Pharmacotherapy For Treatment Research Articles

Do individuals with inflammatory arthritis receive minimally adequate treatment for incident depression and anxiety: A population-based study

ObjectivesDescribe patterns of pharmacotherapy and psychological treatment and evaluate receipt of minimally adequate treatment for incident depression and anxiety in individuals with inflammatory arthritis (IA).MethodsWe used population-based linked administrative health databases from British Columbia, Canada to evaluate pharmacotherapy and psychological treatments for incident depression and/or anxiety among individuals with IA and without IA (‘IA-free controls’). We defined minimally adequate pharmacotherapy as antidepressant prescriptions filled with ≥ 84 days’ supply and adequate psychological treatment as ≥ 4 counselling/psychotherapy services. Multivariable logistic regression models were used to evaluate the odds of individuals with IA receiving minimally adequate pharmacotherapy and/or psychological treatment compared to IA-free controls.Results6,951 (mean age 54.8 ± 18.3 years; 65.5% female) individuals with IA had incident depression and 3,701 (mean age 52.9 ± 16.8 years; 74.3% female) had incident anxiety. Minimally adequate pharmacotherapy and psychological treatment for depression was respectively observed in 50.5% and 19.6% of those with IA, proportions similar to IA-free controls (pharmacotherapy: aOR 1.10, 95% CI 1.00 to 1.21; psychological: aOR 1.07, 95% CI 0.94 to 1.21). Results were similar regarding anxiety treatment. Individuals with IA had a significantly greater likelihood of dispensing ≥ 1 benzodiazepine (anxiety: IA 45.0%, IA-free controls 39.0%, p-value < 0.001) and ≥ 1 tricyclic antidepressant prescription (anxiety: IA 12.8%, IA-free controls 7.8%, p-value < 0.001). Significantly higher average days’ supply of benzodiazepines was observed for IA (anxiety: IA 123.7 days, controls 112.4 days, p-value = 0.003).ConclusionsA substantial proportion of individuals with IA were not receiving adequate mental health treatment for depression and anxiety, a finding similar for IA-free controls. The undertreatment of mental disorders for people with IA has well-known negative implications for the provision of effective rheumatology care. It remains fundamental to expand publicly funded health care to include mental health services in an effort to address unmet counselling needs.

‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’: Narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia

Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.

Evaluating the Impact of a Clinical Pharmacist in Patients Receiving New Chemotherapy for Breast Cancer: Analysis of a Pilot Study.

Breast cancer treatment may include chemotherapy, which is associated with significant toxicities. At the Sidney Kimmel Cancer Center at Jefferson Health, a pilot program was developed to add an oncology clinical pharmacist to the breast cancer clinic. The purpose of this study is to identify the impact of the clinical pharmacist in supportive care management, add to existing literature discussing the impact of the clinical pharmacist in ambulatory oncology settings, and justify future, permanent ambulatory oncology pharmacist positions within the institution. This single-center retrospective chart review assesses interventions made by the clinical pharmacist in patients with any stage of breast cancer who presented to the breast clinic for new chemotherapy treatment between September 1, 2020, and February 28, 2021. The primary outcome was to describe clinical pharmacist interventions at the first follow-up encounter after chemotherapy initiation. Secondary outcomes included classifying and quantifying total interventions and comparing intervention details between total and included patients within the 6-month timeframe. Of 44 included patients, 29 had a follow-up encounter. The clinical pharmacist directly managed 33% of the 58 patient-reported adverse drug effects. In 6 months, the clinical pharmacist made 1,068 interventions spanning 189.6 documented hours. The most common interventions were coordination of care, education, and supportive care pharmacotherapy interventions. This study identified the pharmacist's role in supportive care management and reports the successful integration of a clinical pharmacist into a breast cancer clinic. Future directions include conducting prospective studies to further explore the impact of the clinical pharmacist on treatment outcomes.

Assessing the Pharmacotherapy and Clinical Outcomes After Deep Brain Stimulation for Treatment-Refractory Obsessive-Compulsive Disorder: A Case-Cohort Study.

