Ongoing Medication Research Articles

Improved glycemic and weight control with Dulaglutide addition in SGLT2 inhibitor treated obese type 2 diabetic patients at high cardiovascular risk in a real-world setting. The AWARE -2 study

We evaluated the effects on glycemic control and body weight of GLP1-RA in obese type 2 diabetic patients treated with SGLT2-inhibitors and other hypoglycemic agents and/or insulin, in a real-world setting. A cohort of 583 type 2 diabetic outpatients treated with an SGLT2 inhibitor and/or other anti-diabetic medications were examined. Because patients had suboptimal glycemic control, the GLP1-R.A. Dulaglutide was added to ongoing medications. At 6 months, 334 patients had a follow-up visit. Patients were classified in terms of cardiovascular risk (CVR) employing the ESC-EASD 2019 criteria, with the Aware APP. The study's primary endpoints were changes in: 1) HbA1c level, 2) BMI, and 3) body weight after six months of treatment. Secondary endpoints were evaluation of Dulaglutide addition in type 2 diabetic patients: 1) with more or less than ten years of T2DM; 2) more or less than 75 years of age and in different subgroups of CVR. In the 334 patients which had a 6 months follow-up visit, age was 65,9+9,8; 33.5% (112) were females and 66.5% (222) were males. After six months of Dulaglutide treatment, we found a significant reduction in HbA1c levels (8.0+10.5mmol/mol; p<0.0001) and in body mass index (1.1+1.1kg/m2; p<0.0001). Efficacy of Dulaglutide was not affected by different CVD risk categories, age and T2DM duration. This real world study provide evidence for significant reductions in HbA1c level, body mass index, and body weight in obese type 2 diabetic patients who received add-on treatment with a weekly GLP-1RA, Dulaglutide.

Cardiovascular responses as predictors of mortality in children with acute brain injury.

Investigate the utility of cardiovascular responses such as heart rate (HR), blood pressure (BP), and heart rate variability (HRV) in the prognosis of children with acute acquired brain injury (ABI). Children under 18 years with severe acute acquired brain injury (ABI) who survived at least 12 h after PICU admission were included in a prospective observational cohort in a tertiary academic PICU. Physiological variables, neurological data, laboratory tests (chemistry and hematology), and medications were recorded within 12 h of admission. Linear and nonlinear HRV indices, CT scans, PICU scores, and survival rates were evaluated. Seventy-two children, median age 10.7 years (IQR 4.1-13.6), were eligible for the study; 28 (38.9%) were diagnosed with brain death (BD). Tachycardia, SBP and MBP < 5th percentile, and MBP and DBP> 99th percentile were significantly associated with mortality. Poincaré SD1/SD2 was significantly associated with mortality after adjusting for age, sex and ongoing medication. Tachycardia, systolic hypotension and median hypo and hypertension were associated to mortality in children with severe ABI. While further validation through larger, multicenter studies is necessary, the Poincaré SD1/SD2 ratio has shown promise as a prognostic tool for predicting mortality in children with severe ABI. This study explores cardiovascular changes, including heart rate and blood pressure, and linear/nonlinear HRV measures using ECG at 1000 Hz, and compare them with other prognostic factors like brain tomography and PICU scores. Tachycardia, hypo/hypertension in the early hours after admission are linked to early mortality in children with severe traumatic and non-traumatic brain injury. Linear/non-linear measures of HRV were also related to survival. Higher HRV values indicating better survival chances. We identified Poincaré SD1/SD2 ratio as a promising tool for predicting mortality in children with severe ABI.

WITHDRAWN: Medication Reconciliation and Detection of Medication Discrepancies at Emergency Department of Public Comprehensive Specialized Hospital in Northwest Ethiopia: A Prospective Observational Study

