Multidisciplinary Health Care Research Articles

Giving voice to the voiceless: Understanding the perceived needs of dementia family carers in Soweto, a South African township.

This qualitative study aimed to provide family caregivers with an independent platform to reflect on and identify their needs in the role of dementia caregiver. Thirty caregivers were interviewed using a semi-structured approach, and data analysis followed a reflective thematic analysis method. The study revealed that Black African caregivers in townships require sufficient information and orientation to dementia-specific services, psychoeducation on dementia as a disease and its behavioural manifestations, as well as practical skills to manage the disease process. Caregivers expressed the need for in-depth, accessible education to boost their confidence and resilience in handling the challenges of dementia caregiving. They also proposed community initiatives to raise awareness, promote knowledge, and facilitate early detection and diagnosis of dementia. Additional needs included informational and educational workshops, resources like transportation services and helplines, day care facilities, media campaigns, and collaboration with the government for funding and policy change. New caregivers were advised to seek comprehensive education, support, and services while preserving the dignity of their family members with dementia. Remarkably, the identified needs and community initiatives aligned with the priority areas outlined by ADI for a National Dementia Plan, which South Africa currently lacks. The study highlights the importance of developing a National Dementia Plan in South Africa through collaboration among stakeholders, including communities, policy-makers, and multidisciplinary healthcare teams, while ensuring that individuals and families affected by dementia have a voice.

Is it "all in the bag?"Multidisciplinary perspectives on ostomy surgery in pediatric IBD across the ImproveCareNow network.

Pediatric inflammatory bowel disease (IBD) is a chronic illness with various treatments, including ostomy surgery. Ostomy-related medical decision-making (MDM) is complex for multidisciplinary healthcare professionals (HCPs). This study sought to understand national multidisciplinary HCPs' perceptions about pediatric IBD ostomy surgery in the United States. This cross-sectional REDCap survey recruited HCPs in pediatric IBD HCP roles from the ImproveCareNow (ICN) Learning Health System. The survey gathered data on, (1) demographics, (2) participants'perspectives on patients/families'ostomy perceptions,(3) participants'own perspectives on ostomies, and (4) participants'perspectives on multidisciplinary collaboration in ostomy surgery. Participants (n = 69, across n = 30 American ICN sites) were 84% White, 62% female, and 54% gastroenterologists. In reflecting on patients/families'perceptions, participants endorsed most (86%) view ostomies as a "failure," various psychosocial concerns (e.g., 97% endorsed body image concerns), and most (81%) have moderate to significant stigma about ostomies. In reflecting on their own perceptions, nearly half (44%) endorsed some to moderate stigma about ostomies and felt ostomy discussions were difficult when families had negative perceptions (88%). Over half (54%) endorsed currently having multidisciplinary care for pediatric IBD surgery. Most (70%) endorsed variability in the amount and/or quality of multidisciplinary collaboration. MDM related to pediatric IBD ostomy surgery presents nuanced clinical complexities for HCPs. This work underscores interest in multidisciplinary care, notable ostomy-related psychosocial needs, and ostomy-related stigma. Future work should develop systematic approaches to multidisciplinary pediatric IBD ostomy care, bolster psychosocial support, and evaluate how systematic care may impact psychosocial, and healthcare utilization outcomes.

Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach.

There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT). Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41). The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT. The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.

Remote pulmonary rehabilitation for interstitial lung disease: developing the model using experience-based codesign

BackgroundRemote delivery may improve access to pulmonary rehabilitation (PR). Existing studies are largely limited to individuals with COPD, and the interventions have lacked codesign elements to reflect the needs and...

Abstract WP53: Bringing Comprehensive Stroke Care Home: Supporting Early Supported Discharge