Background: In the search for effective treatments for refractive obsessive-compulsive disorder (OCD), deep brain stimulation (DBS) serves as an alternative option for those with minimal response to pharmacotherapy. The rarity of reports regarding DBS use for OCD is attributed to the invasive nature of the procedure: placement of electrodes within targeted areas of the brain to provide neuromodulation. This treatment of last resort may decrease functional impairment and pharmacologic complications for a debilitating mental illness. This study compares the pharmacotherapy utilization and treatment outcomes of five treatment-refractory OCD patients after the placement of DBS with those of a matched cohort. Methods: This retrospective, single-center, case-cohort study reviewed the electronic medical records of five subjects treated with DBS for treatment-refractory OCD and compared them to a similar treatment-refractory cohort whose OCD was treated without the use of DBS. Control subjects were matched by age, sex, years since diagnosis, number of previous medication class trials, and additional clinical factors. Inclusion criteria were defined as those that are at least eighteen years of age, assigned a primary diagnosis of OCD per the ICD-10 classification, and received DBS treatment for refractory OCD. Exclusion criteria included comorbid psychotic disorders, unstable neurological or coagulation disorder(s), and/or an eating disorder diagnosis. The primary endpoint was the change in the number of psychotropic medications two years after implantation for the DBS cohort and two years after psychiatric decompensation for the comparator cohort. Secondary endpoints included: Y-BOCS (the Yale-Brown Obsessive-Compulsive Scale) changes over time, duration quantity of psychotropic medication classes prescribed, and additional symptomology scale changes. Results: Patients receiving DBS were more likely to be on fewer medications and trialed fewer medications after treatment. One out of the five patients was found to be a responder in Y-BOCS scoring after DBS treatment. A reduction in anxiety and depression symptoms was also seen in the HAM-A and HAM-D scales for those that received DBS. Conclusions: A reduction in psychiatric medications trialed during therapy was observed, as well as varying reductions in OCD, anxiety, and depression symptomology following DBS. Results from this study indicate that DBS implantation may contribute to a reduction in polypharmacy while displaying DBS's potential impact on comorbid anxiety and depression symptoms. Given that the small sample size limits generalizability, additional prospective, randomized trials comparing the efficacy of DBS for OCD-specific symptomology and its overall impact on pharmacotherapy are needed in order to further establish the role of DBS as an accepted treatment option for OCD.

Medication Management in Adults With Intellectual and Developmental Disabilities: Psychiatric Pharmacists in Primary Care.

This study describes the role of psychiatric pharmacists (PPs) in medication management at a county-hospital-based primary care clinic serving adults with intellectual and developmental disabilities (IDD). During a 20-week period, PPs provided 308 interventions for 97 patients with IDD, 55% of whom had a concomitant psychiatric/behavioral disorder and 70% of whom were taking at least one psychotropic medication. PP services included medication reviews (48%), medication histories (13%), collaborative care (12%), pharmacotherapy interventions (11%), advisory services (9%), and patient/caregiver education (7%). Psychotropics were involved in 66% of interventions. Our results demonstrate that PPs may address psychotropic-related challenges in this practice setting by performing a variety of services. Additional studies are needed to fully evaluate the impact of this integrative model.

Banging My Head Against a Brick Wall! Enablers and Barriers to Nurse Practitioners Delivering Opioid Agonist Treatments in Regional/Rural Victoria, Australia.

The Victorian government's Alcohol and other drugs (AOD) workforce policy calls for greater recruitment of alcohol and other drugs nurse practitioners (AODNPs). However, frontline organisations in Victoria report several systemic barriers to their recruitment and retention. Additionally, there is scant Australian literature that examines the experiences of AODNP in opioid agonist treatment (OAT) provision in regional/rural areas. This research aims to address this gap by examining the AODNP workforce issues in delivering pharmacotherapy treatments in regional/rural areas of Victoria. Using an interpretative phenomenological approach, we conducted qualitative, in-depth interviews with 11 OAT prescribing AODNP's working in regional or rural Victoria. We analysed transcripts using reflective thematic analysis and generated three themes: (1) Professional motivations and values, (2) Enablers to professional role and (3) Barriers to professional role. The findings suggest that AODNPs in regional/rural areas are a dedicated workforce who provide holistic and integrated care for OAT clients. AODNPs play an important role in reducing and providing timely and subsidised health care for OAT clients living in regional/rural locations. AODNPs face many systemic and organisational barriers. These include inadequate funding for AODNP positions to prescribe pharmacotherapy treatments, lack of understanding of the AODNP professional role at the executive/management level within organisations and irregular access to supervision, mentoring, training and education. Also, endemic stigma in the health system acts as a barrier in recruiting and supporting AODNP positions that focus on care for OAT clients.

Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial

IntroductionWe previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global...

Assessment of drug-drug interactions among patients with hematologic malignancy: A clinical pharmacist-led study.

Patients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients. This prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact® and Micromedex® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them. A total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633). DDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.

Pharmacotherapy and electroconvulsive therapy prescription for women with depressive and anxiety disorders in a psychiatric mother-baby unit.