BackgroundIdentifying medication discrepancies (MDs) through medication reconciliation (MedRec) during care transitions-admission, transfer, or discharge- is a key responsibility of clinical pharmacists and is crucial for enhancing both medication and patient safety. More than 60% of medication errors arise at healthcare transitions and to combat it clinical pharmacists have a crucial role in the patient care journey focusing on enhancing the safety and effectiveness of medications. Thus this study aimed to determine the magnitude of MDs at the emergency department of Debre Tabor Comprehensive Specialized Hospital (DTCSH) in Northwest Ethiopia and its predicting factors. MethodsThis prospective observational study included 384 patients with at least one chronic condition and ongoing medication use who visited the hospital emergency department between March 10 and May 30, 2024. Within 24 hours of admission to the emergency department, the best possible medication history (BPMH) was collected using at least two sources. MDs were detected by comparing a BPMH list with the treating physician's medication orders. The collected data was entered into STATA version 17.0 and associations between variables were assessed by the Chi-square (χ2) test, and binary logistic regression was used for analysis. ResultsThree hundred and eighty four (384) patients with chronic diseases visiting the hospital emergency department were recruited in the present study. The mean age (±SD) of the patients was 59.84 (±15.240) and 50.8% were males. Out of 384 patients involved in the study, 218 (56.77%) of patients had encountered at least one MD. Among 218 patients encountered MDs, 61 (15.89%) had one MD, 120 (31.25%) had two MDs, 30 (7.81%) had three MDs, and 7 (1.82%) had more than four MDs. Omission error 190 (45.24%) was the most common type of MD, followed by wrong dose 82 (19.50%). Amongst 420 interventions, 80.48% of the total cases were accepted. Number of previous/home medications (≥5 medicines) [AOR=3.12; 95%CI=1.190, 8.151], older age (>65 years) [AOR=1.62; 95%CI=1.054, 2.495], and number of comorbidities (≥ 3 comorbidities) [AOR=1.65; 95%CI=1.066, 2.546] were significantly associated with the occurrence of MDs. ConclusionThe present study revealed a high prevalence of MDs in the emergency department. Factors associed with the occurrence of MDs included polypharmacy, the presence of comorbidities, and older age. The study finding highlight the need for clinical pharmacist-led MedRec implementation at emergency department setting, and the need to address medication management and patient safety.

Statins have profound effects on the epicardial fat transcriptome

Abstract Background Epicardial adipose tissue (EAT) has direct contact with the myocardium, which enables a common microcirculation allowing bidirectional signaling between the tissues. It is possible that a change in the balance of protective and damaging mediators produced by EAT is a major driver for myocardial dysfunction. Notably, EAT volume and thickness associate with increased pro-inflammatory secretome and with coronary artery disease (CAD). Purpose This aim of this study was to analyze the total transcriptome in EAT and relate putative differences between patient groups to metabolic parameters as well as ongoing medications. Methods Between 2011 and 2016, 44 patients (mean age 68.0 years, 18.2% women) had a biopsy taken from the epicardial fat during coronoray by-pass surgery (CABG, n=36), or during elective aortic valvular replacement due to aortic stenosis (AVR, n=8). RNA from epicardial fat biopsis was extracted and sequenced. Differentially expressed genes were obtained by custom scripts that performed a negative binomial distribution test on effective counts. Multivariate regression analysis with orthogonal partial least-squares-discriminant analysis (OPLS-DA) was applied to extract and interpret the systematic variation in the resolved RNA sequencing profiles. To identify enrichment of biologically relevant functional gene sets, our data were entered in evidence-based network enrichment analysis (EviNet). Results The CABG surgery was performed approximately 7 days after an acute coronary event (75% acute MI), and 44% of them had previously known CAD. None of the AVR cases had significant CAD. At surgery, 97% of the CABG cases were prescribed statins, and 36% of them had statins alredy before the actual admission (long-term statin treatment). 63% of the AVR cases were on statins at admission. The OPLS analysis revealed only one medication with significant outcome, i.e., patients with long-term treatment with statins (n=18) versus patients without (n=26). Long-term statin treatment associated with down-regulated gene expression involved in beta-oxidation and triglyceride biosynthesis whereas gene expression involved in extracellular matrix organization were up-regulated. Gene expression involved in MHC class II presentation and interferon signalling were also reduced in patients with long-term treatment with statisn. A downregulation of genes in the interleukin- and complement cascade genes among CABG patient (versus AVR patients) without long-term statin treatment showed normal levels in statin pretreated patients. Conclusion Long-term statin treatment has a major influence on transcriptional regulation of genes involved in beta-oxidation, triglyceride biosynthesis, extracellular matrix composition, MHC class II presentation and interferon signalling in epicardial adipose tissue. These findings support important metabolic and immune effects of statins beyond the lipid-lowering function.

Downstream Effects of Market Changes on Inhalers: Impacts on Individuals With Chronic Lung Disease.