Background and Issues: Despite holding the highest certification as a Comprehensive Stroke Center, the project site's 'Discharge-to-Home' performance for ischemic stroke survivors ranked below the median compared to similar academic medical centers. Although an innovative Early Supported Discharge (ESD) program was available for patients who met geographical criteria, the utilization of these services was not optimal. Purpose: This Quality Improvement initiative aimed to investigate the impact of an early collaborative discharge planning process led by a multidisciplinary healthcare team on 'Discharge-to-Home' rates of ischemic stroke patients eligible for the site's ESD program, Homeward Stroke Recovery. Methods: Meleis' Transition Theory was used to shape the development of streamlined workflows, simplifying the identification of eligible patients and reducing the time taken to refer them to Homeward Stroke Recovery through enhancements to the electronic medical record system. Additionally, robust team education was provided to improve discharge coordination and improve the utilization of available ESD services. Existing system data was leveraged, and new data flows were created to monitor program-specific metrics. Descriptive statistics were used to examine the effect of an early collaborative discharge planning process on ‘Homeward Stroke Recovery Discharge Rates’ for ischemic stroke survivors. Results: There was a notable increase of 5.6% in the 'Homeward Stroke Recovery Discharge Rate' from Fiscal Year 2022 to Fiscal Year 2023 (rising from 43.9% to 49.5%). Conclusions: In conclusion, this Quality Improvement project successfully addressed the challenge of suboptimal 'Discharge-to-Home' rates for ischemic stroke patients eligible for the site’s ESD program. The observed 5.6% increase in the 'Homeward Stroke Recovery Discharge Rate' between Fiscal Year 2022 and Fiscal Year 2023 reflects the positive impact of the interventions performed, highlighting the importance of multidisciplinary teamwork and systematic improvements in healthcare delivery.

Adolescents on an inpatient unit and their healthcare providers: what's working and what's not.

Adolescents admitted to hospital can face unique medical and psychosocial challenges, and may be treated by healthcare providers who do not recognize or adequately address these needs. Our goal was to better understand the experiences of both patients and providers at a local level. We designed a cross-sectional survey-based study of two participant groups: (1) adolescent patients (aged 10-19) admitted to general medical wards at a tertiary pediatric hospital and (2) pediatric healthcare providers representing multiple disciplines. A total of 65 individuals participated: 25 adolescents (mean age 14.6; range 11-17) and 40 multidisciplinary healthcare providers. Most adolescents reported being treated respectfully (88 %) and taken seriously (92 %) by their providers. Several identified structure and routine, a break from daily stressors, and quality time with loved ones as positive aspects to hospitalization, while the use of correct gender pronouns, privacy, and age-appropriate leisure activities were cited areas for improvement. The majority of providers reported enjoying caring for adolescents (82 %) and forging therapeutic connections with them (87 %). Several areas of discomfort were noted, including gender and sexuality, substance use, and suicidality. Identified care gaps included inadequate training/education, suboptimal ward environments, and lack of community resources. Hospitals should recognize adolescent patients' needs for privacy, youth-centered communication, and developmentally-appropriate spaces. Pediatric healthcare professionals generally enjoy providing care to adolescents in the in-patient setting, however, often have insufficient training in addressing adolescent-specific health and psychosocial issues.

ADJUBIL: A phase II study of immunotherapy with durvalumab and tremelimumab in combination with capecitabine or without capecitabine in adjuvant situation for biliary tract cancer.

TPS583 Background: Despite improvements in multidisciplinary healthcare, patients with biliary tract cancer (BTC) have a poor outcome and effective treatment options are limited. Only 20 % of patients are eligible for surgical resection with curative intent, with 5-year overall survival rates < 10 % for all patients. Data on adjuvant chemotherapy alone for BTC are conflicting, and the SOC is treatment with capecitabine according to the UK BILCAP trial, even though BILCAP was formally negative. Based on the positive data for durvalumab in the TOPAZ-1 trial in BTC and for the STRIDE regimen in HCC according to the Himalaya trial data, the evaluation of the IO combination in the adjuvant setting seems promising. Also, the MediTreme trial showed promising response rates in BTC. Preclinical studies indicate that the antibody combination leads to stronger and more durable anti-tumour effects than single therapies, as it synergistically modulates the tumour's immunosuppressive microenvironment, which is particularly pronounced in cholangiocarcinoma. The aim of the ADJUBIL trial is to evaluate the clinical activity of the anti-PD-L1 (programmed-death 1 ligand) antibody durvalumab and the anti-CTLA-4 (cytotoxic T- lymphocyte-associated antigen 4) antibody tremelimumab in combination with or without capecitabine in patients with respectable BTC in the adjuvant setting. This is a randomized phase II study with a pick-the-winner design. The winner of ADJUBIL could be tested against the current SOC capecitabine in a subsequent phase 2/3 trial. Methods: The ADJUBIL trial is an open-label, multicenter phase II study, including patients with BTC after curative surgery (R0/R1) with no previous systemic treatment. Patients are randomized (1:1) to receive either tremelimumab (300 mg, one dose on C1D1) plus durvalumab (1500 mg every 4 weeks; max. 12 months), with or without capecitabine (1250 mg/m2 twice a day on day 1-14 of 3-weekly cycles; max. 8 cycles). 40 evaluable patients will be enrolled in the study to receive anticancer treatment until disease recurrence or intolerable toxicities. Primary objective is to assess the anti-tumor activity of the treatment in both arms by the recurrence-free survival rate after 12 months. Secondary endpoints are recurrence-free survival, overall survival, toxicity, and quality of life. Exploratory endpoints are to identify predictive biomarkers for recurrence-free survival and overall survival. Study start of the ADJUBIL trial was in June 2021. By September 2023, 15 centers in Germany have been activated and 23 out of 40 planned patients have been enrolled. The first 5 patients in each arm were subject to a safety lead-in phase with close monitoring of (serious) adverse events. The safety assessment revealed no concerns. The study is ongoing. Clinical trial information: NCT05239169 .