The purpose of this study was to understand the pharmacotherapy and electroconvulsive therapy (ECT) prescription of women with depression and anxiety admitted to an Australian inpatient psychiatric mother-baby unit (MBU) and compare prescription to national clinical practice guidelines. A retrospective audit was conducted on women diagnosed with depression or anxiety admitted to a public psychiatric inpatient MBU from March 2017 to July 2019. Data was captured at three time points to assess demographic, clinical and pharmacotherapy treatment characteristics. Descriptive statistics were completed. Of the 74 women, 57 women had depression, with 73% prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) and 14% provided ECT during admission. For women with anxiety (n = 17), 23% were prescribed a benzodiazepine with concurrent antidepressant prescription. SSRI prescription increased, with other antidepressant prescription up trending through admission. Atypical antipsychotic prescription was increased initially and trended downwards at discharge. This study explored the therapeutic armamentarium employed for the treatment of mothers admitted to an inpatient psychiatric MBU with depression and anxiety. The results point to the intricate prescribing practices in a naturalistic setting and highlight that prescribing practices were in line with national guidelines.

Pharmacotherapy profile for mothers with schizophrenia and bipolar affective disorder in a psychiatric mother–baby unit

AbstractBackgroundPharmacotherapy treatment is used to manage women with schizophrenia and bipolar affective disorder admitted to a mother–baby unit (MBU).AimThe aims of this study were (1) to examine prescribing practices for women with schizophrenia and bipolar affective disorder in an MBU, (2) to assess alignment with the Mental health care in the perinatal period: Australian clinical practice guideline and (3) to examine the classes of typical and atypical antipsychotics prescribed to mothers with schizophrenia.MethodA retrospective audit of women with schizophrenia and bipolar affective disorder admitted to a psychiatric MBU, located in Queensland, Australia, was conducted from March 2017–July 2019. The exclusion criteria included women admitted with depression, anxiety, personality disorders, and postpartum psychosis. Pharmacotherapy treatment details were extracted at commencement of admission, mid‐way through admission, and discharge. Descriptive statistics were completed. This project was exempt due to the local policy requirements that constitute research by the Gold Coast Hospital and Health Service Human Research Ethics Committee (Reference no: EX/2023/QGC/102306). The justification for this exemption was as follows: the study was deemed a quality improvement activity and complied with Chapter 2.3 of the National Statement of Ethical Conduct in Research and involved only routinely collected data.ResultsOf the 53 mothers included in the study, 29 (55%) had schizophrenia and 24 (45%) had bipolar affective disorder. In addition, 97% of women with schizophrenia received atypical antipsychotics. Five women (21%) with bipolar affective disorder (mean age = 31.60 years, standard deviation = 6.19 years) were prescribed sodium valproate, with four women given contraception. Sodium valproate or lamotrigine were prescribed to four women (67%) with bipolar affective disorder whilst breastfeeding. Of mothers prescribed lithium, 92% did not breastfeed. Overall, 44% of women involuntarily admitted received antipsychotic depot medication compared with 38% of voluntary patients. Results are discussed in relation to the national guidelines.ConclusionThis is the first naturalistic study to examine the pharmacotherapy management of postpartum women admitted to a psychiatric MBU with schizophrenia and bipolar affective disorder. The study highlights that prescribing patterns across three time points during admission were generally in alignment with Australian national guidelines.

Opportunistic CT screening demonstrates increased risk for peri-articular fractures in osteoporotic patients

BackgroundUnderdiagnosis or undertreatment of osteoporosis consequently impacts individual morbidity and mortality, as well as on healthcare systems and communities as a whole. Dual-energy x-ray absorptiometry (DXA) is the gold standard method for identifying osteoporosis, however, opportunistic CT screening is capable of precisely estimating bone mineral density (BMD) in abdominopelvic imaging with no additional cost, radiation exposure or inconvenience to patients. This study uses opportunistic CT screening to determine the prevalence of osteoporosis and anatomic distribution patterns in patients presenting with lower extremity fractures at our institution. HypothesisTrauma patients with low bone mineral density (BMD) are more likely to present with peri-articular versus shaft fractures. Patients and methodsWe conducted a retrospective review of 721 patients presenting as trauma activations to the emergency department (ED) of a Level 1 Trauma Center with lower extremity fractures. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the ED. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone mineral density. Values of ≤100 HU were consistent with osteoporosis, whereas 101–150 HU were consistent with osteopenia. ResultsThe final cohort included 416 patients, with mean age of 49 ± 21 years. Average bone density was 203.9 ± 73.4 HU. 15.9% of patients were diagnosed as osteopenic and 9.9% as osteoporotic. 64.2% of fractures were peri-articular, 25.7% were shaft, and 10.1% were a combination. Peri-articular fractures were significantly more likely to have lower average BMD than shaft fractures (189 ± 74.7 HU vs. 230.6 ± 66.1 HU, p < 0.001). DiscussionOur study demonstrates a significant relationship between low bone mineral density and lower extremity fracture pattern, however, likely influenced by other factors such as sex. Opportunistic CT screening for osteoporosis in trauma settings provides ample opportunity for early detection of low BMD and implementation of highly effective lifestyle modification and pharmacotherapy intervention. Reduction in the overall incidence of peri-articular fracture with widespread adoption of opportunistic CT screening may lessen the morbidity, mortality, and total cost currently afflicting patients, healthcare systems, and communities. Level of evidenceIII, therapeutic

