (ICON) that was initiated in 2020 to improve consistency in clinical practice using national ITP guidelines. DESIGN/METHODS Within the ICON QI subcommittee, a standardized clinical care pathway for newly diagnosed childhood ITP was developed based on the American Society of Hematology (ASH) 2019 guidelines. Sites initially completed a retrospective analysis documenting the pre-QI pathway management of children, ages 1-16 years, diagnosed with ITP from January to December 2019. After local dissemination of the clinical care pathway, clinicians at all participating sites reviewed the pathway at the time of managing newly diagnosed children and completed a short survey documenting a modified Buchanan-Adix bleeding score and management decisions. Chart review was completed six months following ITP diagnosis to collect data regarding additional treatment or hospitalization. For retrospective data, total patients include those with available data. Results Retrospective data were collected from 7 centers for 205 patients managed for newly diagnosed ITP. In this pre-intervention cohort, 0.5% of patients (1/204) had a bleeding score documented at their initial visit. Most patients (63%,129/204) received initial medication treatment including intravenous immunoglobulin (54%), corticosteroids (9%), and anti-D/other (3%); 37% (75/204) were initially observed. In the 6 months after diagnosis, 11% (23/205) were admitted to the hospital for management of ITP. The ITP QI pathway was implemented prospectively in the care of 126 patients from 7 centers between November 2020 and July 2022. Of these patients,100% (126/126) had a bleeding score documented at their initial visit [Grade 0 (2%), Grade 1 (26%), Grade 2 (27%), Grade 3 (45%), Grade 4 (0%)]. Initial treatment included close observation in the majority (63%, 79/125) and medication treatment in 37% [corticosteroids (22%, 28/125) and IVIG/anti-D (14%, 18/125)] (Figure 1). Most patients were managed per the pathway according to their bleeding score (80%, 93/117). The most common reasons that providers deviated from the pathway were parent preference (50%, 12/24) and provider concern about bleeding risk (29%, 7/24). Of those with low level grade 3 bleeding, in whom the pathway suggested close observation, 62% (21/34) were observed and 38% of patients (13/34) were treated with medication (Figure 2). For patients with high level grade 3 bleeding, in whom the pathway suggested medication treatment, all patients except one were treated with medication. Of the 66 patients with 6 month follow up data, only 2 patients (3%, 2/66) were admitted to the hospital. DISCUSSION For children with newly diagnosed ITP and a platelet count <20 x 109/L who have no or mild bleeding, ASH guidelines suggest observation rather than treatment with corticosteroids. Implementation of an ITP clinical care pathway based on bleeding score led to an increase in the number of children observed. In contrast to the pre-intervention cohort, most patients treated with medication received corticosteroids rather than IVIG as per ASH guidelines. Despite the increase in patients managed with close observation, just 3% were admitted to the hospital within the first 6 months of diagnosis compared to 11% of the retrospective cohort. Our findings suggest that the use of a clinical care pathway based on objective assessment of bleeding symptoms increases management with close observation when indicated in the treatment of childhood ITP without a subsequent increase in hospitalization and increases adherence to national guidelines. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Imaging Review of Gastrointestinal Motility Disorders.

The motor function of the gastrointestinal tract relies on the enteric nervous system, which includes neurons spanning from the esophagus to the internal anal sphincter. Disorders of gastrointestinal motility arise as a result of disease within the affected portion of the enteric nervous system and may be caused by a wide array of underlying diseases. The etiology of motility disorders may be primary or due to secondary causes related to infection or inflammation, congenital abnormalities, metabolic disturbances, systemic illness, or medication-related side effects. The symptoms of gastrointestinal dysmotility tend to be nonspecific and may cause diagnostic difficulty. Therefore, evaluation of motility disorders requires a combination of clinical, radiologic, and endoscopic or manometric testing. Radiologic studies including fluoroscopy, CT, MRI, and nuclear scintigraphy allow exclusion of alternative pathologic conditions and serve as adjuncts to endoscopy and manometry to determine the appropriate diagnosis. Additionally, radiologist understanding of clinical evaluation of motility disorders is necessary for guiding referring clinicians and appropriately imaging patients. New developments and advances in imaging techniques have allowed improved assessment and diagnosis of motility disorders, which will continue to improve patient treatment options. Online supplemental material is available for this article. ©RSNA, 2022.

Gastrointestinal Manifestations in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disorder of unknown etiology. Women of childbearing age are affected approximately nine times more often than men. Its presentation and course are highly variable, ranging from mild to fulminant systemic disease. Any organ can be affected by SLE. Although less common than in other systems, such as the skin, joints, and kidneys, 40%–60% of SLE patients have gastrointestinal (GI) involvement. SLE can affect any part of the GI tract, from the mouth to the anus. GI manifestations can be caused by SLE, medication-related side effects, or non-SLE causes including infection. This article reviews the most common types of GI involvement associated with SLE.

Chemotherapy-associated oral microbiome changes in breast cancer patients.