Proactive Risk Management using Healthcare Failure Mode Effect Analysis Tool to Improve Medication Management Process

Proactive risk management program is essential to maintain the quality and safety of patient care, treatment, and services within a healthcare system. According to the Joint Commission, hospitals need to adopt a proactive approach for risk management and develop risk mitigation strategies to reduce or eliminate the potentially harmful impact of possible risk. There are multiple tools that can be used for proactive analysis. Leaders of Evercare hospital Dhaka selected Healthcare FMEA tool to identify the potential failure modes in the current medication management process as it is one of the complex and high processes in healthcare settings. A multidisciplinary Healthcare FMEA team was formed comprising physician, nurse, pharmacist, quality, IT personnel and senior managements of EHD to conduct Healthcare FMEA. After completing Healthcare FMEA, twenty failure modes(n-20) and fifty-nine potential causes(n-59) of failure modes were detected in existing medication management process of EHD. The hazardous score was Two hundred & seventeen (n-217). There were Twelve major failures modes with higher hazardous score. Healthcare FMEA team members decided to eliminate major failures and actions were taken to control these failures. The main objective of this study is to maintain the medication error of EHD within the target (2/1000 patient days) by implementing required strategies and redesigning existing medication management process. The limitation of this study was it is a time-consuming process, it only helps to identify the possibilities of fail; it does not eliminate them, additional efforts are required to develop corrective action. Pulse Vol.15, 2023 P: 28-33

Publicly funded healthcare costs associated with orofacial clefts for children born in Alberta, Canada between 2002 and 2018.

Orofacial clefts (OFCs) include cleft palate (CP), cleft lip (CL), and cleft lip with cleft palate (CLP) and require multidisciplinary healthcare services. Alberta, Canada has a publicly funded, universal access healthcare system. This study determined publicly funded healthcare costs for children with an OFC and compared these costs to children without congenital anomalies. This retrospective population-based cohort analysis used the Alberta Congenital Anomalies Surveillance System to identify children born between 2002 and 2018 with an isolated OFC. They were matched 1:1 to a reference cohort based on sex and year of birth. The study population included 1614 children, from birth to 17 years of age linked to administrative databases to estimate annual inpatient and outpatient costs. Average annual all-cause costs were compared using two-sample independent t tests. The mean total cleft-related costs per patient were highest for children with CLP ($74,138 CAD, standard deviation (SD) $43,447 CAD), followed by CP ($53,062 CAD, SD $74,366 CAD), and CL ($35,288 CAD, SD $49,720 CAD). The mean total all-cause costs per child were statistically significantly higher (p < .001) in children with an OFC ($56,305 CAD, SD $57,744 CAD) compared to children without a congenital anomaly ($18,600 CAD, SD $61,300 CAD). Despite public health strategies to mitigate risk factors, the trend for OFCs has remained stable in Alberta, Canada for over 20 years. The costs reported are useful to other jurisdictions for comparison, and to families, healthcare professionals, service planners, and policy makers.