COPD and asthma are two of the most common chronic lung diseases, affecting over 545 million people globally and 34 million in the United States. Annual health care costs related to chronic lung disease are estimated at €380 billion in the European Union, and $24-$50 billion in the United States averaging to $4,000 in out-of-pocket costs per person in the U.S. A full-text literature search was conducted for English publications between January 1, 2005-March 18, 2024. It returned over 5,000 publications that were further narrowed using key search words, resulting in 172 peer-reviewed articles. Using their experience and subject expertise, the authors further narrowed the peer-reviewed articles to 55 that were in their opinion relevant. Also, 38 recently published industry reports and news articles specific to downstream effects of inhaler market changes and the future impact were included. The literature suggests that individuals with chronic lung disease face increased challenges with access to inhaled medication due to rising medication costs, discontinuation of branded medications, introduction of generic medications not covered by insurance, exclusionary preferred drug list tactics that force health care providers into non-medical switching of medication or devices, and ongoing medication shortages. Providers experience ongoing hurdles in prescribing appropriate inhaled medications for individuals with chronic lung disease, including increased time and costs spent on administrative tasks due to inhaler denials, a loss of patient trust, and limits on their ability to prescribe appropriate inhaled medication for individuals with chronic lung disease.

Inborn Errors of Immunity in Pediatric Intensive Care: Prevalence, Characteristics, and Prognosis.

Inborn errors of immunity (IEI) are a heterogeneous group of genetic diseases characterized by impaired immune system function. This prospective study aimed to determine the frequency, characteristics, and clinical course of IEI patients admitted to the pediatric intensive care unit (PICU) and identify mortality-related factors. Using a comprehensive immunological evaluation protocol, we screened 753 PICU admissions for potential IEIs during three years. Patients with pre-existing IEI diagnoses, chronic diseases, ongoing chronic medication regimens, other known comorbidities, trauma cases, post-surgical cases, and poisonings were excluded. Thirty-three patients were newly diagnosed with IEIs during or as a result of their PICU stay, representing an incidence of 4.39%. The most common disorders were immunodeficiencies with immune dysregulation (48.5%), followed by combined immunodeficiencies (24.2%). Severe viral infections (61%) and life-threatening infections (51.7%) were the most frequent warning signs. Only 31% of patients exhibited at least two Jeffrey Modell Foundation warning signs. The mortality rate was 58%, highlighting the need for early diagnosis and treatment. Newborn screening and family segregation studies are crucial to improving outcomes for IEI patients in intensive care settings.

Study of Medication Reconciliation Process at the Time of Admission in the Patients of a Tertiary Care Teaching Hospital.

Reconciliation errors are those that are considered harmful or possibly dangerous to patients; in fact, reconciliation errors significantly influence adverse drug events (ADEs) among admitted and discharged patients. Medication reconciliation facilitates the identification and prevention of medication errors and adverse drug events. Worldwide, ongoing medication management is a major source of concern for patient safety. Therefore, this study aims to study medication reconciliation on admission in trauma and emergency care (TEC) at a tertiary care teaching hospital. The objective of our study was to identify discrepancies and medication errors. A prospective observational study on medication reconciliation was conducted at the Tertiary Care Teaching Hospital of Shree Krishna Hospital (SKH) in Karamsad, Anand, from February 2023 to February 2024. The total number of identified discrepancies on admission was 64 in 45 patients. Out of 64 discrepancies, 39 were of adding type, documented as intentional discrepancies and 25 were of omission type, documented as unintentional discrepancies. The majority of those errors were moderate to severe in terms of severity. The results of this study demonstrate the importance of identifying medication discrepancies in hospital settings and provide evidence for the need to establish medication reconciliation services that would assist healthcare providers in identifying and resolving medication discrepancies.

Clinical features and outcomes of horses presenting with presumed equine immune mediated keratitis to two veterinary hospitals in the United Kingdom and Finland: 94 cases (2009-2021).