Neurobiology and Treatment of Posttraumatic Stress Disorder.

The recent worldwide surge of warfare and hostilities exposes increasingly large numbers of individuals to traumatic events, placing them at risk of developing posttraumatic stress disorder (PTSD) and challenging both clinicians and service delivery systems. This overview summarizes and updates the core knowledge of the genetic, molecular, and neural circuit features of the neurobiology of PTSD and advances in evidence-based psychotherapy, pharmacotherapy, neuromodulation, and digital treatments. While the complexity of the neurobiology and the biological and clinical heterogeneity of PTSD have challenged clinicians and researchers, there is an emerging consensus concerning the underlying mechanisms and approaches to diagnosis, treatment, and prevention of PTSD. This update addresses PTSD diagnosis, prevalence, course, risk factors, neurobiological mechanisms, current standard of care, and innovations in next-generation treatment and prevention strategies. It provides a comprehensive summary and concludes with areas of research for integrating advances in the neurobiology of the disorder with novel treatment and prevention targets.

Longitudinal invariance of the Patient Health Questionnaire-9 among patients receiving pharmacotherapy for major depressive disorder: A secondary analysis of clinical trial data.

Comparing self-reported symptom scores across time requires longitudinal measurement invariance (LMI), a psychometric property that means the measure is functioning identically across all time points. Despite its prominence as a measure of depression symptom severity in both research and health care, LMI has yet to be firmly established for the Patient Health Questionnaire-9 depression module (PHQ-9), particularly over the course of antidepressant pharmacotherapy. Accordingly, the objective of this study was to assess for LMI of the PHQ-9 during pharmacotherapy for major depressive disorder. This was a secondary analysis of data collected during a randomized controlled trial. A total of 1,944 veterans began antidepressant monotherapy and completed the PHQ-9 six times over 24 weeks of treatment. LMI was assessed using a series of four confirmatory factor analysis models that included all six time points, with estimated parameters increasingly constrained across models to test for different aspects of invariance. Root-mean-square error of approximation of the chi-square difference test values below 0.06 indicated the presence of LMI. Exploratory LMI analyses were also performed for separate sex, age, and race subgroups. Root-mean-square error of approximation of the chi-square difference test showed minimal change in model fits during invariance testing (≤ 0.06 for all steps), supporting full LMI for the PHQ-9. LMI was also supported for all tested veteran subgroups. As such, PHQ-9 sum scores can be compared across extended pharmacotherapy treatment durations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Boosting Smoking Cessation Intervention Utilization in Chinese Health Care Providers: A Randomized Controlled Trial of the "WeChat WeQuit" Medical Education Program.

In China, standard smoking cessation practices are rarely used by health care service providers (HSPs). WeChat, a popular social media app, has been widely used in China. In this single-blind, randomized trial, undertaken in China with 8-week interventions and follow-up to 34 weeks, 1887 HSPs were randomly selected to the intervention (n = 942) or control group (n = 945) from October 2020 to October 2021. The intervention group received regular smoking cessation training program messages from the professional team for 8 weeks and followed for 34 weeks. The control group received thanks messages for 8 weeks, and follow-up to 34 weeks. Both groups received a hard copy of the manual after randomization. The primary outcome measure was the utilization rate of behavioral and pharmacotherapy interventions for smoking patients from 9 to 34 weeks. This trial is registered at ClinicalTrials.gov (number NCT03556774). HSPs in the intervention group demonstrated a better overall utilization rate of smoking cessation at 20-week follow-up compared to the control group (35.54% vs. 31.41%, p = .036). Additionally, both groups showed a significant increase in the adoption of various components of the 5A's model-including "Assess," "Assist: set a quit date," "Assist: recommend cessation program," "Assist: provide information," "Assist: recommend medication," and "Arrange"-at the 9-week follow-up relative to baseline. Notably, at the 20-week follow-up, the intervention group reported significantly enhanced utilization rates for all these components, except "Assist: set a quit date." The "WeChat WeQuit" training program effectively enhanced smoking cessation intervention adoption among Chinese HSPs. "WeChat WeQuit" training program was effective in increasing the provision of effective tobacco cessation interventions by Chinese-speaking HSPs to patients with cigarette smoking, which could provide valuable insights into bridging the gap between need and services for smoking cessation in China.