PROCare4Life integrated care model validation

This article focuses on reporting the methodology and results of the EU funded project PROCare4Life, whose main goal has been to develop an integrated, personalised, IT system, to empower and improve the Quality of Life of elderly people living with Parkinsons’, Alzheimer’s or other dementia. Research has been implemented to evaluate the results against PROCare4Life integrated care strategy. Multimethod, quantitative, and qualitative research has been performed, profiting from the pilot 3 results gathered by consortium members. The article has been organised according to the research questions, which were based on the expected results by PROCare4Life that might relate to supporting the future integration of care when the system is further developed and integrated into healthcare provision organisations. The PROCare4Life system is a digital tool that includes features that might support the advance of the integration of care, such as data sharing among multidisciplinary healthcare professionals and with patients and caregivers, the enhancement of direct communication among them or the constant sharing of the data monitored by the PROCare4Life system. TRL 7 was achieved by the final prototype of the PROCare4Life system. Pilot representatives consider the PROCare4Life idea and underlying model of care very innovative and promising, and believe it can certainly improve care practice through more enhanced integrated care. It is usable for people of different ages, conditions, socioeconomic levels. It has been assessed to be more effective for elderly people living with Parkinson’s than with dementia. Patients and caregivers indicated that the system helped them reduce their anxiety and increase their quality of life. Although overall assessment of the system by healthcare professionals was positive, divided opinions were shared on its capability to save time. Requirements for future scalability have been included in the last section.

The Relationship Between Perceived Stress and Coping Styles in Women Following Breast Cancer Surgery: A Cross-sectional Descriptive Study

Purpose: The present study aimed to examine therelationship between perceived stress levels andcoping styles of women with breast cancer.Materials and Methods: This descriptive and crosssectional study was carried out with 132 women whounderwent breast cancer surgery at a training andresearch hospital in Turkey between March andOctober 2021. Data were collected face-to-facemethod before the discharge from the hospital via thePersonal Information Form, the Perceived StressScale, and the Brief Cope Inventory. Data wereanalyzed with descriptive statistics, independentsample t-test, One-Way ANOVA and Pearsoncorrelation analysis.Results: It was found that women who hadsecondary or above education, were housewives, had comorbidities, had undergone a total radicalmastectomy, and were supported by their childrenduring the disease had higher perceived stress levels(p&lt;0.05). Women without social security had lowercoping styles (p&lt;0.05). On the other hand, there wasa significant negative relationship between women'sperceived stress levels and their coping styles(p&lt;0.05).Conclusions: The results emphasize the importanceof evaluating the perceived stress levels and copingstyles of women undergoing breast cancer surgeryby the multidisciplinary healthcare team andproviding counseling on this issue.

Assistência fisioterapêutica a indivíduos com Acidente Vascular Encefálico residentes na comunidade na atenção básica no Brasil: um estudo transversal

ABSTRACT After hospital discharge, it is recommended that post-stroke individuals receive follow-up by a physical therapist throughout all the stages of recovery. Despite clinical recommendations, few studies have investigated physical therapy care to community-dwelling individuals with stroke. This study aimed to describe physical therapy care to community-dwelling individuals with stroke in primary care setting and identify clinical-functional and sociodemographic characteristics that determined physical therapy assistance. This is an exploratory cross-sectional study. Community-dwelling individuals with stroke who were assisted by the primary healthcare team from an important Brazilian metropolis were included. Their medical records were analyzed to identify the care provided by physical therapists. Individuals who received and did not receive physical therapy care were compared (α=0.05). Out of the 100 included individuals, 55% received assistance from the multidisciplinary primary healthcare team and 44% from physical therapists. Physical therapy approaches consisted mainly of general orientations (89%) and assessments (75%). Only 45% of the individuals who received physical therapy care were followed-up, and those who received this type of care had significantly more stroke events and higher levels of disability (p&lt;0.001). It was observed that many individuals with various levels of disabilities have not received physical therapist assistance. Moreover, follow-up care and referrals were not frequent physical therapy approaches. Therefore, physical therapy care in primary care needs to be expanded to ensure that all individuals with some level of disability receive treatment. Moreover, it is necessary to increase the number of individuals receiving follow-up and encourage multidisciplinary work between physical therapists and other primary healthcare professionals.