There is limited literature regarding equine immune mediated keratitis (IMMK) in Europe. North America-based publications describe minimal blepharospasm, rare corneal ulceration and no uveitis; clinical impression suggests these are seen in Europe. Assess the prevalence of blepharospasm, corneal ulceration and uveitis and their impact on outcome in horses diagnosed with IMMK in Europe (UK and Finland). Retrospective case series. Clinical records of 94 horses with IMMK were evaluated. The UK and Finland populations were comparable; therefore, descriptive statistics were performed on combined data on subtypes of IMMK and clinical features. Odds ratios (OR) and confidence intervals (CI) were calculated for impact of blepharospasm, ulceration or presence of uveitis on the outcome of enucleation and treatment duration. IMMK subtype was classified as 10/94 (10.6%) epithelial, 50/94 (53.2%) anterior stromal, 14/94 (14.9%) mid-stromal, 4/94 (4.25%) endothelial and 16/94 (17.0%) unrecorded. After excluding three horses with incidental corneal ulceration, blepharospasm was documented in 34/91 (37.4%), corneal ulceration in 26/91 (28.6%), and signs of uveitis in 23/91 (25.3%) horses. Increased odds of enucleation were significantly associated with the presence of blepharospasm (OR 5.5, 95% CI 1.6-19.4, p = 0.008) and signs of uveitis (OR 8.9, 95% CI 2.6-30.8, p < 0.001), but not corneal ulceration. The presence of blepharospasm, corneal ulceration or uveitis did not significantly alter the odds of ongoing medication. Data were collected over a wide timeframe; the diagnosis was mainly made without histopathology; a broad definition of uveitis was used and there was a bias towards complicated cases being retained for follow-up. The clinical features of IMMK were similar between two European countries but differed to USA descriptions. Blepharospasm, corneal ulceration and signs of uveitis can occur with IMMK; presence of blepharospasm and uveitis increase the odds of enucleation.

Evaluation of Patient Outcomes after Pharmacological Intervention in Home Health Care Utilizing Pharmaceutical Care Records

The purpose of this study was to identify patient outcomes after pharmacist interventions in the home health care context using pharmaceutical care records accumulated during daily operations. We focused on 591 cases at Nakajima Pharmacy from April 2020 to December 2021, where dispensing fees were charged to prevent duplication of medication and unnecessary interactions of home patients (excluding those related to adjustment of ongoing medications). The study investigated the content and background of prescription changes, the follow-up rate, and patient outcomes. The most common circumstances that led to pharmacist intervention for homebound patients were symptom occurrence (uncontrolled symptom, new symptom, drug adverse event). Of the patients for whom pharmacist intervention was provided for symptoms, 72.8% received follow-up according to the pharmaceutical care records. Furthermore, 59.2% of patients with follow-up showed an improvement of their symptoms. In addition, many patients had their medications discontinued or the dosage reduced by the pharmacist despite stable symptoms. More than 90% of these patients showed no change in symptoms. Besides interventions associated with the occurrence of symptoms, many interventions related to medication adherence were found to result from the patient's physical condition, such as poor swallowing function. The results suggest that tracking pharmacy drug histories may help pharmacists to better understand the need for follow-up implementation and the changes in patient outcomes after interventions.

A Case Study of the Management of Childhood Atopic Dermatitis Applying &lt;i&gt;Ayurveda&lt;/i&gt; Treatment

Background: Chronic inflammatory skin disease Atopic Dermatitis (AD) compromises the skin barrier and decreases cell-mediated immune activity. The acute stage of this condition is characterised by erythema, edema, vesicles, and fluid leakage, while the chronic stage is marked by thickening and hyperpigmentation, known as lichenification. The prevalence of skin conditions is increasing daily. Other medicinal methods offer just a partial cure, though. Skin issues can be effectively managed with the help of Ayurveda. Vicharchika can be likened to atopic dermatitis, exhibiting similar characteristics as described in ancient Ayurvedic texts. Aim: The study aims to assess the efficacy of Ayurvedic treatment in managing Atopic dermatitis. The study aims to evaluate the impact of Ayurveda intervention on the severity of symptoms and quality of life of paediatric patients with Atopic dermatitis. Methods: The study involved a 4-year-old girl presenting with scaly, dry, pruritic skin, reddish, blackish excoriated lesions, and oozing. The patient sought treatment at the Kaumarbhritya outpatient section of Mahatma Gandhi Ayurved College, Hospital and Research Centre. The treatment plan spanned two weeks of Ayurvedic medicines and dietary recommendations, followed by a one-month inpatient phase. Inpatient care included dietary modifications, internal medicines, Snehapana (ghee consumption), Kushtahara (itch-alleviating), and Kandughna (anti-pruritic) Dravyas. Results: The Ayurvedic treatment yielded positive results for the patient. Notable improvements were observed, including a reduction in excoriation, irritation and dryness. The severity of the condition was assessed using SCORAD SCALE, which showed a decline from the initial score of 46.3 to a post-treatment score of 17.8. Additionally, the patient’s condition improved significantly, transitioning from severe eczema to a state of near clarity as assessed by the POEM SCALE. Conclusion: This study demonstrates the efficacy of Ayurvedic treatment in effectively managing atopic dermatitis in pediatric patients. The positive outcomes observed, both in terms of symptom relief and improved quality of life, underscore the potential of Ayurveda as a valuable therapeutic approach for addressing chronic inflammatory skin disorders like atopic dermatitis. Maintaining dietary restrictions and ongoing internal medication emerged as essential strategies to prevent the recurrence of the condition.