Validation of predicted individual treatment effects in out of sample respondents.

Personalized medicine promises the ability to improve patient outcomes by tailoring treatment recommendations to the likelihood that any given patient will respond well to a given treatment. It is important that predictions of treatment response be validated and replicated in independent data to support their use in clinical practice. In this paper, we propose and test an approach for validating predictions of individual treatment effects with continuous outcomes across samples that uses matching in a test (validation) sample to match individuals in the treatment and control arms based on their predicted treatment response and their predicted response under control. To examine the proposed validation approach, we conducted simulations where test data is generated from either an identical, similar, or unrelated process to the training data. We also examined the impact of nuisance variables. To demonstrate the use of this validation procedure in the context of predicting individual treatment effects in the treatment of alcohol use disorder, we apply our validation procedure using data from a clinical trial of combined behavioral and pharmacotherapy treatments. We find that the validation algorithm accurately confirms validation and lack of validation, and also provides insights into cases where test data were generated under similar, but not identical conditions. We also show that the presence of nuisance variables detrimentally impacts algorithm performance, which can be partially reduced though the use of variable selection methods. An advantage of the approach is that it can be widely applied to different predictive methods.

“Just Got Diagnosed; What Worked for You?”: A Mixed-Methods Analysis of Treatment Experiences in the Prolactinoma Subreddit

Abstract Introduction With improvement in complication and remission rates, recent studies have suggested the viability of transsphenoidal surgery as first-line management for prolactinomas. Reddit, an online forum, allows posters to interact with one another, and discuss symptoms, treatments, and disease courses through specialized forums known as “subreddits.” Given the lack of research comparing patient experience on pharmacotherapy versus surgery, we sought to assess the sentiment of treatment within the “r/Prolactinoma subreddit” community. Methods A search was done by filtering the r/Prolactinoma subreddit. Posts were sorted by “top” of “all time,” meaning entries with the most engagement throughout the site's history. Welch's t-test was used to analyze treatment type, while sentiment regarding treatment was analyzed using grounded theory qualitative methods. Results From 189 total entries, 82 were included; 33% (n = 27/82) were posts. Of posters disclosing their treatment, 11% underwent surgery (n = 9/79), while 76% received medication (n = 60/79). The proportion of positive:negative sentiment and level of engagement on posts regarding pharmacotherapy versus surgical treatments were not significantly different (p &gt; 0.05). Qualitative analysis showed themes of changes after medical treatment, immediate changes postsurgery, and online community. Conclusion Our mixed-methods study found statistically nonsignificant differences in sentiment when comparing Reddit posts from patients who underwent medical and surgical management. Qualitative analysis revealed several themes regarding patients' perceptions of medical and surgical management and the benefits of an online community. The qualitative themes brought to light by this study may serve to inform future studies examining the patient experience with prolactinoma care.

Urgent need for treatment addressing co-use of tobacco and cannabis: An updated review and considerations for future interventions

BackgroundThere are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions. MethodsWe conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized. ResultsMost of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances. ConclusionsThe literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity.

Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study.

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of "all-or-nothing thinking" cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as "labeling", "mental filtering", "should statements" and "minimizing the positive" regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality.

From Atherosclerotic Plaque to Myocardial Infarction-The Leading Cause of Coronary Artery Occlusion.

Cardiovascular disease (CVD) constitutes the most common cause of death worldwide. In Europe alone, approximately 4 million people die annually due to CVD. The leading component of CVD leading to mortality is myocardial infarction (MI). MI is classified into several types. Type 1 is associated with atherosclerosis, type 2 results from inadequate oxygen supply to cardiomyocytes, type 3 is defined as sudden cardiac death, while types 4 and 5 are associated with procedures such as percutaneous coronary intervention and coronary artery bypass grafting, respectively. Of particular note is type 1, which is also the most frequently occurring form of MI. Factors predisposing to its occurrence include, among others, high levels of low-density lipoprotein cholesterol (LDL-C) in the blood, cigarette smoking, chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, and familial hypercholesterolaemia (FH). The primary objective of this review is to elucidate the issues with regard to type 1 MI. Our paper delves into, amidst other aspects, its pathogenesis, risk assessment, diagnosis, pharmacotherapy, and interventional treatment options in both acute and long-term conditions.

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path.

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.