Cytotoxic chemotherapy with or without a combination of humanized monoclonal antibodies is regarded as the gold standard of personalized medicine for the treatment of breast cancer patients. Significant medication-related side effects are common accompanying phenomena for these patients, such as oral discomfort, mucositis, or even osteonecrosis of the jaw. In this study, we analyze the saliva samples of 20 breast cancer patients at three time points throughout their chemotherapy: at the baseline prior to treatment initiation (T1), after four-to-six cycles of chemotherapy (T2), and 1 year after the start of the treatment (T3) to investigate and characterize the long-term effects of chemotherapy on the oral microbiome. We aimed to characterize changes in the oral bacterial microbiome based on 16S rRNA gene amplicon analysis during chemotherapeutic treatment, as a potential target to treat common oral side effects occurring during therapy. The chemotherapeutic drugs used in our study for patient treatment were trastuzumab, docetaxel, pertuzumab, epirubicin, and cyclophosphamide. We find a significant increase in the relative abundance of potentially pathogenic taxa like Escherichia/Shigella and non-significant trends in the relative abundance of, for example, Actinomyces ssp. In conclusion, the role of microbiota in the oral side effects of chemotherapeutic treatment needs to be considered and should be analyzed in more detail using larger patient cohorts. Oral side effects in breast cancer patients undergoing chemotherapy are a common burden and should be treated for a better tolerability of the therapy.

Is Maintenance of Sinus Rhythm of Value in Patients with Atrial Fibrillation and Heart Failure?

Heart failure (HF) and atrial fibrillation (AF) frequently co-exist, with the prevalence of AF increasing in patients with more advanced HF symptoms. When present, AF increases morbidity and mortality in patients with HF. The purpose of this review is to examine emerging evidence addressing the value of restoration and maintenance of sinus rhythm in patients with HF. Earlier trials comparing a rhythm control strategy with antiarrhythmic drugs have failed to demonstrate benefit in patients with HF and reduced ejection fraction. More recent trials, including the recently published RAFT-AF, utilizing catheter ablation for rhythm control, have shown greater promise, possibly due to reduced medication-related side effects and higher efficacy in maintaining sinus rhythm. A strategy of sinus rhythm maintenance with catheter ablation appears to improve mortality, reduce HF events and improve quality of life in patients with AF and HF.

Error traps in acute pain management in children.

Providing effective acute pain management to hospitalized children can help improve outcomes, decrease length of stay, and increase patient and parental satisfaction. Error traps (circumstances that lead to erroneous actions or undesirable consequences) can result in inadequately controlled pain, unnecessary side effects, and adverse events. This article highlights five error traps encountered when managing acute pain in children. They include failure to appropriately assess pain, optimally utilize regional anesthesia, select suitable systemic analgesics, identify and treat medication-related side effects, and consider patient characteristics when choosing medication or dosing route. These issues are easily addressed when the clinician is cognizant of ways to anticipate, identify, and mitigate or avoid these errors.

Combination of ketamine, corticosteroids and sevoflurane inhibits the risk of bronchospasm in intubated children under general anesthesia

Asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. In the study, an asthmatic child with a recent cold, received general anesthesia for emergency surgery centered on sevoflurane, corticosteroids and ketamine. The purpose of this study is to demonstrate the beneficial effects of the combination of sevoflurane, ketamine and corticosteroids in asthmatic children and to prevent complications when they are given general anesthesia for emergency surgery.

Development of a New Patient-Reported Medication Adherence Instrument: Concerns Influencing Medication Adherence.

PurposeThe purpose of this research was to conceptualize and develop a tool for identifying persons who are, or are likely to be, non-adherent to medications prescribed by their healthcare provider(s) by identifying concerns that patients have regarding their treatments.Patients and MethodsThe target populations were persons diagnosed with atrial fibrillation or osteoarthritis, who were prescribed anticoagulants or over-the-counter or prescription pain medications, respectively. In this two-stage, multi-year, qualitative research study, relevant concepts were explored, confirmed and refined. The focus was on non-adherence due to active (thus potentially modifiable) patient decisions to forego taking medications as prescribed.ResultsThe most common concerns among participants with atrial fibrillation were medication-related side effects and fear of bleeding. Participants with osteoarthritis were most concerned about short-term stomach problems and long-term kidney and liver side effects. The Concerns Influencing Medication Adherence (CIMA) instrument was developed based on these concerns and those identified in the literature. It is comprised of 16 items: a core set of 11 items potentially applicable to multiple disease states, 3 items specific to atrial fibrillation, and 2 items unique to osteoarthritis. The instrument is intended to be completed electronically, and publicly available for use in direct patient care in the United States or in population health management.ConclusionTo our knowledge, this is the first instrument focused on medication adherence that includes documented details of patient input as recommended by the United States Food and Drug Administration guidance. Patient input is considered a key component of content validity. In this research, for example, the concerns that patients have regarding their treatments can be expected to have affected past medication adherence and can potentially impact future adherence. Although applicability outside atrial fibrillation or osteoarthritis was not assessed, the general items may be useful in assessing adherence in other chronic diseases.