Improving the quality of medication administration practices in a tertiary Australian hospital: a best practice implementation project.

Medication safety is an important health priority that focuses on preventing harm from medication-related events. Unsafe medication administration practices can lead to errors, which can cause avoidable injury (or harm) to patients. This paper reports on an evidence implementation project conducted in a large tertiary hospital in Australia to improve nursing compliance with best practice recommendations for medication administration. The project was guided by JBI's seven-phase approach to evidence implementation, using audit and feedback and a structured framework to identify barriers, enablers, and implementation strategies. The project resulted in improved compliance with best practice recommendations. This was achieved through multimodal strategies, including education, improved access to resources, and targeted feedback and discussion sessions to encourage culture and behavior change. The project improved nurses' medication administration practices, specifically in performing independent second checks. Collaborative efforts of the project leads facilitated the review of medication administration policy and the development of staff education resources. Patient engagement remains an area for improvement, along with the potential need for further ongoing medication education. http://links.lww.com/IJEBH/A237.

Medication reconciliation to minimise medication errors: Iatrogenic hypercalcaemia as a case report

Hypercalcaemia is a relatively less common yet life-threatening electrolyte disorder and is caused by parathyroid-dependent and independent factors. This case report describes an elderly lady, a known patient of stable hypothyroidism, hypertension, type 2 diabetes mellitus and non-oliguric chronic kidney disease-IV who presented with complaints of gradually worsening drowsiness. Investigations revealed a hypercalcemic crisis; all other contributory investigations were unremarkable. She was put on intravenous saline rehydration, furosemide, pamidronate, and calcitonin. However, due to new-onset haemodynamic instability, cardiomyopathy, and worsening renal parameters, haemodialysis was initiated to reduce the serum calcium levels rapidly. The patient remained asymptomatic after that, and her renal parameters improved to near baseline levels, though cardiac function improvement was not obtained at the end of one month. History elicited from the patient after her neurological improvement revealed that failing to interpret the prescription of three orthopaedics she had visited lately, she followed all simultaneously and had thus consumed toxic levels of calcium and Vitamin D. Medication reconciliatory measures such as e-prescribing, computerised drug dispensing system, automated patient drug dispensing boxes and ‘brown-bagging’ all ongoing medications during the physician visits would ensure reduction in medication errors, thus avoiding adverse events, reducing uncalled for mortalities and morbidities and healthcare cost.

Therapeutic aid to improve sleep

At a medical-psychological center, a therapeutic program based on relaxation and mindfulness meditation sessions is offered to people suffering from chronic insomnia referred by the center's psychiatrists, psychologists and advanced practice nurse. This treatment, which can be complementary to ongoing medication, is an alternative to pharmacological approaches.

A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression.

After participating in this CME activity, the psychiatrist should be better able to:• Compare and contrast therapies used in combination with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for treating MDD. Noninvasive neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a major area for treating major depressive disorder (MDD). This review has two primary aims: (1) to review the current literature on combining TMS and tDCS with other therapies, such as psychotherapy and psychopharmacological interventions, and (2) to discuss the efficacy, feasibility, limitations, and future directions of these combined treatments for MDD. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases: PubMed, PsycInfo, and Cochrane Library. The last search date was December 5, 2023. The initial search revealed 2,519 records. After screening and full-text review, 58 studies (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication) were included. The current literature on tDCS and TMS paired with psychotherapy provides initial support for integrating mindfulness interventions with both TMS and tDCS. Adding TMS or tDCS to stable doses of ongoing medications can decrease MDD symptoms; however, benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response. Pairing citalopram with TMS and sertraline with tDCS can lead to greater MDD symptom reduction compared to using these medications alone. Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.