Qualidade de vida relacionada à saúde de uma criança com Trissomia 21 e Leucemia Mieloide Aguda: relato de caso

ABSTRACT Trisomy 21 (Down syndrome) is a genetic condition arising from the presence of three chromosomes at position 21. Individuals diagnosed with this syndrome have a greater likelihood of developing systemic problems, as well as cognitive, developmental, and psychiatric disorders. This paper reports a case of a child with Down syndrome under treatment for acute myeloid leukemia, emphasizing its impact on quality of life. The mother’ perception on health-related quality of life (HRQoL) was measuredby the Pediatric Quality of Life Inventory (PedsQL), Generic Core and Cancer Module Scales. The mother’s perception shown that physical and functional functioning indicated a higher negative impact on the child’s life. The lowest scores were in the domains nausea and anxiety about the procedure. Intraoral examination revealed an incomplete primary dentition with ectopic eruption. The child has had a multidisciplinary health care approach (pediatrician, hematologist, gastroenterologist, cardiologist, physiotherapist and dentist). Therefore, it is essential that health professionals, including dentists, to incorporateinto their practice the knowledge on the difficulties and emotional aspects of this population, providinga patient-centered humanized care.

Health Promoting Self-Care: Evaluating the Impact of 28-Day Food and Fitness Program on the Physical and Mental Well-Being of Health Care Workers

The aim of this pilot study was to evaluate the impact of the 28-Day Food and Fitness Program on the physical and mental well-being of health care workers. Social determinants of health significantly impact an individual’s overall well-being and quality of life. Access to nutritious foods and physical activity is crucial to positive physical and mental well-being. The urgency for hospital executives, administrators, and leaders to prioritize the physical and mental well-being of health care workers has become increasingly evident with unprecedented rates of burnout, stress, and turnover following the COVID-19 pandemic. This 8-week prospective cohort study followed 65 multidisciplinary health care workers from a single Santa Monica, California, hospital, who voluntarily signed-up for a 28-day Food and Fitness Program in the spring of 2022. Participants completed body composition testing pre- and-post-intervention, and were surveyed using the Professional Quality of Life (ProQOL) scale at baseline, 28 days (4 weeks), and 56 days (8 weeks). Pre- and-post-intervention data showed nonsignificant decreases in variables such as weight and body mass index with increases in lean body and skeletal muscle mass. Mean scores for all 3 subcategories of the ProQOL numerically improved from baseline, but did not reach statistical significance. Preliminary results support use of the 28-Day Food and Fitness Program to improve caregiver physical and mental well-being, but further research is needed to quantify impact more reliably.

Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team.

Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.

Cardiovascular Consequences of Sickle Cell Disease.

Sickle cell disease is an inherited blood disorder which can lead to severe complications, particularly in the cardiovascular and respiratory systems, potentially resulting in arrhythmias, pulmonary hypertension (PH), and cardiomegaly. This study aims to investigate the risk of PH and arrhythmias in adult SCD patients. Retrospective analysis of medical records from King Abdulaziz University Hospital (KAUH) for patients with SCD aged 15 and above between 2009 and 2021. The study included 517 patients, with echocardiograms and electrocardiograms assessed according to the European Society of Cardiology/the European Respiratory Society (ESC/ERS) guidelines for categorizing PH risk (low, moderate, high) and detecting arrhythmias. Data analysis employed the Statistical Package for the Social Sciences (SPSS), utilizing quantitative and qualitative data representation. Multivariate logistic regression identified independent risk factors with odds ratios at a 95% confidence interval (CI). Among participants, 50.3% were male, with a total sample average age of 34.45 ± 9.28 years. Results indicated that 1.4% of patients experienced arrhythmias, 3.7% had a moderate PH risk, and 3.3% were classified as high PH risk. Logistic regression revealed significant independent risk factors for PH and arrhythmia in patients with SCD, with chronic kidney disease (CKD) carrying the highest odds (26.4 times higher odds of PH and 15.36 times higher odds of arrhythmias). Patients with SCD are at risk for developing PH and various arrhythmias but are often underdiagnosed. Key risk factors for PH included CKD, liver cirrhosis, and pre-existing cardiac conditions. Arrhythmias were significantly associated with CKD and pre-existing cardiac conditions. To mitigate these risks, we recommend involving a multidisciplinary healthcare team in the care of adult patients with SCD. Future prospective studies are advised for early detection of PH and arrhythmias in hemoglobinopathy patients, potentially reducing mortality.

Câncer bucal e reabilitação protética: como reage o paciente?