Clinical efficacy and safety of intravenous ferric carboxymaltose for treatment of restless legs syndrome: a multicenter, randomized, placebo-controlled clinical trial.

Iron therapy is associated with improvements in restless legs syndrome (RLS). This multicenter, randomized, double-blind study evaluated the effect of intravenous ferric carboxymaltose (FCM) on RLS. A total of 209 adult patients with a baseline International RLS (IRLS) score ≥ 15 were randomized (1:1) to FCM (750 mg/15 mL) or placebo on study days 0 and 5. Ongoing RLS medication was tapered starting on Day 5, with the goal of discontinuing treatment or achieving the lowest effective dose. Co-primary efficacy endpoints were changed from baseline in IRLS total score and the proportion of patients rated as much/very much improved on the Clinical Global Impression (CGI)-investigator (CGI-I) scale at day 42 in the "As-Treated" population. The "As-Treated" population comprised 107 FCM and 101 placebo recipients; 88 (82.2%) and 68 (67.3%), respectively, completed the day 42 assessment. The IRLS score reduction was significantly greater with FCM versus placebo: least-squares mean (95% confidence interval [CI]) -8.0 (-9.5, -6.4) versus -4.8 (-6.4, -3.1); p = .0036. No significant difference was observed in the proportion of FCM (35.5%) and placebo (28.7%) recipients with a CGI-I response (odds ratio 1.37 [95% CI: 0.76, 2.47]; p = .2987). Fewer patients treated with FCM (32.7%) than placebo (59.4%) received RLS interventions between day 5 and study end (p = .0002). FCM was well tolerated. The IRLS score improved with intravenous FCM versus placebo, although the combination of both co-primary endpoints was not met. Potential methodological problems in the study design are discussed.

Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from an Italian longitudinal study

IntroductionThe prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. In particular, baseline AP exposure in CHR-P individuals may be considered as a functional equivalent of the psychometric transition to psychosis, as already postulated in the original ‘Ultra High-Risk’ model.ObjectivesThe main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period.MethodsThis research was settled within the ‘Parma At-Risk Mental States’ program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. The acquisition of drug and outcome information was collected both at baseline and across the follow-up period. Finally, logistic regression analyses with dichotomized 1-year outcome parameters (previously showing statistically significant differences in inter-group comparisons) as dependent measures and sociodemographic and clinical characteristics as independent variables were also performed.ResultsHundred and seventy-eight CHR-P individuals (aged 12–25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals.ConclusionsThe current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic. Moreover, our findings confirm that baseline AP prescription appears to increase psychotic transition risk.Disclosure of InterestNone Declared

Patients' perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary care.

Over the past decade, long-term use of prescription opioids for chronic non-cancer pain has risen globally despite the associated risks. Most opioid users receive their first prescription in primary care. To investigate the perspective of patients who are long-term opioid users in primary care regarding the role of healthcare providers (HCPs) in their prolonged opioid use. Semi-structured interviews in Dutch primary care. We recruited patients who were long-term users of opioids for chronic non-cancer pain from seven community pharmacies in the Netherlands. In-depth, semi-structured interviews focused on patients' experiences with long-term opioid use, access to opioids, and the guidance of their HCPs (primarily their GPs and pharmacists). A directed content analysis was conducted on the transcribed interviews using NVivo. Participants (n = 25) described ways in which HCPs impacted their long-term use of opioids. These encompassed the initiation of treatment, chronic use of opioids, and discontinuation of treatment. Participants stressed the need for risk counselling during initial prescribing, ongoing medication evaluations including tapering conversations, and more support from their HCP during a tapering attempt. Patients' perspectives illustrate the important role of HCPs across the spectrum of opioid use - from initiation to tapering. The results of this study underscore the importance of clear risk counselling starting at initial prescribing, repeated medication assessments throughout treatment, addressing tapering at regular intervals, and strong support during tapering. These insights carry significant implications for clinical practice, emphasising the importance of informed and patient-centred care when it comes to opioid use for chronic non-cancer pain management.