ABSTRACT Objective: The aim of this study was to evaluate the comprehension of dental practitioners regarding the complexities encountered by patients undergoing prosthetic rehabilitation following oral cancer surgery. Methods: This research employed a descriptive-quantitative approach. The study population comprised 37 dentists representing various specialized fields located in Montes Claros, Minas Gerais, Brazil. Data were gathered through an online semi-structured questionnaire designed to elicit insights into the knowledge and perceptions of these professionals pertaining to prosthetic rehabilitation in post-oral cancer surgery patients. Results: The results indicated that 75.7% of the participants reported a high level of patient satisfaction with prosthetic treatment. Notable improvements were observed in mastication (94.6%), respiration (35.1%), oral muscle function (48.6%), phonation (56.8%), overall health (59.5%), self-esteem (100.0%), and occlusion (62.2%). Furthermore, the presence of a multidisciplinary healthcare team for managing these patients was noted. Conclusion: In conclusion, it can be inferred that dentists possess a comprehensive understanding of the diverse challenges confronted by patients in the context of prosthetic rehabilitation following oral oncologic surgery. Additionally, the study underscores the pivotal role of prosthetic rehabilitation in enhancing patients’ functional abilities, aesthetics, and overall comfort.

Identifikacija terapijskih problema tokom uvođenja usluga farmaceuta na Odeljenju gerijatrije Kliničko-bolnickog centra

Introduction: Patients with multiple comorbidities and undergoing polypharmacy are at a high risk of experiencing drug-related problems (DRPs). These DRPs can lead to increased morbidity, mortality, and healthcare costs. Objective: This study aims to identify the prevalence and causes of DRPs in geriatric inpatients, as well as the factors that contribute to them. Additionally, the study intends to evaluate the implementation of ward-based pharmacy services in the geriatric department. Method: The pharmacist analyzed inpatient therapy, identified DRPs, and formulated recommendations. DRPs were categorized according to the PCNE-DRP classification, version 9. A total of 100 patients, of which 52% were men, average age of 79.7±7.88 years, were included in the study. Results: Our study found that on average, each patient had 2.36 drug-related problems (DRPs). The most common DRP was related to treatment safety, accounting for 44.9% of cases, followed by treatment effectiveness (33.1%) and unnecessary drug treatment (22%). The main cause of DRPs was inadequate drug selection (61%) and inadequate dose selection (38.1%). Patients with atrial fibrillation and chronic renal failure had more DRPs than those without these conditions. In total, we identified 229 interventions to address these DRPs. However, the acceptance rate of these recommended interventions was low at 25.9%. Conclusion: The rate of drug-related issues in elderly hospital patients was found to be high, but the rate of acceptance of interventions to address these issues was low. In order to enhance the implementation of pharmaceutical services and improve healthcare for elderly patients, it is crucial to improve the collaboration between healthcare providers and pharmacists. Recognizing the unique skills and expertise that pharmacists bring to the table can facilitate their integration as a valuable member of a multidisciplinary healthcare team.

Home Care Practices that Improve Performance of Activities of Daily Living of Patients Post-stroke:A Systematic Review.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.

Sotatercept for Pulmonary Arterial Hypertension in the Inpatient Setting.

Patients with pulmonary arterial hypertension (PAH) who are admitted to the hospital pose a challenge to the multidisciplinary healthcare team due to the complexity of the pathophysiology of their disease state and PAH-specific medication considerations. Pulmonary arterial hypertension is a progressive disease that may lead to death as a result of right ventricular (RV) failure. During acute on chronic RV failure it is critical to decrease the pulmonary vascular resistance with the goal of improving RV function and prognosis; therefore, aggressive PAH-treatment based on disease risk stratification is essential. Pulmonary arterial hypertension treatment for acute on chronic RV failure can be impacted by end-organ damage, hemodynamic instability, drug interactions, and PAH medications dosage and delivery. Sotatercept, a first in class activin signaling inhibitor that works on the bone morphogenetic protein/activin pathway is on track for Food and Drug Administration approval for the treatment of PAH based on results of recent trials in where the medication led to clinical and hemodynamic improvements, even when added to traditional PAH-specific therapies. The purpose of this review is to highlight important considerations when starting or continuing sotatercept in patients admitted to the hospital with PAH.