Navigating Diagnostic Challenges: A Case Report on Early Parkinson's Disease Identification

In late life stages, symptoms of neurodegenerative diseases can be masked by depression, apathy, and stress. This case study explores the challenges of early Parkinson's Disease (PD) diagnosis. A 58-year-old man with initial symptoms of depression, anxiety, insomnia, and increased gambling behavior after age 50 was treated for assumed bipolar disorder using olanzapine, with minimal response. Further history and examination revealed motor symptoms, including tremors and asymmetric bilateral rigidity, which raised the suspicion for an underlying neurodegenerative disorder. We further expanded the differential diagnosis to include causes of Parkinsonism, e.g., idiopathic Parkinson's, atypical parkinsonian disorders, drug induced Parkinsonism. Based on Postuma et al.’s MDS Clinical Diagnostic Criteria for Parkinson's Disease, the patient's physical examination confirmed a diagnosis of clinically established PD. The patient underwent medication adjustments, incorporating carbidopa-levodopa, quetiapine, and buspirone, resulting in significant improvements in PD symptoms and anxiety. Ongoing medication management and follow-ups contributed to restoring mood and appetite, reducing impulsivity, and overall enhancing functioning. This case navigates through the complexities of PD diagnosis, emphasizing the role of early identification of nonmotor symptoms and their treatments, adding to the patient's quality life trajectory through early recognition and treatment of non-motor symptoms associated with Parkinson's disease.

Change in neurocognitive functioning in patients with treatment-resistant depression with serial intravenous ketamine infusions: The Bio-K multicenter trial

This nonrandomized, multicenter, open-label clinical trial explored the impact of intravenous (IV) ketamine on cognitive function in adults (n = 74) with treatment-resistant depression (TRD). Patients received three IV ketamine infusions during the acute phase and, if remitted, four additional infusions in the continuation phase (Mayo site). Cognitive assessments using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were conducted at baseline, end of the acute phase, and end of the continuation phase (Mayo site). Results showed a significant 53 % (39/74) remission rate in depression symptoms after the acute phase. In adjusted models, baseline language domain score was associated with a higher odd of remission (Odds Ratio, 1.09, 95 % CI = 1.03–1.17, p = 0.004) and greater improvement in MADRS at the end of the acute phase (β =-0.97; 95 % CI, -1.74 to -0.20; P = 0.02). The likelihood of remission was not significantly associated with baseline immediate or delayed memory, visuospatial/constructional, or attention scores. In the continuation phase, improvements in immediate and delayed memory and attention persisted, with additional gains in visuospatial and language domains. Limitations included an open-label design, potential practice effects, and ongoing psychotropic medication use. Overall, the study suggests cognitive improvement, not deterioration, associated with serial IV ketamine administrations for TRD. These findings encourage future studies with larger sample sizes and longer follow-up periods to examine any potential for deleterious effect with recurrent ketamine use for TRD.Trial Registration: ClinicalTrials.gov: NCT03156504

Efficacy and Safety of Antidiabetic Agents for Major Depressive Disorder and Bipolar Depression: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Trials.

This meta-analysis aimed to determine the efficacy and safety of antidiabetic agents in the treatment of major depressive disorder and bipolar depression. Randomized controlled trials (RCTs) of antidiabetic agents in major depressive disorder or bipolar depression were searched in three electronic databases and three clinical trial registry websites from their inception up to October 2023. The differences in changes in the depression rating scale scores from baseline to endpoint or pre-defined sessions, response rate, remission rate, rate of side effects and dropout rate between antidiabetic agents and placebo were meta-analyzed. Six RCTs involving 399 participants were included in the final meta-analysis, which did not find that antidiabetics outperformed the placebo in reducing depressive symptoms. The standardized mean difference (SMD) in the depression scores from baseline to endpoint was 0.25 (95% CI -0.1, 0.61). However, a subgroup analysis found a significant difference between antidiabetics and placebos in reducing depressive symptoms in Middle Eastern populations, with an SMD of 0.89 (95% CI 0.44, 1.34). The current meta-analysis does not support the efficacy of antidiabetics being superior to the placebo in the treatment of unipolar and bipolar depression. However, a subgroup analysis indicates that patients from the Middle East may benefit from adding an antidiabetic medication to their ongoing medication(s) for their depression. Larger studies with good-quality study designs are warranted.